Rethinking patient counseling techniques for changing contraceptive use behavior.

Some women who use contraception become pregnant. Determinants of pregnancy in these women are fecundity, frequency of intercourse, contraceptive method, and contraceptive behaviors. Current counseling content emphasizes the choice of method, with "education" about a limited set of use behaviors. A listing of use behaviors for oral contraceptives (OCs) shows that "use" should be conceptualized as multidimensional with numerous levels and not a simple dichotomous concept of use versus nonuse. The multidimensional understanding of "use" suggests the need for multidimensional counseling to affect distal determinants of use behaviors: knowledge, motivation, ability, and intentions. A review of behavioral theories suggests that various techniques can be used, in addition to the current emphasis on history taking and patient education, to help women have effective use behaviors. These include assessment for need and individualized counseling. With use of techniques that are widely recognized in other intervention programs, the emphasis of contraceptive counseling would be on the future, on intentions and behaviors, and on mobilizing self-planning and action by the OC user.