Implementing Structured Contraception Counseling to Increase the Contraception Knowledge of Women of Childbearing Age Seen in a Private Obstetrics and Gynecology Clinic: A Quality Improvement Project

Abstract

This is an evidence-based project that is aimed implementing a structured contraceptive counseling at our clinical setting. The number of unintended pregnancies that have been reported at our clinic have been on the rise lately, and this is a great concern since it puts pressure on the women and their families. We have analyzed several studies and they all point to the fact that structured contraceptive counseling is beneficial to the providers and to the clients. By using structured contraceptive counseling, it is possible to increase the knowledge of women on contraceptive, which is currently lacking within our clinical setting. The contraceptive counseling being conducted at out clinic is not structured and some of the providers tend to forget what they taught the client, which results in the client not receiving the appropriate information. Having a structured contraceptive counseling has been shown to be more effective and offers the client an opportunity to ask questions and seek clarification for what they did not understand. This paper is aims to demonstrate the efficacy of using a structured contraceptive counseling method and the benefits that will be gained from using such a method. As shown in our literature review, there are numerous methods that a clinic can adopt that are all aimed at implementing a structured education method. We have made recommendations based on our analysis and we recommend that the clinic implement audio-visual and shared decision-making methods.

Section One: Introduction and Overview of the Problem

A wide variety of contraceptive methods are available in the United states for women to select in order to prevent or reduce the number of unwanted pregnancies. However, the number of unintended pregnancy rates have remained high and it is estimated that approximately 49% of pregnancies within a year are unintended. The number of unintended pregnancies is most high amongst women who are aged <25 years (Abdel-Tawab & Roter, 2002; Zapata et al., 2015). The high frequency of unintended pregnancy places a huge burden on the women, their families, and the healthcare system. It is also indicated that unintended pregnancy is experienced disproportionately amongst women from ethnic and racial minority groups, and women of lower socioeconomic statuses, which could be a contributor to their cycle of disadvantage. There is knowledge that some contraceptive methods are more effective than others, and the choice of method could be a contributor to unintended pregnancies (Zapata et al., 2015). There has been a slight reduction in the number of unintended pregnancies as was demonstrated in an analysis carried out in 2001 (Abdel-Tawab & Roter, 2002). The number of unintended pregnancies in 2001 was 48% (approximately 1.5 million pregnancies) and all occurred in a month that women reported to have been using contraception. This was in comparison to 51% in 1994 (Zapata et al., 2015).

The high frequency of unintended pregnancy is mainly associated with nonuse of contraceptive methods, incorrect and inconsistent use of methods, and use of less effective methods. The disparities in unintended pregnancy are also contributed to by racial and ethnic differences in the use of contraceptive methods. The lack of knowledge and failure to understand or remember what has been taught regarding contraceptive usage is also a contributor of unintended pregnancy. The increase in unintended pregnancy rates results in an increase in the terminations rates, which currently stand at 47% at the clinic (Zapata et al., 2015). The number of women who present to their healthcare providers with unintended pregnancies has continued to be high (Abdel-Tawab & Roter, 2002). A majority of the women state that if they had known more about contraceptives they would have prevented the pregnancy. Many of the women have indicated they would have used a contraceptive method if they had the information (Dehlendorf, Kimport, Levy, & Steinauer, 2014). However, the information that most women receive form their healthcare providers in regards to contraceptives is insufficient and inconsistent. The impact that the information has on a woman's choice of contraception is determined by age, preference, and recommendation by the healthcare provider (Culwell & Adams Hillard, 2008). It has been noted that a majority of the contraceptive methods that women choose is influenced by provider counseling. Therefore, there is evidence that most women are listening to the advice they receive from their providers, but they must be finding it hard to recall what the provider advised or taught them on the contraceptive method. Without proper information women are left to figure contraceptives out for themselves and this results in usage problems as reported by the women who visit the clinic.

