A method can predict whether a woman is at high risk of forgetting to take oral contraceptives

Validated by a URV study, this tool uses a questionnaire from other healthcare settings to prevent unwanted pregnancies

Contraceptive pills (Photo: jcomp, freepik)

The alarming statistic that one in three pregnancies is unwanted is of considerable concern to the URV’s Department of Nursing, which has just published a study validating a method that will help to prevent this situation. The method is the so-called Morisky-Green four-item scale (MMAS-4), which predicts the regularity with which a person will administer a drug, in this case the combined oral contraceptive (COC).

This validated scale is a simple four-question questionnaire: Do you sometimes forget to take your medicine? Are you sometimes careless about taking your medicine? If you feel better, do you sometimes stop taking your medicine? If you sometimes feel worse when you take your medicine, do you stop taking it? If someone answers just one of the questions in the affirmative, they are considered to be non-compliant. For some time now, this scale has been applied in other healthcare settings, but it has never been used in contraceptive counselling. Due to its proven efficacy, the URV hopes that it will soon be widely used in this area.

“If we know from the outset that a person will sometimes not take oral contraceptives, that they will forget or not be regular, we know that they should be advised to use another contraceptive method,” explains Inmaculada de Molina-Fernández, midwife and researcher at the URV’s Nursing Department, where for the last year they have been monitoring the women attending the contraceptive counselling service who had been given the MMAS-4 scale. This study has confirmed the validity of the method. According to de Molina, 60% of the 327 participants in the study, who were taking or wanted to take combined oral contraceptives, were classified as non-compliant with the MMAS-4 scale and a subsequent year-long follow-up “found that they were actually more forgetful than the users classified as compliant.”

Inma de Molina, departament d'Infermeria
Inmaculada de Molina-Fernández, a researcher from the Department of Nursing

The research was based on another study, which evaluated the effectiveness of a tool to help make shared decisions on contraceptives. The digital tool was developed by research staff from the URV’s Department of Nursing, headed by Immaculada de Molina-Fernández, and was funded by the Catalan Health Service and the Catalan Agency for Health Quality and Assessment (AQUAS). This tool is freely available on the website Shared Decisions of the Health Department of the Catalan Government: Of the nearly 900 women who were attending the counselling consultation service and who agreed to take part, 327 were chosen for the adherence study.

“By applying this method, which standardizes questions that patients are usually asked but not always in the same way or with the same care, you can find out if it will be a good contraceptive for them, and thus avoid risky behaviour and unwanted pregnancies,” says de Molina. Currently, the most commonly used contraceptive method is the condom, used by 31% of couples, followed by the combined oral contraceptive, used by 18%.

Bibliographic reference: de Molina-Fernandez, M.I.; Reyes-Martí, L.; De la Flor-López, M.; Aguarón-García, M.J.; Roca-Biosca, A.; Rubio-Rico, L.; Raventós Torner, R.D.; Valls-Fonayet, F. Medication Adherence and Contraceptive Counseling. Healthcare 2023, 11, 1304. https://doi.org/10.3390/healthcare11091304.

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