Patient-Centered Contraceptive Counseling: Evidence to Inform Practice

  • Christine Dehlendorf
  • Edith FoxEmail author
  • Lauren Sobel
  • Sonya Borrero
Family Planning (A. Burke, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Family Planning


Patient centeredness is an increasingly recognized aspect of quality health care. The application of this framework to contraceptive counseling and care has not been well described. We propose a definition of patient-centered contraceptive counseling that focuses on and prioritizes each patient’s individual needs and preferences regarding contraceptive methods and the counseling experience. Guided by this definition, we review recent research that has advanced our understanding of how patient-centered contraceptive counseling can be delivered in practice, focusing on how women decide on a contraceptive method, their preferences for counseling, and their experiences with counseling. This research provides evidence that women have diverse preferences around attributes of their contraceptive methods and value personal, supportive relationships with their family planning providers that focus on their individual preferences. We discuss the implications of this research for practice and review recent interventions that incorporate patient centeredness to varying degrees.


Contraception Contraceptive counseling Patient-centered Decision making 


Compliance with Ethics Guidelines

Conflict of Interest

Christine Dehlendorf, Edith Fox, Lauren Sobel, and Sonya Borrero declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures performed in studies by the authors involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Mohammed K, Nolan MB, Rajjo T, et al. Creating a patient-centered health care delivery system: A systematic review of health care quality From the Patient Perspective. American Journal of Medical Quality 2014;1062860614545124.Google Scholar
  2. 2.
    Institute of Medicine. (U.S.). Committee on Quality of Health Care in America. Crossing the quality chasm: A new health system for the 21st century. National Academy Press; 2001.Google Scholar
  3. 3.
    Gavin L, Moskosky S, Carter M, et al. Providing quality family planning services: recommendations of CDC and the U.S. Office of Population Affairs. MMWR Recommendations and reports: morbidity and mortality weekly report. Center Dis Control. 2014;63:1–54.Google Scholar
  4. 4.
    Epstein RM, Street RL. The values and value of patient-centered care. Ann Fam Med. 2011;9:100–3.PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Rathert C, Wyrwich MD, Boren SA. Patient-centered care and outcomes: A systematic review of the literature. Medical Care Research and Review 2012;1077558712465774.Google Scholar
  6. 6.
    Moskowitz E, Jennings B. Directive counseling on long-acting contraception. Am J Public Health. 1996;86:787–90.PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Stevens J, Berlan ED. Applying principles from behavioral economics to promote long‐acting reversible contraceptive (LARC) methods. Perspect Sex Reprod Health. 2014;46:165–70.CrossRefPubMedGoogle Scholar
  8. 8.
    Aiken ARA, Dillaway C, Mevs-Korff N. A blessing I can’t afford: factors underlying the paradox of happiness about unintended pregnancy. Soc Sci Med. 2015;132:149–55.CrossRefPubMedGoogle Scholar
  9. 9.
    Aiken ARA, Potter JE. Are Latina women ambivalent about pregnancies they are trying to prevent? Evidence from the border contraceptive access study. Perspect Sex Reprod Health. 2013;45:196–203.PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.••
    Borrero S, Nikolajski C, Steinberg JR, et al. “It just happens”: A qualitative study exploring low-income women’s perspectives on pregnancy intention and planning. Contraception. 2015;91:150–6. The results of this study indicate how public health goals for reducing unintended pregnancy may be misaligned with the reality of women’s lives, in which pregnancy intention and planning are not always relevant. Furthermore, such intentions and plans (or lack thereof) are complexly and variously related to individual women’s feelings about pregnancy, the acceptability of pregnancy, and actual contraceptive use. In the context of contraceptive counseling, the results indicate a need for increased focus on the meaning of pregnancy and goals for contraceptive use of individual women, rather than a uniform application of a planned behavior model.PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Guendelman S, Denny C, Mauldon J, Chetkovich C. Perceptions of hormonal contraceptive safety and side effects among low-income Latina and non-Latina women. Matern Child Health J. 2000;4:233–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Becker D, Klassen AC, Koenig MA, LaVeist TA, Sonenstein FL, Tsui AO. Women’s perspectives on family planning service quality: an exploration of differences by race, ethnicity and language. Perspect Sex Reprod Health. 2009;41:158–65.CrossRefPubMedGoogle Scholar
