Web-based educational aid helps pregnant women with tubal sterilization decision-making

Key takeaways:

• A web-based aid led to improved tubal sterilization knowledge among pregnant women vs. usual care.
• Women in the intervention vs. usual care reported less conflict in decision-making about tubal sterilization.

A web-based educational aid significantly improved decision-making for pregnant women considering tubal sterilization after delivery vs. usual care, researchers reported in JAMA Network Open.

“Interventions are needed to support practitioner counseling and facilitate optimal decision-making about permanent contraception, particularly for communities whose reproduction has been devalued by society,” Sonya Borrero, MD, MS, professor of medicine and founding director of the Center for Innovative Research on Gender Health Equity at the University of Pittsburgh School of Medicine, and colleagues wrote. “Our team developed a patient-facing decision aid to support informed and value-concordant decision-making among individuals with low income considering tubal sterilization.”

Borrero and colleagues conducted a multisite randomized clinical trial with data from 350 pregnant women (mean age, 29.7 years) from March 2020 to November 2023 recruited from outpatient obstetric clinics in three U.S. cities. All women spoke English or Spanish, had Medicaid and were considering tubal sterilization after delivery.

Participants were randomly assigned to usual prenatal care (n = 178) or usual care plus a web-based decision aid (n = 172). The web-based aid, MyDecision/MiDecisión, included written, audio and video information about tubal sterilization procedures, an interactive table comparing contraception options, values-clarifying exercises, knowledge checks and a summary report. Researchers assessed knowledge about tubal sterilization by the percentage of correct true-false responses in the knowledge check and used the low-literacy Decision Conflict Scale to measure decisional conflict with lower scores indicating less conflict.

Researchers assessed participant knowledge and decisional conflict immediately after completing the web-based aid, at the third trimester and at 3 months postpartum.

Primary outcomes were tubal sterilization knowledge and decisional conflict regarding contraceptive decisions.

The intervention group had higher mean tubal sterilization knowledge (76.5% vs. 55.6%; P < .001) and lower mean decisional conflict scores (12.7 vs. 18.7 points; P = .002) compared with the usual care group.

Between the two groups, researchers observed the greatest knowledge differences for questions about permanence, with more women in the intervention group answering correctly that tubal sterilization is not easily reversible (90.1% vs. 39.3%; OR = 14.2; 95% CI, 7.9-25.4; P < .001) and that fallopian tubes do not spontaneously “untie” after the procedure (86.6% vs. 33.7%; OR = 13; 95% CI, 7.6-22.4; P < .001).

The results were consistent through the third trimester of pregnancy and at 3 months postpartum.

“This web-based decision aid takes less than 20 minutes to complete and can be widely implemented to supplement practitioner counseling on permanent contraception. Furthermore, if this scalable decision aid is found to be superior to the current Medicaid consent form, it could potentially replace it,” the researchers wrote. “Ultimately, once people are safeguarded with an evidence-based process that can truly ensure informed consent, it may be possible to consider potentially shortening or waiving the 30-day waiting period that has restricted access to desired sterilization for many people with low income.”