To see if a multimedia instructional tool intervention, relative to standard care, will increase the usage of long-acting reversible contraception (LARC) at 12 weeks postpartum in high-risk pregnancies. Individuals aged 13–50 with high-risk pregnancies were randomly allocated to either a multimedia instructional tool or regular treatment in this single-center randomized experiment. Participants were enrolled from the first day of pregnancy till the first day of postpartum. Those assigned to the multimedia educational tool (MET) group received a tablet with a preloaded 3–5-minute multimedia presentation, which was watched without the presence of research personnel and resent by secure email every 4 weeks if not received. The major goal was for LARC (implant or intrauterine device) use to begin within 12 weeks following birth. Secondary outcomes were overall contraceptive usage and a composite of maternal and neonatal adverse outcomes. According to a priori calculations, 380 individuals were required to detect a 40% difference in LARC usage (baseline 40%; alpha=0.05, power=0.8, assuming a loss to follow-up of 20%). The relative risk (RR) and number needed to treat (NNT) were determined, as well as the 95% CIs.
From July 2020 to December 2020, 536 people were screened and 380 were randomly assigned to one of two groups: 190 were assigned to the multimedia instructional tool and 190 were assigned to normal care. The groups’ demographic features were comparable. The primary result was greater in the MET group (32.4%) than in the RC group (20.9%) (RR 1.55; 95% CI 1.09–2.21; NNT 9, with 95% CI 5–42). Overall, the MET group used more contraception than the RC group (RR 1.16; 95% CI 1.03–1.32). When compared to usual treatment, implementation of a multimedia-based instructional tool improved postpartum LARC uptake by 55% among women with high-risk pregnancies.