  13. 13.
    Silverman J, Torres A, Forrest JD. Barriers to contraceptive services. Fam Plan Perspect. 1987;19:94–102.CrossRefGoogle Scholar
  14. 14.
    RamaRao S, Lacuesta M, Costello M, Pangolibay B, Jones H. The link between quality of care and contraceptive use. International Family Planning Perspectives 2003:76–83.Google Scholar
  15. 15.
    Koenig MA, Hossain MB, Whittaker M. The influence of quality of care upon contraceptive use in rural Bangladesh. Studies in Family Planning 1997:278–89.Google Scholar
  16. 16.
    De Cetina TEC, Canto P, Luna MO. Effect of counseling to improve compliance in Mexican women receiving depot-medroxyprogesterone acetate. Contraception. 2001;63:143–6.CrossRefGoogle Scholar
  17. 17.
    Backman T, Huhtala S, Luoto R, Tuominen J, Rauramo I, Koskenvuo M. Advance information improves user satisfaction with the levonorgestrel intrauterine system. Obstet Gynecol. 2002;99:608–13.CrossRefPubMedGoogle Scholar
  18. 18.
    Weisman CS, Maccannon DS, Henderson JT, Shortridge E, Orso CL. Contraceptive counseling in managed care: preventing unintended pregnancyin adults. Womens Health Issues. 2002;12:79–95.CrossRefPubMedGoogle Scholar
  19. 19.
    Becker D, Tsui AO. Reproductive health service preferences and perceptions of quality among low‐income women: racial, ethnic and language group differences. Perspect Sex Reprod Health. 2008;40:202–11.CrossRefPubMedGoogle Scholar
  20. 20.
    Radecki SE, Bernstein GS. Use of clinic versus private family planning care by low-income women: access, cost, and patient satisfaction. Am J Public Health. 1989;79:692–7.PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Chetkovich C, Mauldon J, Brindis C, Guendelman S. Informed policy making for the prevention of unwanted pregnancy: understanding low-income women’s experiences with family planning. Eval Rev. 1999;23:527–52.CrossRefPubMedGoogle Scholar
  22. 22.
    Yee LM, Simon MA. Perceptions of coercion, discrimination and other negative experiences in postpartum contraceptive counseling for low-income minority women. J Health Care Poor Underserved. 2011;22:1387–400.CrossRefPubMedGoogle Scholar
  23. 23.
    Nobili MP, Piergrossi S, Brusati V, Moja EA. The effect of patient-centered contraceptive counseling in women who undergo a voluntary termination of pregnancy. Patient Educ Couns. 2007;65:361–8.CrossRefPubMedGoogle Scholar
  24. 24.•
    Lessard LN, Karasek D, Ma S, et al. Contraceptive features preferred by women at high risk of unintended pregnancy. Perspect Sex Reprod Health. 2012;44:194–200. This study contributes to the previously very limited research on women’s preferences for contraceptive methods, increasing understanding of women’s contraceptive decision making processes. Women ranked effectiveness, side effects, and affordability as the most preferred features; all of these preferences and others may strongly influence women’s contraceptive decisions depending on her personal desires, experiences, and circumstances. CrossRefPubMedGoogle Scholar
  25. 25.
    Madden T, Secura G, Nease R, Politi M, Peipert J. The role of contraceptive attributes in women’s contraceptive decision making. Am J Obstet Gynecol. 2015;213:46.e1–6.CrossRefGoogle Scholar
  26. 26.•
    Melo J, Peters M, Teal S, Guiahi M. Adolescent and young women’s contraceptive decision-making processes: Choosing “the best method for her”. J Pediatr Adolesc Gynecol. 2015;28:224–8. Drawing from semi-structured interviews, the authors present a model for understanding adolescents’ and young women’s contraceptive decision making, strengthening the limited research in this area. This model acknowledges the important roles of both providers and peers in information-gathering about contraception, and underscores the primacy of patients’ individual circumstances in their contraceptive decisions. CrossRefPubMedGoogle Scholar
  27. 27.
    Weisberg E, Bateson D, Knox S, et al. Do women and providers value the same features of contraceptive products? Results of a best-worst stated preference experiment. Eur J Contracept Reprod Health Care. 2013;18:181–90.CrossRefPubMedGoogle Scholar
  28. 28.
    Anderson N, Steinauer J, Valente T, Koblentz J, Dehlendorf C. Women’s social communication about IUDs: a qualitative analysis. Perspect Sex Reprod Health. 2014;46:141–8.PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.••