At the Obstetrics (OB) and gynecology (GYN) clinic there are four healthcare providers who provide their own versions of contraceptive education and counseling. There is no standard method that is employed for delivery of education. Without a standardized method of contraceptive education delivery, there are some conflicting information that could be confusing the women who visit the clinic. Some the providers have a preference to a particular type of contraceptive (Dehlendorf, Kimport, et al., 2014), which they will advocate for irrespective of the desires of the women. This could result in failure by the women to follow the guidelines for using the contraceptive since they feel they do not like or understand the method. Contraceptive method selection should be done with the client and after they have understood the different methods available. Education should be targeted to instill knowledge and not just to push for a particular method (Dehlendorf, Levy, Kelley, Grumbach, & Steinauer, 2013). If there could be a standardized method of delivering education, the four healthcare providers would be offering the same information to the women and this would increase the retention rate for the information being taught. With diverse information being provided the women get confused and they end up not understanding or remembering how and when to use contraceptives.

It is for this reason that we are seeking to implement a method for contraceptive education that will assist in preventing the negative patient outcomes that are being experienced at the clinic. The method to be implemented will provide an effective method for increasing the patients contraceptive knowledge in the hopes that the education will increase their usage of contraceptives (Dehlendorf et al., 2013). With a better approach to contraceptive education patients will be more comfortable and there might be interactive sessions so that the patients can ask questions (Culwell & Adams Hillard, 2008). This would reinforce the education and they are likely to remember what they learn and apply the knowledge to reduce cases of unintended pregnancies.

Reducing the rates of unintended pregnancies due to a lack of knowledge regarding the use of contraceptive is what we intend to reduce with this project. Delivering contraceptive education in a manner that is suitable for the women who visit the clinic and ensuring that the four healthcare providers are offering the same education in the prescribed manner will definitely have a positive outcome on the population served by the clinic. Any reduction in the rates of unintended pregnancies is beneficial not only for the clinic, but also for the women (Culwell & Adams Hillard, 2008; Dehlendorf, Tharayil, et al., 2014). The project aims to implement a structured education system that will be used for the delivery of contraceptive education. Using the structurd education method will allow the healthcare providers to better disseminate information and there will be uniformity of the information being delivered to the patients (Moos, Bartholomew, & Lohr, 2003). Offering advice and recommendations that are backed with evidence, will be vital and helpful to the patients since the proposed contraceptive method would be suitable and in line with the patient's need or desire.

In 2016, the clinic reported 76 out of 1,000 women had an unintended pregnancy. This is 30% higher than the national average for the country. Seeing at how high the figure is, there is need to look for interventions that will assist in reducing the numbers. It has been earlier established that contraceptive counseling can be quite effective in reducing the rate of unintended pregnancy. However, even after the clinic adopted a contraceptive counseling the rates have not reduced as expected. It has been discovered that there is further need to have structured education on contraceptive. This would ensure that the healthcare providers follow the same procedures and educate the patients using the same methods. A majority of the patients who visit the clinic with unintended pregnancy have stated they were not aware of contraceptives and the ones who were aware seemed to have misunderstood the instructions. In order for contraceptive to be effective, there is need to use the contraceptive as expected or as recommended for it to be effective. Therefore, for the clinic to reduce the rate of unintended pregnancy it should adopt the strategies being proposed and have identical knowledge being given to the patients by the providers.

Our PICOT question is "What methods of contraceptive counseling are shown to improve patients retention of contraceptive knowledge." It is our intention to increase the retention capability of the patients and we need to establish the best methods that we could employ. Analyzing what other researchers have noted to be effective in retention of knowledge will enable us to come up with strategies that we can implement in our setting and have a change in practice that is backed by evidence. Our target is to change the current practice where the different healthcare providers offer contraceptive education that is not structured and some of them do not recall what they recommended or suggested to a patient. Having a structured way of delivering education to the patients will ensure that one can be certain they have passed on the requisite information and they have checked to ensure that the patient understands what they have been taught or advised. Inconsistency of teaching means that some information may be omitted unintentionally if the healthcare provider fails to recall the information.

