Health Education Project Research Articles

Let me go Potty, I Don't Want a CAUTI

This project is the capstone work for the Health Education and Research Trust Project Protect: Infection Prevention Fellowship addressing urinary catheter associated infections. The project successfully decreased utilization of urinary catheters in the emergency department (ED) of a 255 bed acute care hospital. This is a quality improvement project utilizing the Plan, Do, Study, Act (PDSA) method. A whole house prevalence study of patients with urinary catheters was done each month to determine the number of patients in the hospital with foley catheters that were inserted in the ED. Interventions included, systemwide changes to the EHR to improve removal of kits from the ED rooms, selection of an insertion algorithm with indications for use, ongoing email communication with direct care staff, improved catheter kits for ICU patients, implementation of a new condom catheter and case review by direct care staff. In 2013 there were 19 CAUTI, 14 (78%) of them were associated with urinary catheters inserted on admission via the ED. The median time to infection was 8 days. Between Jnauary 1 and December 12, 2014 there were 10 CAUTI, (20%) of them were associated with urinary catheters that were placed in the ED. The incidence density rate of CAUTI related to urinary catheters inserted in the ED decreased from 1.9 in 2013 to 0.3 in 2014 (p 0.005). Whole house urinary cathter use was reduced by 1116 days; this was a 48%reduction in utilization. There was a statistically significant reduction in the incidence of CAUTI related to foley catheters inserted in the ED. While few CAUTI occured within the first 72 hours after insertion of the urinary catheter, timely removal was problematic. Reducing insertion in the ED may impact catheter utilization throughout the hospital.

Evaluation of undergraduate psychiatry teaching in Malawi

In Malawi, mental health services account for only 2% of the health budget; there are just 4.5 full-time psychiatrists and 433 psychiatric beds. The Scotland Malawi Mental Health Education Project (SMMHEP) aims to provide sustainable support for psychiatric training for healthcare professionals and has increased the number of psychiatrists in the country. There has been a recent change in the educational programme in order to maximise clinical exposure and experience, particularly with the care of in-patients. The new programme has had a positive effect on students' attitudes towards psychiatry and their consideration of psychiatry as a career. This paper supports the ongoing work SMMHEP does in developing psychiatric services through education.

LA EDUCACIÓN PARA LA SALUD EN LOS PROGRAMAS DE INICIACIÓN PROFESIONAL

INTRODUCTION. This article offers the perceptions of teaching staff about Initial Professional Qualification Programmes (PCPI) in the Basque Country regarding health education. METHOD. The research is of a quantitative nature and ex-post facto, and its aim is to describe the implementation processes for health education projects in these educational establishments. RESULTS. The results obtained indicate that teachers need to train students in taking responsible decisions regarding health. Although subjects related to health education are important for teaching staff, the latter recognise that they are taught sporadically and not very systematically in the classroom. Lastly, when analysing the collaboration that exists between social and educational organisations, it can be ascertained that basic social services and institutions from the social sector are those that are most involved in lending support to these programmes. Teachers’ centres, Ministries of Education and Health, volunteers, the university and education inspection provide little suport to teachers from Initial Professional Qualification Programmes on preventive work and on promoting health. DISCUSSION. It is therefore worrying that educational establishments where so many resources are invested actually contribute so little to a fundamental aspect of the development of individuals. If the school attempts to encourage students’ integral development it must necessarily tackle the issues related to health by integrating it into their educational and curricular project, and coordinate it alongside other initiatives being developed in society.

