. 2024 Feb 2;14:04038. doi: 10.7189/jogh.14.04038

Table 3.

Available evidence on the impact of tools to promote patient-centred family planning counselling

Tool/author	Study type		Ease of use/acceptability		Effect on quality of care and provider-patient interactions		Effect on contraceptive knowledge	Effect on contraceptive decision-making, use, and continuation
OKQ
Baldwin et al., 2018 [12]	RCT with post-test survey (clients: OKQ n = 39, FPQ n = 37; providers OKQ n = 43, OKQ n = 36).		OKQ patients were less likely than FPQ patients to find the tool helpful and use it to track reproductive health goals (51 vs. 76%, P = 0.02).		OKQ and FPQ clients were equally likely to find the tool helpful in communicating their reproductive goals to their provider (68 vs. 66%, P = 0.88).
Baldwin et al., 2018 [12]					OKQ providers were more likely than FPQ providers to agree the tool helped focus their counselling, but the effect was not significant (50 vs. 37%, P = 0.25).
Gawron et al., 2022 [8]	Cross-sectional pre-post patient chart review (n = 41, 52).		Patient perceptions about the screening tool were not assessed, but clients were willing to complete it, and five clients voluntarily gave positive feedback.		Chart reviews show decreased documentation of a reproductive plan (22 vs. 6%, P = 0.02), and no change in documentation of contraceptive counselling (20 vs. 13%, P = 0.36) or the patient’s contraceptive method (20 vs. 37%, P = 0.08).			Chart reviews show no significant change in documentation current contraceptive method (20 vs. 37%, P = 0.08).
Stulberg et al., 2019 [36]	Cross-sectional pre-post pilot patient survey (n = 29, 34), no control group.				The percentage of clients who said their provider discussed birth control increased from 52 to 76% (P = 0.04); percentage who recommended LARC increased from 10 to 32% (P = 0.04).
FPQ/RepLI
Baldwin et al., 2018 [12]	RCT with post-test survey (clients: OKQ n = 39, FPQ n = 37; providers OKQ n = 43, OKQ n = 36).		FPQ patients were more likely than OKQ patients to find the tool helpful and use it to track reproductive health goals (76 vs. 51%, P = 0.02).		FPQ clients were as likely as OKQ clients to find the tool helpful in communicating their reproductive goals to their provider (68 vs. 66%, P = 0.88).
Baldwin et al., 2018 [12]					FPQ providers were less likely than OKQ providers to agree the tool helped focus their counselling, but the effect was not significant (37 vs. 50%, P = 0.25).
Madrigal et al., 2019 [35]	Post-test only study with clients (n = 790) and providers (n = 66).		Completion of the FPQ/RepLI tool by a health educator took about five minutes. 92% of patients found the tool helpful and would use it to track their reproductive goals.		Most patients agreed the tool helped them think about their personal goals (94%) and helped communicate their personal goals to the provider (90%).
Madrigal et al., 2019 [35]			Most providers agreed that the tool was useful to facilitate discussing reproductive health (91%) and that this type of tool is needed (83%).		Most providers agreed that the tool helped them understand the patient’s reproductive plan (91%), help focus their counselling (92%), and improved the family planning counselling they provided (73%).
Smart Choices
Koo et al, 2017 [11]	Post-test only study with intervention (n = 126) and control clients (n = 214).		The average completion time was 14 min.		In multivariate analyses, intervention women rated their visit more patient-centred than controls (mean score 3.9 vs. 3.7, P < 0.05). Intervention women reporting discussing more sexual health topics than control women (1.2 vs. 0.9, P < 0.10). No effect was found on the number of childbearing-related topics that were discussed.		After controls, intervention women knew 11.1 contraceptive methods vs. 10.7 for the control group (P < 0.001).	After controls, intervention women were less likely than controls to adopt IUDs or implants (9 vs. 20%), and more likely to select oral contraceptives (64 vs. 54%, P < 0.10).
My Birth Control
Dehlendorf, Fitzpatrick, et al., 2019 [38]		RCT with post-test survey of providers (n = 28) and clients (n = 758).				Intervention clients reported higher interpersonal quality of counseling (OR = 1.45 (1.03–2.05)) and greater satisfaction with side-effects information (OR = 1.61 (1.11–2.33)). The tool had no effect on patient satisfaction with how the provider helped with method choice (OR = 1.30 (0.93–1.82)).	The tool improved knowledge of several contraceptive attributes. E.g. intervention clients were more likely to know that IUDs are more effective than pills (OR = 2.65 (1.94–3.62)), that methods that cause period to stop are safe (OR = 1.86 (1.28–2.71)), and that implants to not affect fertility (OR = 1.54 (1.14–2.07)).	The tool had no effect on satisfaction with the chosen method (OR = 1.19 (0.88–1.61)), or on method continuation at seven months (OR = 0.89 (0.65–1.22)).
Dehlendorf, Reed et al., 2019 [39]		Qualitative assessment of providers (n = 15).		All providers found it acceptable and feasible to incorporate the tool in their practice. Some noted that use of the tool prior to the visit sometimes slowed clinic flow. Most providers noted the tool was acceptable to clients but could be difficult for patients not used to the technology. Use of the tool increased overall visit time by 12 min.		Nearly all providers reported the tool made contraceptive counselling more efficient and let them allocate more time to issues the patient wanted to discuss.	Providers reported the tool improved patient’s pre-counselling knowledge of contraceptive options and method attributes.	Providers said the tool helped patients be more engaged and active in contraceptive method selection.
My Path
Callegari et al., 2021 [37]		Cross-sectional pre-post pilot patient survey with intervention (n = 30) and control group (n = 28).		Most clients liked the tool, found it easy to understand and felt comfortable answering the questions. Average completion time was 11 min.		Most providers agreed it made counselling more efficient and helped them discuss pregnancy goals and contraceptives. 93% of intervention clients vs. 68% of control clients reported discussing pregnancy or contraceptive needs (P < 0.05). Scores for self-efficacy in communicating with providers improved more among intervention than control clients (0.8 vs. 0.2, P < 0.05). Use of the tool did not affect clients’ rating of provider communication quality.	Scores for correct knowledge improved more among intervention than control clients (1.7 vs. 0.2, P < 0.01).	The tool had no significant effect on the likelihood of switching from non-prescription to prescription contraceptive methods.
Callegari et al., 2021 [37]				Providers did not think the tool increased their workload or hurt the clinic flow.
iMACC
Dev et al., 2019 [40]		Qualitative assessment of clients (n = 25) and providers (n = 17).		Most clients and providers reported that iMACC was easy to use and self-explanatory; clients had no issues comprehending questions and material. Average completion time was 15 min. Most providers said iMACC reduced their workload because it addresses common questions; a few worried that women’s increased knowledge about contraceptives would take longer to counsel.		Clients valued the confidentiality of the tool and felt it would allow adolescents to answer more honestly.	iMACC helped clients understand their contraceptive options and potential side-effects and dispel myths.	iMACC made clients feel empowered to make informed decisions about methods most suitable for them.
Dev et al., 2019 [40]						Most providers noted the tool allowed women to ask more questions; some claimed most women had already decided on a method before meeting them.