In conclusion, it is vital that the rates of unintended pregnancies be reduced, which would be beneficial to the women served by the clinic. Providing the women with accurate information regarding contraception will result in positive outcomes for the clinic and will reduce the rate of unintended pregnancies. The lack of knowledge has been identified as the main cause of the high rates, and considering that the clinic offers educational programs for the women then there is need to ensure that the information passed is well understood and adhered to by the women (Dehlendorf, Tharayil, et al., 2014; Moos et al., 2003). The best way is to increase the retention rate for the women. We aim to have a structured method for ensuring that the healthcare providers are able to deliver the same information to the patients, without having left out some information.

Section Two: Review of Literature/Synthesis of Literature

In order to identify the appropriate literature, we made use of numerous search strategies all aimed at answering our PICOT question. To maximize the likelihood of obtaining a coherent body of evidence, especially in relation to structured education on contraceptive methods, we only included articles that made use of data that was collected after 2009. Our search strategies were aimed at identifying all research covering structured contraceptive counseling approaches in clinical settings targeted towards improving knowledge and retention of the knowledge. We carried out our search using these four database search engines Ovid SP, PubMed, CINAHL, and Cochrane Library. Initially, we started by searching for contraceptive counseling aimed at increasing knowledge retention amongst women, but we found there were many irrelevant or redundant results. The searches resulted in a large number of articles discussing mostly the prevalence of unintended pregnancies and high rates of abortion. This was not the focus of our review. Eventually we decided to narrow down and search using the phrase structured contraceptive counseling. This narrowed down the results and we were able to select the required 5 articles for conducting our literature review. Not all the databases contained the relevant articles that we were seeking, but by making a combination of the four we were able to narrow down and identify the most appropriate articles for supporting our DNP project. With an aim of improving quality within our clinical setting, it was vital that we seek data and information from relevant and appropriate articles that demonstrate the importance of using different strategies for conducting contraceptive education.

The titles and abstracts of the initially identified articles were analyzed in order determine the articles to include and the ones to exclude based on our eligibility criteria. Abstracts that suggested experimental and cohort designs, qualitative methodology, or cross-sectional data were advanced for full article review. However, even after this abstract review we found we had to drill down further and eliminate more articles in order have our agreed number of 5 articles. Therefore, there was need for further review of the abstracts and article to select only the final articles for usage.

Literature Review

Structured counseling is designed to prevent unintended pregnancy. Making use of a structure will allow the client to visualize and understand the information that is being presented in order for them to progress through the stages towards making an informed choice of contraceptive method. According to Farrokh?Eslamlou et al. (2014), structured counseling is standardized in that the client will receive tailored and well-structured information on the use, effectiveness, and side effects of contraceptive methods. This is supported by Dehlendorf, Krajewski, and Borrero (2014), who also posits that structured counseling has been shown to be more effective than normal contraceptive counseling. Communicating the side effects that a particular contraceptive method would have on the client will ensure that the client understands the risks and knows what might go wrong. Dehlendorf, Krajewski, et al. (2014) showed that 37% of the women who choose to use hormonal IUD were not aware that there is a likelihood of them experiencing irregular bleeding. This demonstrates that the women were not properly educated on the contraceptive method that they selected. However, if the women had undergone structured counseling they would have been able to know of the side effects of the contraceptive method and they might have opted to use a method they are more comfortable with (Dehlendorf, Tharayil, et al., 2014). Using structured counseling within a clinical setting will offer the clients an opportunity for them to interact with the healthcare provider. Asking questions is a key component for structured counseling. Allowing the clients to ask questions will ensure that they understand what they are learning and they can be better informed. Questions are a way for making clarification and this has been proven to be quite effective in increasing knowledge of the clients (Secura, Allsworth, Madden, Mullersman, & Peipert, 2010). They are more likely to remember what they have learnt when they are given the chance to ask questions. Using structured counseling is not ony beneficial to the client, but also for the healthcare providers. Providers who use a structured process they are more likely to provide complete information, promote compliance, and improve their performance by reducing guesswork. (Farrokh?Eslamlou et al., 2014)