Abstract T P387: Stroke Health and Risk Education Project: main results

Objective: The Stroke Health and Risk Education (SHARE) Project is a cluster-randomized, faith-based, culturally-sensitive, theory-based behavioral intervention trial to reduce key stroke risk factor behaviors. Methods: Ten Catholic churches in Corpus Christi, Texas were randomized to intervention or control group. Subjects were enrolled as friend or family partners who provided reciprocal support to each other. The intervention group received a 1-year multicomponent intervention that included self-help materials (physical activity guide with pedometer, healthy eating guide, blood pressure management photonovella, and motivational short film), 2 tailored newsletters, 5 motivational interviewing counseling calls, and a peer partnership support workshop. Multilevel modeling, accounting for clustering within pairs and parishes, was used to test treatment differences in the average of two measures of change since baseline (ascertained at 6 and 12 months), using standardized questionnaires, in dietary sodium, dietary fruit and vegetable intake, and physical activity of moderate or greater intensity. The primary endpoint was met if any one of the three outcomes was significant based on a pre-specified p-value threshold of 0.05/3. Results: Of 801 subjects who consented, 760 completed baseline data assessments. The median age was 52; 84% were Hispanic, the remainder were non-Hispanic whites; 64% were women. The intervention group had a greater increase in fruit and vegetable intake than the control group (0.25 (95% CI: 0.08, 0.42) cups per day, p = 0.002), a greater decrease in sodium intake (-123.17 (-194.76, -51.59) mg/day, p=0.04), but no difference in change in moderate or greater intensity physical activity (-27.47 (-526.32, 471.38) MET-minutes per week, p=0.56). Conclusion: This cluster-randomized trial was effective in increasing fruit and vegetable intake among Hispanic and non-Hispanic white Catholic parishioners, reaching its primary endpoint. The intervention also seemed to lower sodium intake. Church-based health promotions can be successful in primary stroke prevention efforts.

Application of Kern's Six-step approach to curriculum development by global health residents

Global health practitioners have a responsibility to deliver appropriate and effective health education to patients and families. We demonstrate how residents in a global health elective can utilize Kern's six-step approach to develop educational products for patients and their families. Residents completed a pre-curricular survey of knowledge, skills and attitudes regarding curriculum development. Kern's six-steps were introduced through a series of lectures; workshop exercises highlighted the application of each step: (i) Problem identification and general needs assessment, (ii) targeted needs assessment, (iii) goals and objectives, (iv) educational strategies, (v) implementation and (vi) evaluation and feedback. Residents used the six-steps to develop health education projects they subsequently implemented locally and abroad. Reflective exercises were conducted after utilization of each of the six steps. Residents also completed a post-curricular assessment of knowledge, skills and attitudes regarding curriculum development. Mean scores on pre- and post-curricular self-assessment of knowledge were 18 and 26.5 (out of 28); skills 19.8 and 33.5 (out of 35); and attitudes 13.3 and 19.8 (out of 21), respectively. Reflective exercises highlighted resident sentiment that the six steps enabled them to be more thoughtful of the interventions they were undertaking in communities locally and abroad. They were impressed how the model allowed them to ensure their goals were aligned with those of patients and their families, fully engage their audience and effectively implement the curricula. Kern's six-step approach to curriculum development is an effective method for global health residents to develop educational products for patients and families.

A cross-sectional study of childhood and adolescent obesity in affluent school children from western suburb of Mumbai 2001-2002 and 2013-2014

Introduction: Change in lifestyle patterns associated with genetic factors is causing increasing prevalence of childhood and adolescent obesity in India. Obesity during childhood and adolescence puts these children at a high risk for adult cardio-metabolic disorders and other chronic diseases. It is important that this avalanche is prevented in time by comprehensive school health education programmes and other timely interventions. An observational cross-sectional study, as a part of the School Health Education and Enlightened Living (SHEEL) project, was conducted to assess the prevalence in childhood overweight and obesity during the academic years 2000-2001 and 2013-2014 at a private school. Materials and Methods: As a part of the SHEEL project, a total of 2421 children consists of 1346 boys and 1075 girls (age ranged, 4 -15 years) were evaluated for their height (stadiometer), weight (electronic weighing scale) and body mass index (BMI) during the academic year 2000-2001 (stage 1 study). We approached the same school again in the academic year 2013-14 (stage 2 study). In this stage, a total of 2056 children (1067 boys and 989 girls; age range 5-15 years) were measured for the same parameters to evaluate in childhood and adolescent obesity when compared with that observed in 2000-2001.The measurements were plotted on gender specific BMI charts (Center for Disease Control and Prevention [CDC] charts) for obtaining percentiles. Identification of overweight and obesity was arrived at by CDC centile charts. Results: The stage 1 study done during the academic year 2000-2001 in school children from an affluent class of society showed a prevalence of overweight, in girls as 16.7% (180/1075) and in boys, 13.7% (185/1346). The prevalence of obesity for the total number of children was 15.3% (14.2% in 1075 girls and 16.1% in 1346 boys). In stage 2 study done during the academic year 2013-2014 in the same school, prevalence of overweight in girls was 16% (158/989) and in boys, 15.3% (163/1067) and the prevalence of obesity was 11.1% (9.1% in 989 girls and 12.9% in 1067 boys). If children at risk for obesity (overweight) and obese were clubbed together, nearly 1/3 of the children, 30.4% in 2001 and 26.7% in 2013, had above-normal BMI percentiles. In this study, the percentage of children showing overweight/obesity increased from the age groups 7 to 8 years and above as compared to the younger age groups. Conclusions: The current cross-sectional study shows that the prevalence of childhood and adolescent overweight and obesity amongst children from a upper-socio-economic stratum of society has remained high at 25-30% during both the periods of the school-based study. However, the trend for the prevalence of overweight and obesity in this >10 years has shown a definite decline of 5.8% in girls, while the decline of 1.6% in boys was not as remarkable.

