Impact of a theory-based video intervention on immediate post-abortal LARC uptake: A randomized controlled trial
Abortion, Contraception
Awarded 2013
Complex Family Planning Fellowship Research
AuTumn Davidson, MD, MS
The University of Chicago

Background: Of the 1.3 million women undergoing abortion procedures in the US annually, half have had a prior abortion.  Multiple studies have shown that when women use a long acting reversible contraceptive method (LARC) such as an IUD or a subdermal implant immediately following their abortion, their likelihood of having a repeat abortion is decreased.  However, less than 8% of women receive postabortal LARC.  Some of the reasons women do not use postabortal LARC methods is that there is a general lack of awareness about the methods, women have misperceptions about the risks or side effects, and, the methods are very expensive.  Multiple studies have evaluated the effects of counseling at the abortion visit on postabortal contraceptive method choice.  These studies have found that counseling does not significantly impact postabortal contraceptive method choice.  However, these studies did not evaluate theory – based counseling methods.  Theory-based interventions have been used in a variety of clinical settings and have been shown to help people adopt new, healthy behaviors.  There have been no studies evaluating a theory-based intervention intended to increase LARC initiation at the abortion visit.  
Methods: The purpose of this study was to develop a short, theory based video intervention and test whether it could increase rates of postabortal LARC uptake among women having abortion procedures.  In this study, we employed Prochaska’s Transtheoretical Model, which describes how individuals move through various stages of behavioral change.  First, we recruited women from our abortion clinic who had used a postabortal LARC method, and who were willing to speak about their experiences on video. We asked these women a series of questions based on the concepts of the Transtheoretical model in order to elicit the women’s own decision-making process around contraception use.  We also made a video of a health care provider discussing each of the LARC methods, how they work, and their known side effects.  The final video was 7 minutes long and included two testimonials of the women discussing their experience with postabortal LARC and one testimonial from a health care provider.  
In order to test the effect of this video on rates of postabortal LARC uptake, we recruited 191 women from the abortion clinic.  Before they underwent their standard counseling procedure, we showed half of the women the intervention video and half of the women a control video, which was also seven minutes in length, but discussed techniques of stress management, which had nothing to do with contraception.  We then calculated how many women from each group chose to use a LARC method after their abortion procedure.  Because we wanted to ensure that all women in our study had equal access to a LARC method, we provided all contraception to women in our study free of charge.
Findings:  Among the women who watched the intervention video, 59% used a LARC method.  Among the women who watched the control video, 52% used a LARC method.  There was no statistically significant difference between these two groups.  In other words, this difference may well have been due to chance.  The rate of LARC use among women who were seeking abortions at the same clinic but who were not in our study was 20%. 
Conclusions:  We concluded that our theory – based intervention alone did not increase rates of postabortal LARC uptake in this group.  However, we saw an unexpectedly high number of women in our study using a LARC method.  Therefore we hypothesize that something about the combination of providing free contraception and being in the study itself significantly increased the use of postabortal LARC methods.  It is possible that as more women gain access to no-cost contraception through the Affordable Care Act, rates of postabortal LARC use may increase.