Madden, Mullersman, Omvig, Secura, and Peipert (2013) also made use of structured contraceptive counseling. The difference in this study was that a majority of the research team members did not have any formal healthcare training. The study demonstrates that even non-healthcare providers can be effective in delivering contraceptive education if there is a structured method for delivering the education. The study participants were able to select from different contraceptive methods and they understood the methods they were selecting. This study supports what Farrokh?Eslamlou et al. (2014) posits that structured counseling is more effective in ensuring adherence and retention of knowledge amongst women as compared to other methods of contraceptive counseling. Both studies had a success rate of 89% when the providers made use of structured counseling.

Visual aids have been the most used educational methods for conducting contraceptive counseling sessions. Dehlendorf, Krajewski, et al. (2014) established that using audio-visual aids was more effective in increasing the understanding of women and knowledge retention as compared to using oral communication. Langston, Rosario, and Westhoff (2010) also established that there was increased usage of contraceptive and continuation of effective contraceptive methods when the clients are educated using audio-visual method. Making use of audio-visual training methods allows the client to both visualize and hear the information that is being presented (Hersh et al., 2017). Combining the two methods allows the client to better understand what they are being taught especially in regards to contraceptive methods and retention of the knowledge. Langston et al. (2010) indicates that 54% of the women who participated in their study were able to select an effective contraceptive method after they underwent the contraceptive education. Visual aids allow the healthcare provider to communicate the efficacy of contraceptive in a meaningful manner. Understanding the efficacy of contraceptive might not be the vital factor that drives method selection, but it has some impact on the method chosen by the client. There is no better way to communicate the side effects of a contraceptive…

Implementing Structured Contraception Counseling to Increase the Contraception Knowledge of Women of Childbearing Age Seen in a Private Obstetrics and Gynecology Clinic: A Quality Improvement Project

Abstract

This is an evidence-based project that is aimed implementing a structured contraceptive counseling at our clinical setting. The number of unintended pregnancies that have been reported at our clinic have been on the rise lately, and this is a great concern since it puts pressure on the women and their families. We have analyzed several studies and they all point to the fact that structured contraceptive counseling is beneficial to the providers and to the clients. By using structured contraceptive counseling, it is possible to increase the knowledge of women on contraceptive, which is currently lacking within our clinical setting. The contraceptive counseling being conducted at out clinic is not structured and some of the providers tend to forget what they taught the client, which results in the client not receiving the appropriate information. Having a structured contraceptive counseling has been shown to be more effective and offers the client an opportunity to ask questions and seek clarification for what they did not understand. This paper is aims to demonstrate the efficacy of using a structured contraceptive counseling method and the benefits that will be gained from using such a method. As shown in our literature review, there are numerous methods that a clinic can adopt that are all aimed at implementing a structured education method. We have made recommendations based on our analysis and we recommend that the clinic implement audio-visual and shared decision-making methods.

Section One: Introduction and Overview of the Problem

A wide variety of contraceptive methods are available in the United states for women to select in order to prevent or reduce the number of unwanted pregnancies. However, the number of unintended pregnancy rates have remained high and it is estimated that approximately 49% of pregnancies within a year are unintended. The number of unintended pregnancies is most high amongst women who are aged <25 years (Abdel-Tawab & Roter, 2002; Zapata et al., 2015). The high frequency of unintended pregnancy places a huge burden on the women, their families, and the healthcare system. It is also indicated that unintended pregnancy is experienced disproportionately amongst women from ethnic and racial minority groups, and women of lower socioeconomic statuses, which could be a contributor to their cycle of disadvantage. There is knowledge that some contraceptive methods are more effective than others, and the choice of method could be a contributor to unintended pregnancies (Zapata et al., 2015). There has been a slight reduction in the number of unintended pregnancies as was demonstrated in an analysis carried out in 2001 (Abdel-Tawab & Roter, 2002). The number of unintended pregnancies in 2001 was 48% (approximately 1.5 million pregnancies) and all occurred in a month that women reported to have been using contraception. This was in comparison to 51% in 1994 (Zapata et al., 2015).

