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Christine dehlendorf

What does respect have to do with birth control counseling?

Being warm and listening to patients has a bigger impact than you might expect.

by Christine Dehlendorf, MD, MAS, and Alexis Hoffman

published 09/27/16

Having a good rapport with your patient is considered a pillar of high quality health care, especially when that care includes counseling around personal matters like sexual health. But what if I told you that our rapport—and the quality of the care we provide overall—actually affects our patients’ long-term birth control use?

A new study that we did shows exactly that. Patients who reported high “interpersonal quality of family planning care”—meaning they felt respected and heard while talking about birth control with their provider—were more likely to keep using their chosen birth control method six months later.

Measuring patients’ experiences with their providers

So how did we measure whether a patient felt respected and heard while talking about birth control with a provider? We recognize that this is no easy task: there are so many unique ways a patient might feel about her or his visit. We needed to find a way to capture the many layers of unique interactions between patients and health care providers.

Using previous work on women’s preferences for contraceptive counseling, we created the interpersonal quality in family planning (IQFP) scale. The scale let patients rate their experiences from 0 meaning “poor” to 5 meaning “excellent,” and asked questions like whether the provider:

  • Respected them as a person,

  • Took their preferences about birth control seriously,

  • Considered their personal situation when advising about birth control, and

  • Answered all their questions.

In addition to asking each client these questions, we got their permission to audio record their visits. We listened to the visits afterwards and evaluated how well the provider engaged in patient-centered communication described by the Four Habits framework. We used the same 5-point scale of poor to excellent to give providers at each visit a rating on the habits related to birth control shown in the box.

Respect + listening + warmth = contraceptive continuation

We got back in touch with patients about six months after their visit and asked them about their birth control. Patients who reported that their provider respected them, took their preferences seriously, gave them personalized information, and answered all their questions were more likely to be using their chosen birth control method 6 months later, even after taking into account other factors that might influence this.

Two of the four habits were also important for birth control continuation. Patients whose providers used Habits 1 and 2 (investing in the beginning and eliciting the patient perspective) were more likely to use their chosen method continuously. We wouldn’t say that the other two habits aren’t important, but they weren’t as strongly related to birth control continuation.

How can providers use this information?

There are lots of ethical arguments for why we as providers should offer high-quality counseling to the people we serve. This study provides concrete evidence that the quality of birth control counseling matters for our patients’ outcomes. Continuing to use a method of birth control suggests that these patients had found a method that was working for them, which can be a long journey.

Respectful, personalized, and patient-centered birth control counseling sets a foundation for our patients to find the method that works best for them. If you want to try this in your own practice, pay attention to how well you engage in each of the Four Habits during your clinical encounters.

When our patients trust us as providers and view counseling experiences positively, they may be more likely to return to us for care—for birth control or any other highly personal issue. In the end, having a respectful relationship and paying careful attention to the dynamics between you and your patient has bigger implications than just being a “gold standard” for care. It has the potential to empower your patients to achieve their reproductive health and life goals—outcomes about which both patients and providers can be happy.

Christine Dehlendorf, MD, MAS, is the Director of the Program in Woman-Centered Contraception at the University of California, San Francisco. As a family doctor, she is passionate about taking care of women in all stages of life, and about honoring and trusting women in their reproductive decisions. That said, she is still wondering why no one gave her a how-to manual when they sent her home from the hospital with her first child. Alexis Hoffman is a research assistant at the Program in Woman-Centered Contraception. Thanks to extremely lackluster counseling when she was a teenager, the only birth control method she knew existed was the pill! She is passionate about every patient knowing the full scope of methods available to them, increasing accessibility to compassionate care, and decreasing stigma associated with exerting reproductive choices. She’s also an NPR and podcast lover.
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