Perceived Health Status of Farm/Ranch Women

Abstract Purposes: To (a) describe the self-reported perceptions of health among a group of farm/ranch women with chronic illness, and (b) examine the women’s impressions of the impact of farm/ranch living on their health. Sample and Methods: A secondary analysis was done with data generated from a paper/pencil survey of 21 farm/ranch women with chronic illnesses who participated in the Women to Women (WTW) computer-based support and health education project at Montana State University during the past decade. Questions were related to perceived general health status, health as it relates to chronic illness, and health problems associated with farm/ranch living and work. Findings: Farm/ranch women perceived their health positively. In addition to their chronic illnesses, some had illnesses or injuries related to living and or working on a farm/ranch, though few attributed their health problems to the farm/ranch life style. Conclusions: Rural healthcare providers need to be aware of the challenges faced by farm/ranch women with chronic illness such as: isolation, healthcare access, healthcare costs, fatigue, pain, and feelings of anger and guilt. In response, they must provide preventive counsel for the health risks, e.g., injuries, skin conditions, hearing impairment, respiratory disease, which may be associated with living and working on a farm/ranch. Key words: chronic illness, farm/ranch health, rural women

Projetos de Educação para a Saúde em meio escolar: Da avaliação às práticas de referência

Planear intervenções pertinentes e eficazes no âmbito da Educação para a Saúde (EpS) em meio escolar determina a implementação de procedimentos de avaliação que traduzam, não só um balanço da ação desenvolvida, mas contribuam, igualmente, para a reflexão em torno do processo deimplementação da EpS na realidade escolar portuguesa, com vista à otimização qualitativa das intervenções. À luz deste pressuposto, e visando estabelecer uma ligação entre a análise teórica e a reflexão a partir de uma prática concreta, o presente artigo tem como objetivos: (i) apresentar o modelo avaliativo instituído no estudo multicasos de índole qualitativa "Escola,Saúde e Sociedade: Estudos de Avaliação de Projetos de Educação para a Saúde", que se desenvolveu entre 2009/2011; (ii) divulgar as práticas de referência usadas num dos Projetos de Educação para a Saúde envolvidos no estudo, o qual evidenciou os critérios de qualidade que podem levar aconsiderá-lo como um ‘bom’ projeto. Palavras-chaveEscola; Projetos de Educação para a Saúde; Avaliação; Práticas de referência

Lifestyles management and community engagement in scoping a “health café”

Purpose – The purpose of this paper is to underpin a scoping study commissioned by community leaders to assess the potential for creating a “health café” in the centre of Boston, in eastern England, UK, to facilitate healthier lifestyles. Design/methodology/approach – A mixed methods and framework analytic approach was adopted, using documentary, focus group, interview and survey data. The paper drew on social marketing principles to enhance the community relevance of findings. Findings – Community stakeholders and public were generally supportive of a “health café” facility in the town centre. Accessibility and a welcoming environment were seen as key factors. A wide range of health-related services in addition to providing healthy foods were proposed. Key issues identified were: a wider role of the facility as a community “health hub”; appropriate marketing approaches; food provision issues and sustainability. All groups contacted saw the word “health” as off-putting. Research limitations/implications – As with many commissioned scoping studies, the timetable for delivery was very short, just three months, significantly influencing the choices of methodological approaches taken up. This made it important to provide a multi-disciplinary multi-methods design to enhance triangulation and a research team with extensive community research experience including previous research in this region. It was also important to specify and locate any knowledge claims from the findings. Practical implications – The research helped engage community stakeholders to tap a diversity of views which could be adopted by community leaders into their ongoing health strategies and development plans for a “health hub” for Boston. Originality/value – The paper provides important information for those embarking on community health education projects and particularly in how to tailor health research methods to real-world timescales and stakeholder perspectives. Insights are also provided into community attitudes, understandings and behaviours towards healthy living in a part of the UK with a well-documented history of poor health.

