Association of willingness to use hormonal contraception with knowledge: A national survey

To determine if willingness to use and concern with using hormonal contraception (HC) is associated with knowledge about HC.

We conducted an online cross-sectional survey of self-identified women, US residents 18 and older using Amazon Mechanical Turk and ResearchMatch.org. Primary outcome was HC knowledge level, with participants categorized into binary knowledge level variable based on accuracy of responses to seven statements about HC (e.g. HC causes infertility, HC decreases acne). We assessed participant willingness and concern with using HC, including the primary type of concern with HC (physical, emotional, complications, other). We used bivariate tests and a multivariable logistic regression model to test the association of willingness and concern about HC to knowledge level.

Of 1041 respondents ages 18-81, 18% had no concerns and were willing to use HC, 64% had some concerns but were willing to use HC, and 18% had concerns and were not willing to use HC. Respondents who had concerns but were still willing to use HC were less likely to be concerned about complications than those who were unwilling (31.0% vs. 43.7%; p < 0.001). The median number of correct responses to knowledge statements was three (IQR 2-5) and 94.8% of participants answered at least one statement incorrectly. After controlling for age, current form of contraception, education, rurality, census region, political, and religious beliefs, participants who were willing to use HC without concerns (aOR=4.32; 95% CI: 2.45-7.62) and those who were willing but had concerns (aOR=2.11; 95% CI: 1.35-3.30) was associated with being more knowledgeable as compared to those not willing to use HC (reference).

Women willing to use HC are more likely to be more knowledgeable about HC. More than 80% of women report concerns with HC.

Patients unwilling to use HC are more likely to have knowledge gaps in their understanding of HC side effects and risk of complications. For shared decision-making, providers should specifically address the facts and myths surrounding HC to ensure patients are making informed decisions about their reproductive health.