The Role of Patient Activation in Contraceptive Use

Purpose: Many unintended pregnancies occur due to to contraceptive misuse and nonuse, which is partly due to to lack of knowledge and low self-efficacy related to contraception. We conducted an exploratory, cross-sectional study among low-income women to examine the relationship between knowledge, skills, and confidence in managing one's health, measured using the Patient Activation Measure (PAM) and factors that influence contraceptive use. Methods: A survey and chart review were conducted among 18- to 45-year-old women from a community health center in Chicago, Illinois, to measure the relationship between activation, self-confidence in avoiding pregnancy, contraception use, and contraceptive counseling. Associations between PAM and outcomes were evaluated using the chi(2) test and adjusted logistic regression models. Results: Among 112 participants (61% Latina, 15% Black, 14% White), we found no differences in PAM by age, race/ethnicity, or parity. Women with higher PAM were more likely to be confident they could avoid pregnancy compared with women with lower PAM (50% vs. 7%; p=.02). Higher PAM remained a significant predictor for self-confidence after risk adjustment (odds ratio, 3.13; 95% CI, 1.11-8.78; p=.031). Greater confidence in avoiding pregnancy was associated with using a moderately or highly effective contraceptive method (43% vs. 14%; p=.047). Women with lower PAM were less likely to receive contraceptive counseling in the prior month (0% vs. 57%; p<.01). Conclusions: Patient activation may be an important construct for understanding factors that influence women's contraceptive use, including self-confidence in avoiding pregnancy until it is desired and receiving contraceptive services in primary care. Copyright (C) 2016 by the Jacobs Institute of Women's Health. Published by Elsevier Inc.