Lessons from the Contraceptive CHOICE Project: The Hull LARC Initiative

Abstract

AIM: To discover whether a hand-out explaining the benefits of intrauterine contraceptives (IUCs) and implants could increase their uptake in Hull, UK. METHODS: We developed a simple double-sided A4 hand-out. On one side was a script with pictures of copper and levonorgestrel IUCs beside a 20-pence coin and of an implant beside a hairgrip. On the other side was the three-tiered effectiveness chart published in the textbook Contraceptive Technology. We implemented the project in family planning (FP), abortion and antenatal clinics and GP practices. The plan was that the receptionist would give the hand-out to every woman and ask her to read it before seeing a clinician. We evaluated it in FP clinics and GP practices because routine electronic monitoring reports were available only for these. RESULTS: There was no impact in GP practices. There was no overall impact in FP clinics, with the exception of the service hub, in which there was an increase in the proportion of women receiving IUCs or implants of 15.0% between the periods October 2011-April 2012 and May 2012-November 2012 (p=0.0002). This clinic is open on six days per week and has permanent sexual health staff on the reception desk. Impact fell when a change in clinic procedure. The proportion returned to baseline in December 2012-November 2013, when a change in clinic procedure to reduce waiting times caused staff to stop dispensing handouts. CONCLUSION: This was not a formal study, so there was no research coordinator to monitor the project. We think there was no impact among GPs because the project was never implemented by them. The project was poorly implemented at the four satellite FP clinics. Only the service hub implemented the project, where it had a clear impact. We conclude that when implemented as intended this simple extremely low-cost LARC intervention was highly effective and also extremely cost effective.