Towards an understanding of fidelity within the context of school-based health education

Schools and schooling have long provided a tempting site for the delivery of public health strategies that address and promote young people’s current and future health. However, an emerging concern regarding the mobilisation of public health interventions within school settings has been the failure of school teachers to deliver such programs with fidelity. For educators, these notions of fidelity stand in stark contrast to the tenets of student-centred teaching. In seeking to explore these tensions further, this paper draws upon a collaborative health education project conducted with schools and teachers from Queensland, Australia. Findings from this project reveal the complexity associated with curriculum implementation in school settings, where diverse resources including timetable allocations and teacher expertise mitigate the achievement of program fidelity. In our efforts to explain the findings emerging from this project, we have drawn on the conceptual reference points of Basil Bernstein’s theory of the pedagogic device to reveal the predictable misalignment of the health and education sectors’ expected outcomes of school-based health initiatives. In conclusion, we argue that our exploration of issues pertaining to fidelity demonstrates the need for health and education sectors alike to conduct their work according to a clear articulation of the realistic, educative role that schools can play in promoting healthy living.

Improving immunisation timeliness in Aboriginal children through personalised calendars

BackgroundDelayed immunisation and vaccine preventable communicable disease remains a significant health issue in Aboriginal children. Strategies to increase immunisation coverage and timeliness can be resource intensive. In a low cost initiative at the Aboriginal Medical Service Western Sydney (AMSWS) in 2008–2009, a trial of personalised calendars to prompt timely childhood immunisation was undertaken.MethodsCalendars were generated during attendances for early childhood immunisations. They were designed for display in the home and included the due date of the next immunisation, a photo of the child and Aboriginal artwork. In a retrospective cohort design, Australian Childhood Immunisation Register data from AMSWS and non-AMSWS providers were used to determine the delay in immunisation and percentage of immunisations on time in those who received a calendar compared to those who did not. Interviews were undertaken with carers and staff.ResultsData on 2142 immunisation doses given to 505 children were analysed, utilising pre-intervention (2005–2007) and intervention (2008–2009) periods and a 2 year post-intervention observation period. 113 calendars were distributed (30% of eligible immunisation attendances). Improvements in timeliness were seen at each schedule point for those children who received a calendar. The average delay in those who received a calendar at their previous visit was 0.6 months (95% CI -0.8 to 2.6) after the due date, compared to 3.3 months (95% CI −0.6 to 7.5) in those who did not. 80% of doses were on time in the group who received a calendar at the preceding immunisation, 66% were on time for those who received a calendar at an earlier point and 57% of doses were on time for those who did not receive a calendar (P<0.0001, Cochran-Armitage trend test). Interview data further supported the value and effectiveness of the calendars as both a prompt to timely immunisations and a community health education project without undue resource implications.ConclusionsPersonalised calendars can increase the timeliness of immunisations in Aboriginal children. This simple, low cost tool appears practicable and effective in an Aboriginal community setting in improving early childhood vaccination timeliness and has high potential for local adaptation to suit the needs of diverse communities.

An Organizational Capacity-Building Program to Enhance Adolescent Sexual and Reproductive Health

To present a new practice for promoting sexual health among youth, and a pilot evaluation. The Afterschool Health and Sexuality Education Project is a capacity-building program that provides staff training, technical assistance, resource materials, and policy recommendations to create organizational change that facilitates staff members' abilities to promote sexual and reproductive health for adolescents. The evaluation included assessment of (a) sexual health educational materials, resources, and referral lists; (b) organizational policies that guide provision of sexual information and referrals; and (c) communication about sexual health. Data were collected prior to intervention, 7 months later, and 1 year later using anonymous surveys of staff and adolescents, and researcher observations. Results indicate that organizational support for addressing youth sexual health increased as did communication between staff and youth, with decreased barriers. Most, but not all, improvements were maintained at the 1-year follow-up. Organizational policies that support youth sexual health and the availability of educational materials, resources such as condoms, and referral lists also increased and were maintained at follow-up. Organizational systems change may create a broader, more sustainable environment for increasing communication between youth and adults and increasing resources to promote sexual health.