    Dehlendorf C, Levy K, Kelley A, Grumbach K, Steinauer J. Women’s preferences for contraceptive counseling and decision making. Contraception. 2013;88:250–6. While some previous qualitative research has explored women’s perceptions of the quality of their contraceptive counseling experiences, this study is the first to thoroughly examine what approach women would like providers to take in the decision making process. Its results indicate the acceptability of shared decision making. PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    Brown MK, Auerswald C, Eyre SL, Deardorff J, Dehlendorf C. Identifying counseling needs of nulliparous adolescent intrauterine contraceptive users: a qualitative approach. J Adolesc Health. 2013;52:293–300.PubMedCentralCrossRefPubMedGoogle Scholar
  31. 31.
    Dehlendorf C, Diedrich J, Drey E, Postone A, Steinauer J. Preferences for decision-making about contraception and general health care among reproductive age women at an abortion clinic. Patient Educ Couns. 2010;81:343–8.PubMedCentralCrossRefPubMedGoogle Scholar
  32. 32.
    Evans M, Chan P, Dehlendorf C. Provider self-disclosure during contraceptive counseling. Contraception. 2013;3:464.CrossRefGoogle Scholar
  33. 33.•
    Donnelly KZ, Foster TC, Thompson R. What matters most? The content and concordance of patients’ and providers’ information priorities for contraceptive decision making. Contraception. 2014;90:280–7. This study not only examines women’s information priorities in making contraceptive decisions (a topic little researched previously), but importantly compares these information priorities with providers’ priorities for counseling. The results suggest that patients’ information priorities may be inadequately met in counseling visits, and highlight method side effects as one type of information that could be more highly prioritized by providers to meet patients’ needs and preferences.CrossRefPubMedGoogle Scholar
  34. 34.
    Dehlendorf C, Tharayil M, Anderson N, Gbenedio K, Wittman A, Steinauer J. Counseling about IUDs: a mixed-methods analysis. Perspect Sex Reprod Health. 2014;46:133–40.PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.•
    Dehlendorf C, Kimport K, Levy K, Steinauer J. A qualitative analysis of approaches to contraceptive counseling. Perspect Sex Reprod Health. 2014;46:233–40. This article presents results from an innovative study using audiorecordings of patient visits to observe how contraceptive counseling visits occur in practice. It importantly documents that providers infrequently engaged with patient preferences, indicating a deficiency of patient-centeredness in current counseling.PubMedCentralCrossRefPubMedGoogle Scholar
  36. 36.
    Levy K, Minnis AM, Lahiff M, Schmittdiel J, Dehlendorf C. Bringing patients’ social context into the examination room: an investigation of the discussion of social influence during contraceptive counseling. Womens Health Issues. 2015;25:13–21.PubMedCentralCrossRefPubMedGoogle Scholar
  37. 37.
    Hoggart L, Newton VL, Dickson J. “I think it depends on the body, with mine it didn’t work”: explaining young women’s contraceptive implant removal. Contraception. 2013;88:636–40.CrossRefPubMedGoogle Scholar
  38. 38.
    Upadhyay UD. Informed choice in family planning. Helping people decide. Population Reports Series: Family Planning Programs 2001:1–39.Google Scholar
  39. 39.
    Makoul G, Clayman ML. An integrative model of shared decision making in medical encounters. Patient Educ Couns. 2006;60:301–12.CrossRefPubMedGoogle Scholar
  40. 40.
    Dehlendorf C, Krajewski C, Borrero S. Contraceptive counseling: best practices to ensure quality communication and enable effective contraceptive use. Clin Obstet Gynecol. 2014;57:659–73.PubMedCentralCrossRefPubMedGoogle Scholar
  41. 41.••
    Gomez AM, Fuentes L, Allina A. Women or LARC first? Reproductive autonomy and the promotion of long-acting reversible contraceptive methods. Perspect Sex Reprod Health. 2014;46:171–5. This commentary explains the need for contraceptive counseling and family planning programs to respect the preferences and circumstances of individuals in the current climate of enthusiasm for LARC methods among health professionals. It pays special attention to the potential of LARC promotion to push women whose fertility has been historically devalued in the United States, including black, Latina, low-income, and young women, towards LARC methods in spite of their own preferences, perpetuating this devaluation.PubMedCentralCrossRefPubMedGoogle Scholar
  42. 42.
    Higgins JA. Celebration meets caution: LARC’s boons, potential busts, and the benefits of a reproductive justice approach. Contraception. 2014;89:237–41.PubMedCentralCrossRefPubMedGoogle Scholar
  43. 43.
    Stern AM. Sterilized in the name of public health: race, immigration, and reproductive control in modern California. Am J Public Health. 2005;95:1128–38.PubMedCentralCrossRefPubMedGoogle Scholar
  44. 44.
