Family planning patients' knowledge of OCP package insert information

In family planning clinics (FPC) oral contraceptive pills (OCP) are the leading method of birth control. The OCP patient package insert (PP1) may be the only patient education women receive about OCP use. PURPOSE: This study investigated the relationship between literacy and women's knowledge and beliefs about information in OCP PPI. METHODS: 200 patients in an FPC in Shreveport. LA who were prescribed OCPs were interviewed; 84% were AA; 41% were nulliparous; 76% had used OCPs in the past. All new OCP users (n=47) had completed a contraception class. Literacy was assessed using the REALM. Knowledge and attitudes about the PPI were assessed using a questionnaire developed by the investigators. RESULTS: The OCP PPI was written on a 10^th-grade reading level. Most patients (81%) reported having completed high school, but only half (52%) were reading a 9^th grade level. 80% of patients reported having read the PPI. and 90% felt it was fairly easy to read; yet. only 14% said the most useful information about OCPs came from the PPI. 99% reported a health care provider had explained OCP use, including missed-pill instructions, and 98% of the patients believed they had enough knowledge to take OCPs correctly. Knowledge of one-step instructions was high with almost all (98%) knowing what day to begin taking pills, and 94% knowing what to do for one missed-pill. However, knowledge requiring two or more steps was surprisingly low with 20% of patients, regardless of literacy level, knowing what to do for two missed-pills, and only 1% knowing what to do for three missed-pills. Most patients knew to use a condom after missing two and three pills (86% and 95%, respectively), but only half (54% and 51%) knew condoms should be used a minimum of seven days. Correct knowledge of duration of condom use was significantly related to literacy (p < .01). CONCLUSIONS: OCP PPIs are written on a level that is appropriate for most public health patients' education level, but not their reading level. Most patients felt they had sufficient knowledge for correct OCP use, and simple, one-step instructions were almost universally understood. However, instructions that were more complex and multi-step were almost universally misunderstood. Therefore, instructional materials need to be simple, concrete and have a limited number of steps.