Enhancing a Safe Water Intervention with Student-Created Visual AIDS to Promote Handwashing Behavior in Kenyan Primary Schools

The Nyando Integrated Child Health Education (NICHE) project was a collaborative effort by the U.S. Centers for Disease Control and local partners to assess the effectiveness of multiple interventions for improving child survival in western Kenya. To increase handwashing in schools, NICHE trained teachers and installed handwashing stations with treated water and soap in 51 primary schools. This cluster-randomized trial evaluated an additional educational strategy (a poster contest themed, "Handwashing with Soap") to improve handwashing behavior in 23 NICHE primary schools. Pupils were engaged in the poster development. Pupil handwashing behavior was observed unobtrusively at baseline and after four months. Intervention schools displayed a significant increase in the number of handwashing stations and proportion of teacher-supervised stations over the study period. No significant between-group differences of intervention in handwashing frequency, soap availability, or visibility of handwashing stations was observed. Despite finding a limited effect beyond the NICHE intervention, the trial appeared to promote sustainability across some measures.

"King archie, who was quite grouchy" - a vocal dysphonia health education project

PURPOSE: one major cause of dysphonia can be linked to the presence of vocal folds nodules - a condition commonly seen in children due to vocal misuse and/or vocal abuse. The present health education project, also directed to parents and educators, aims at making children (the project's chief target-population) aware of how to make a correct use of their voice. METHOD: the target population includes parents, educators and children from both sexes and aged between five and eight years old. RESULT: a health education initiative was developed, which main instrument consists in a children's literature book, supplemented by an interactive CD. The instrument relies on a simple and easy-to-follow story where the issue of child dysphonia is addressed. CONCLUSIONS: the developed health education instrument is substantial for its chief target-population; it works as a suitable vehicle for promoting, in children, access, sensibility and awareness regarding aspects of one's voice one should be attentive to.

Pain and Depression in a Cohort of Underserved, Community-Dwelling Primary Care Patients

Almost 17% of the US population exhibits a major depressive disorder in their lifetimes. Prevalence data show that whites experience depression earlier than African Americans, and women have a higher prevalence than men. Less is known regarding depression among underserved minority populations. The goal of our study was to examine the relationship of depression and associated self-reported conditions in participants enrolled in a community-based research registry, a substantial number of whom were underrepresented minorities. This study used a research registry of community members who had expressed interest in participating in health education projects conducted by the Center for Primary Care Community-Based Research. The patients received care at 10 family health centers. Participants were surveyed regarding family history of depression/anxiety and associated symptoms. Descriptive analyses, univariate analyses, and logistic regressions were used. The population (N = 2421) included women (72.2%), African Americans (54.9%), and reported good or very good general health (68.9%). Comorbid pain was found, with headache as the predominant complaint. Compared with nonwhites, whites had a significantly higher prevalence of current depression (26.3% vs. 23.8%; P = .01), current anxiety (25.5% vs. 16.6%), and current headache (14.2% vs. 11.2%). Whites also had a higher prevalence of a family history of depression (38.4% vs. 32.1%) and anxiety (8.9% vs. 7.7%) and of taking depression (22.4% vs. 14.8%) and anxiety (15.8% vs. 7.8%) medications. However, nonwhites had a higher prevalence of leg pain (18.8% vs. 14.9%) but a lower prevalence of headache (11.2% vs. 14.2%). Pain was common in patients with comorbid behavioral conditions. Headache was more common in whites, whereas leg pain was more common in nonwhites. Physicians should screen for depression and anxiety in patients with headache and other pain symptoms.

Comunicação em saúde na atenção terciária: estudo exploratório sobre a informação retida pelo paciente

This study aims to evaluate patient’s knowledge about his disease and therapy after six months of outpatient follow-up, with health education activities in an extension project. The delineation was longitudinal and experimental. At each monthly visit by the patient to the ambulatory, students provided, recurrently, the information about his chronic disease, as well as its treatment, applying a health educational process during appointments and individually. When conducting the survey, a standard questionnaire was used in order to evaluate the information retained by patient, applied when assistance begun (in the service) and six months after health education project implementation. There was expansion of information about diagnosis (was extended), which were congruent with reality, as well as about used (the) medications (in use). 33.3% of those who reported knowledge of used drugs’ name at the beginning of follow up, turn out 65,5%. 12.5% of those aware of drugs’ side effects have become 41,7%. One may conclude that, in the short term, the benefits of the Continuum Extension Project have increased the information obtained by patients. More than drawing conclusions, this study raises the issue regarding the need of embracing educational actions programs, focused on the patient, (with the aim of) aiming at increasing his knowledge about his own treatment and, consequently, the possibilities of therapy adherence.

