Evaluating information on oral contraceptive use: a randomized controlled trial to assess missed pill instructions.

BACKGROUND Instructions for what women should do when they miss oral contraceptive pills are complex and vary according to the quantity and the timing of missed pills. METHODS A randomized controlled trial was conducted to assess the comprehensibility of four types of instructions rendered in both 21- and 28-day versions, as well as in graphic and text formats. Interviews were conducted with 864 current and past pill users in Kingston, Jamaica. Each was provided with scenarios of missed pills and one version of the instructions; they were then asked what they should do to avoid pregnancy. RESULTS More than 60% of respondents knew what to do when one pill was missed, but most did not give correct answers for missing two or more pills in a row, regardless of the instruction type. CONCLUSION Women generally do a poor job of identifying steps to take when multiple pills are missed. Graphic instructions are easier to understand than text-only instructions and less information is better. Findings suggest that rendering missed pill instructions in graphic format while scaling back on the breadth of medical information results in better comprehension.