Knowledge of oral contraceptive pills and condom use among family planning patients

INTRODUCTION: A large part of contraceptive effectiveness depends on patient comprehension of verbal and written instructions. PURPOSE: The purpose of this study was to assess the relationship between literacy and knowledge of oral contraceptive pills (OCP) and condom use. METHODS: 200 OCP users attending a family planning clinic (FPC) in Shreveport, LA, were given the REALM literacy test and a structured interview developed by the authors. Women ranged in age from 13 to 41 with a median age of 23; 84% were AA. 76% had used OCPs in the past; 59% were parous. 48% were reading below a high school level, despite the fact that 81% completed high school. 85% had attended a contraceptive class at the FPC, and the remaining 15% had first been prescribed OCPs at another clinic. RESULTS: 80% reported that they knew the definition of contraception, but only 67% were actually correct. Understanding of contraception varied significantly by age (p<.0001) and literacy level (p<.0001). 33% of patients < 20 years of age understood contraception compared to 75% of those ≥ 20. Patients reading < 9^th grade level had less knowledge about contraception than those reading on ≥ 9^th grade (54% vs. 80%). Most patients (72%) thought they knew how OCPs worked; however, only 29% actually understood. Knowledge of how OCPs worked was significantly related to literacy (17% of patients reading < 9^th grade level vs. 41% reading ≥ 9^th grade; p<.01) but not to age. With regard to knowledge of risks, side effects, and benefits, 54% of patients could not name a risk associated with OCP use, and 31% could name only one risk. One in three patients (33%) could not name a side effect, and almost two in three (63%) could not name a non-contraceptive benefit of taking OCPs. Regarding condom use, 99% of women knew to use a condom to protect themselves against HIV and 100% knew it was not safe to use a condom twice. CONCLUSIONS: Most young OCP users lacked important understanding of contraception. Patients with low literacy lacked sufficient knowledge of both contraception and OCPs. Current educational efforts must be supplemented in order for women to have a better understanding of contraception and OCPs. The fact that almost all women knew the importance of condom use in the prevention of HIV transmission, however, indicates that it is possible to successfully educate the public, regardless of age and literacy level, about contraceptive methods.