Agreement between women's and providers' assessment of hormonal contraceptive risk factors

Abstract

To measure agreement between women's self-administered risk factor questionnaire and their providers' evaluation of their medical eligibility for hormonal contraceptive use. This was an anonymous cross-sectional study. Participants were women 15-45 years old who completed a 20-item self-administered questionnaire. Women were recruited from six public health family planning clinics in the Seattle Metropolitan area. A matching medical evaluation questionnaire was completed concurrently by each participant's health care provider. Using provider evaluation as the "gold standard" against which we compared self-reported medical history, we calculated participant-provider agreement with point estimates and 95% confidence interval (CI). Of 399 participant and provider pairs, participant-provider agreement was obtained for 392 participant pairs. The majority of the participants (90.3%) were 15-30 years old and 77.7% had used a hormonal contraceptive method for more than 1 year. The estimated proportion of the overall agreement was 96% (95% CI, 0.92-0.98). Women were more likely to report severe headaches (12.4% vs. 3.3%), possible pregnancy (7.3% vs. 3.5%) and smoking (6.2% vs. 2.1%) than providers, but less likely to report smoking more than 15 cigarettes per day (2.6% vs. 9.2%) and irregular menses (6.5% vs. 9.9%). Overall, a high proportion of the women in this study completed our medical history questionnaire in concordance with their health care providers' same-day medical evaluation. Agreement on critical medical eligibility criteria such as hypertension was well above 90%. For criteria on which there was disagreement, women were more likely to identify contraindications than were their providers.