THE COST-EFFFECTIVENESS OF IMPROVED COMMUNICATION OF PREGNANCY RISK AND CONTRACEPTIVE INFORMATION

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  • March 21, 2019
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  • Anderson, Seri
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
Abstract
  • To prevent unplanned pregnancies, the Centers for Disease Control and Prevention (CDC) recommends that women receive contraceptive counseling and suggests a contraceptive poster that it designed as one tool to accomplish this goal. However, the CDC poster has not been evaluated to determine whether it improves contraceptive knowledge or intentions. Furthermore, it was not developed with the input of patients. This project’s overall objective was to fill these gaps in the literature by creating and evaluating a patient-centered poster designed to better communicate information about pregnancy risk and contraceptive effectiveness. My central hypothesis was that the patient-centered poster would be a more cost-effective and acceptable method of preventing unplanned pregnancies among women of reproductive age than the CDC poster. This project is innovative because it draws on women’s insights to develop the poster. This project’s first aim compared the comprehension, relevance, and acceptability of the two posters through cognitive interviews with N=26 women. The second aim compared how effectively the two posters changed: women’s contraceptive knowledge, the accuracy of women’s perceived pregnancy risk, and the effectiveness of the contraceptive methods women were most likely to use in the following year. We did this by conducting a randomized control trial of the posters in an Amazon Mechanical Turk sample of N=990 women. The third aim compared the cost-effectiveness of the two posters in comparison to the status quo. To do this, we created two Markov models using a private payer perspective. In the first aim, we found that the final version of the patient-centered poster was preferred overall and in terms of comprehension and relevance by the majority of women. It generated few remaining acceptability issues. In the second aim, we found that the patient-centered poster improved contraceptive knowledge significantly more than the CDC poster, and both posters significantly improved the effectiveness of women’s most likely contraceptive method. In the third aim, we found that both the patient-centered and the CDC poster reduced costs and improved health outcomes relative to the status quo. This project helps advance the CDC counseling recommendation and the Healthy People 2020 goal of reducing unplanned pregnancies.
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  • In Copyright
Advisor
  • Wheeler, Stephanie
  • Hassmiller Lich, Kristen
  • Frerichs, Leah
  • Halpern, Carolyn
  • Kaysin, Alexander
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2018
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