    Dehlendorf C, Ruskin R, Grumbach K, et al. Recommendations for intrauterine contraception: a randomized trial of the effects of patients’ race/ethnicity and socioeconomic status. Am J Obstet Gynecol. 2010;203(319):e1–8.PubMedGoogle Scholar
  45. 45.
    Downing RA, LaVeist TA, Bullock HE. Intersections of ethnicity and social class in provider advice regarding reproductive health. Am J Public Health. 2007;97:1803.PubMedCentralCrossRefPubMedGoogle Scholar
  46. 46.
    Thorburn S, Bogart LM. Conspiracy beliefs about birth control: Barriers to pregnancy prevention among African Americans of reproductive age. Health Educ Behav. 2005;32:474–87.CrossRefPubMedGoogle Scholar
  47. 47.
    Dehlendorf C, Bellanca H, Policar M. Performance measures for contraceptive care: what are we actually trying to measure? Contraception. 2015;91:433–7.CrossRefPubMedGoogle Scholar
  48. 48.
    Stevens LM. Planning parenthood: health care providers’ perspectives on pregnancy intention, readiness, and family planning. Soc Sci Med. 2015;139:44–52.CrossRefPubMedGoogle Scholar
  49. 49.
    Madden T, Mullersman JL, Omvig KJ, Secura GM, Peipert JF. Structured contraceptive counseling provided by the Contraceptive CHOICE Project. Contraception. 2013;88:243–9.PubMedCentralCrossRefPubMedGoogle Scholar
  50. 50.
    Bommaraju A, Malat J, Mooney JL. Reproductive life plan counseling and effective contraceptive use among urban women utilizing Title X Services. Womens Health Issues. 2015;25:209–15.CrossRefPubMedGoogle Scholar
  51. 51.
    Whitaker AK, Quinn MT, Martins SL, Tomlinson AN, Woodhams EJ, Gilliam M. Motivational interviewing to improve postabortion contraceptive uptake by young women: development and feasibility of a counseling intervention. Contraception. 2015;92:323–9.CrossRefPubMedGoogle Scholar
  52. 52.
    Miller WR, Rollnick S. Motivational interviewing: Helping people change. Guilford Press; 2012.Google Scholar
  53. 53.
    Garbers S, Meserve A, Kottke M, Hatcher R, Chiasson MA. Tailored health messaging improves contraceptive continuation and adherence: results from a randomized controlled trial. Contraception. 2012;86:536–42.CrossRefPubMedGoogle Scholar
  54. 54.
    Garbers S, Meserve A, Kottke M, Hatcher R, Ventura A, Chiasson MA. Randomized controlled trial of a computer-based module to improve contraceptive method choice. Contraception. 2012;86:383–90.CrossRefPubMedGoogle Scholar
  55. 55.
    French RS, Cowan FM, Wellings K, Dowie J. The development of a multi-criteria decision analysis aid to help with contraceptive choices: my Contraception Tool. J Fam Plann Reprod Health Care. 2014;40:96–101.CrossRefPubMedGoogle Scholar
  56. 56.
    Wilson EK, Krieger KE, Koo HP, Minnis AM, Treiman K. Feasibility and acceptability of a computer-based tool to improve contraceptive counseling. Contraception. 2014;90:72–8.CrossRefPubMedGoogle Scholar
  57. 57.
    Wyatt KD, Anderson RT, Creedon D, et al. Women’s values in contraceptive choice: a systematic review of relevant attributes included in decision aids. BMC Womens Health. 2014;14:28.PubMedCentralCrossRefPubMedGoogle Scholar
  58. 58.
    Craig AD, Dehlendorf C, Borrero S, Harper CC, Rocca CH. Exploring young adults’ contraceptive knowledge and attitudes: disparities by race/ethnicity and age. Womens Health Issues. 2014;24:e281–9.PubMedCentralCrossRefPubMedGoogle Scholar
  59. 59.
    Rocca CH, Harper CC. Do racial and ethnic differences in contraceptive attitudes and knowledge explain disparities in method use? Perspect Sex Reprod Health. 2012;44:150–8.CrossRefPubMedGoogle Scholar
  60. 60.
    Frost JJ, Lindberg LD, Finer LB. Young adults’ contraceptive knowledge, norms and attitudes: associations with risk of unintended pregnancy. Perspect Sex Reprod Health. 2012;44:107–16.CrossRefPubMedGoogle Scholar
  61. 61.
    Yee LM, Simon MA. The role of health literacy and numeracy in contraceptive decision-making for urban Chicago women. J Community Health. 2014;39:394–9.CrossRefPubMedGoogle Scholar
  62. 62.
    Selby JV, Beal AC, Frank L. The Patient-Centered Outcomes Research Institute (PCORI) national priorities for research and initial research agenda. J Am Med Assoc. 2012;307:1583–4.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Christine Dehlendorf
    • 1
    • 2
    • 3
  • Edith Fox
    • 1
    Email author
  • Lauren Sobel
    • 4
  • Sonya Borrero
    • 5
    • 6
  1. 1.Department of Family & Community MedicineUniversity of CaliforniaSan FranciscoUSA
  2. 2.Department of Obstetrics, Gynecology, & Reproductive SciencesUniversity of CaliforniaSan FranciscoUSA
  3. 3.Department of Epidemiology & BiostatisticsUniversity of CaliforniaSan FranciscoUSA
  4. 4.Touro University California College of Osteopathic MedicineVallejoUSA
  5. 5.University of Pittsburgh School of MedicinePittsburghUSA
  6. 6.VA Center for Health Equity Research and PromotionVA Pittsburgh Healthcare SystemPittsburghUSA

Personalised recommendations