Randomized Controlled Trial of a Tubal Sterilization Decision Aid Among Medicaid Enrollees: Effects on Intended...

Tubal sterilization is a permanent contraceptive method, yet misconceptions about its permanence are prevalent, and its history is marked by both coercion and barriers to access-particularly among Medicaid enrollees. Decision aids may help to support more informed, value-concordant decision-making.

From March 2020 to November 2023, English- and Spanish-speaking pregnant Medicaid enrollees at less than 24 weeks' gestation were randomized to either receive or not receive a novel web-based tubal sterilization decision aid. Participants completed surveys after randomization (control group) and after the decision aid (intervention group) at time point 1 (T1), in the third trimester (T2), and at 3 months postpartum (T3). Positive impacts of the decision aid on the primary outcomes of tubal sterilization knowledge and decisional conflict were previously reported. Secondary outcomes analyzed were intended contraceptive method at T1 (sterilization vs. other/no method) and satisfaction with the contraceptive decision-making process at T3.

We included 350 pregnant Medicaid enrollees who completed surveys at T1, 301 who completed them at T2, and 286 who completed them at T3. There were no statistically significant differences between the decision aid and control groups in the intention to use tubal sterilization (55.6% vs. 61.24%; p = .238) or optimal contraceptive decision-making satisfaction (59.2% vs. 54.9%; p = .406).

Although the decision aid was previously shown to improve sterilization decision quality, it did not appear to influence intended contraceptive method immediately after use of the tool during pregnancy or satisfaction with contraceptive decision-making.