Contraceptive Education for Active-Duty Service Members: An evaluation using the RE-AIM framework

Abstract

Background: Nearly two-thirds of military pregnancies are unintended, with 5.5% of military women experiencing unintended pregnancy in 2015. Education-based interventions are effective at improving contraceptive knowledge as well as contraceptive behaviors among military populations. However, traditional education-based interventions often require multiple hours or days of staff and participants’ time. Additionally, little is known about baseline contraceptive knowledge of Army service members. We assessed the impact of a one-hour contraceptive education course embedded within a same-day contraceptive clinic.Methods: Participants were recruited from a convenience sample of active-duty service members presenting for a scheduled bi-weekly contraceptive clinic. All service-members participating in the contraceptive clinic were offered the opportunity to participate in the contraceptive education course. Education course participants were asked to complete a pre and post intervention questionnaire. Pre and post course questionnaires included a validated 25-question contraceptive knowledge assessment and asked about preferred contraceptive method. The post-course survey included an additional validated 16-question contraceptive decision conflict scale. A control group consisted of active-duty Army women presenting for routine appointments to the same primary care clinic who did not complete the education course. The control group participants were asked to complete pre and post appointment questionnaires for contraceptive knowledge, preference, and decision conflict. Implementation of the contraceptive clinic and education course was qualitatively assessed using the RE-AIM evaluation model as described by Glasgow et al. Findings: Fourteen contraceptive class participants and ten control participants enrolled in the study and completed baseline surveys. Baseline contraceptive knowledge was similar between groups, with mean aggregate score of 13.58 out of a possible 25. The questions most frequently missed pertained to proper use of contraceptive methods, method side effects, and medical contraindications. Follow-up surveys were only completed by 4% of total study participants. As a result, change in contraceptive knowledge and preferred contraceptive method could not be assessed. In qualitative program evaluation, several threats to program adoption were identified at the provider and clinic level. Discussion: This study was unable to assess the primary outcome of change in contraceptive knowledge or preferred contraceptive method. However, it provides valuable information about specific contraceptive knowledge deficits among Army women. This information can be used to design future education interventions. Additional studies are needed to assess the impact of this contraceptive education program on contraceptive knowledge retention, contraceptive behaviors, and pregnancy.