Comunicação em saúde na atenção terciária: estudo exploratório sobre a informação retida pelo paciente

This study aims to evaluate patient’s knowledge about his disease and therapy after six months of outpatient follow-up, with health education activities in an extension project. The delineation was longitudinal and experimental. At each monthly visit by the patient to the ambulatory, students provided, recurrently, the information about his chronic disease, as well as its treatment, applying a health educational process during appointments and individually. When conducting the survey, a standard questionnaire was used in order to evaluate the information retained by patient, applied when assistance begun (in the service) and six months after health education project implementation. There was expansion of information about diagnosis (was extended), which were congruent with reality, as well as about used (the) medications (in use). 33.3% of those who reported knowledge of used drugs’ name at the beginning of follow up, turn out 65,5%. 12.5% of those aware of drugs’ side effects have become 41,7%. One may conclude that, in the short term, the benefits of the Continuum Extension Project have increased the information obtained by patients. More than drawing conclusions, this study raises the issue regarding the need of embracing educational actions programs, focused on the patient, (with the aim of) aiming at increasing his knowledge about his own treatment and, consequently, the possibilities of therapy adherence.

Actualizing a Provider Alliance to Expand Health Services Access to a Low-Income Urban Community

Social change to facilitate health care access for vulnerable populations sometimes involves model-driven innovative structures and innovative planning and implementation approaches. This paper described and analyzed the rationale, conceptual framework, program components, and implementation of the South Central Health Care Alliance (SCHCA) implemented in South Los Angeles from January 2002 to December 2004. The program development and implementation was guided by an integrated framework linking the Open Systems Theory, the Social Cognitive Theory, the Health Belief Model, and the Preventive Health Education and Medical Home Project. The performance of the SCHCA as a social system, partnership, and participatory implementation program is also presented. While the SCHCA was found to be a dynamic social system that responded well to contingencies, its performance as a partnership and participatory implementation program was wanting in many respects.

Sex and the Capital City: The Political Framing of Syphilis and Prostitution in Early Republican Ankara

In its initial years, the nascent Turkish republic established the Ministry of Health and Social Assistance in order to promote public health. Beyond simply facilitating its modernizing agenda for the emergent nation-state as it sought to define itself against an Ottoman past, this institution was also geared toward remedying a self-defined population crisis by prioritizing and confronting particular diseases and health conditions. One of the maladies of utmost concern was syphilis. Based upon an analysis of official primary sources, this article engages with how the developing republic distinguished and consequently politically constructed-or framed-the syphilis problem from the vantage of its new forward capital, Ankara. Integral to this project of confronting this sexually transmitted disease, public health officials projected upon both this ailment and their understanding of the suitable means for its treatment their own views of what constituted appropriate sexual practices and relations. In doing so, certain subgroups of the population, especially prostitutes, were particularized as targets for surveillance and policing through regimes of licensing and compulsory medical examinations. Stemming from the state's framing of the disease-and its definition of appropriate sexual practices-this article also examines the subsequent legislative and public health education projects that followed.

Impact of a women's counselling programme on combined hormonal contraception in Portugal – The IMAGINE Study

ABSTRACTBackground The aim of this health education project was to measure the impact of counselling about combined hormonal contraceptive (CHC) methods on the subsequent choice of method by Portuguese women.Method This was a multi-centre study with a representative population, at the national and regional levels, of 2951 Portuguese women ≥ 16 years of age visiting the gynaecologist. Counselling on available CHC methods was provided using a single leaflet, and their CHC choice was assessed before and after counselling.Results A combined oral contraceptive (COC) was the method preferred by the majority of the women prior to counselling. After counselling, 35% of women who initially had chosen the pill, switched to either the vaginal ring or the transdermal patch, and the difference was statistically significant. Ease of use was the major reason for choosing the COC, while a lower probability of omission was the reason for choosing the vaginal ring and the patch.Conclusions The implementation of a counselling programme significantly affected contraceptive choices leading in a number of cases to the selection of alternatives better suited to women's lifestyle. Age and educational level are socio-demographic factors which play an important role.