The high frequency of unintended pregnancy is mainly associated with nonuse of contraceptive methods, incorrect and inconsistent use of methods, and use of less effective methods. The disparities in unintended pregnancy are also contributed to by racial and ethnic differences in the use of contraceptive methods. The lack of knowledge and failure to understand or remember what has been taught regarding contraceptive usage is also a contributor of unintended pregnancy. The increase in unintended pregnancy rates results in an increase in the terminations rates, which currently stand at 47% at the clinic (Zapata et al., 2015). The number of women who present to their healthcare providers with unintended pregnancies has continued to be high (Abdel-Tawab & Roter, 2002). A majority of the women state that if they had known more about contraceptives they would have prevented the pregnancy. Many of the women have indicated they would have used a contraceptive method if they had the information (Dehlendorf, Kimport, Levy, & Steinauer, 2014). However, the information that most women receive form their healthcare providers in regards to contraceptives is insufficient and inconsistent. The impact that the information has on a woman's choice of contraception is determined by age, preference, and recommendation by the healthcare provider (Culwell & Adams Hillard, 2008). It has been noted that a majority of the contraceptive methods that women choose is influenced by provider counseling. Therefore, there is evidence that most women are listening to the advice they receive from their providers, but they must be finding it hard to recall what the provider advised or taught them on the contraceptive method. Without proper information women are left to figure contraceptives out for themselves and this results in usage problems as reported by the women who visit the clinic.

At the Obstetrics (OB) and gynecology (GYN) clinic there are four healthcare providers who provide their own versions of contraceptive education and counseling. There is no standard method that is employed for delivery of education. Without a standardized method of contraceptive education delivery, there are some conflicting information that could be confusing the women who visit the clinic. Some the providers have a preference to a particular type of contraceptive (Dehlendorf, Kimport, et al., 2014), which they will advocate for irrespective of the desires of the women. This could result in failure by the women to follow the guidelines for using the contraceptive since they feel they do not like or understand the method. Contraceptive method selection should be done with the client and after they have understood the different methods available. Education should be targeted to instill knowledge and not just to push for a particular method (Dehlendorf, Levy, Kelley, Grumbach, & Steinauer, 2013). If there could be a standardized method of delivering education, the four healthcare providers would be offering the same information to the women and this would increase the retention rate for the information being taught. With diverse information being provided the women get confused and they end up not understanding or remembering how and when to use contraceptives.

It is for this reason that we are seeking to implement a method for contraceptive education that will assist in preventing the negative patient outcomes that are being experienced at the clinic. The method to be implemented will provide an effective method for increasing the patients contraceptive knowledge in the hopes that the education will increase their usage of contraceptives (Dehlendorf et al., 2013). With a better approach to contraceptive education patients will be more comfortable and there might be interactive sessions so that the patients can ask questions (Culwell & Adams Hillard, 2008). This would reinforce the education and they are likely to remember what they learn and apply the knowledge to reduce cases of unintended pregnancies.

Reducing the rates of unintended pregnancies due to a lack of knowledge regarding the use of contraceptive is what we intend to reduce with this project. Delivering contraceptive education in a manner that is suitable for the women who visit the clinic and ensuring that the four healthcare providers are offering the same education in the prescribed manner will definitely have a positive outcome on the population served by the clinic. Any reduction in the rates of unintended pregnancies is beneficial not only for the clinic, but also for the women (Culwell & Adams Hillard, 2008; Dehlendorf, Tharayil, et al., 2014). The project aims to implement a structured education system that will be used for the delivery of contraceptive education. Using the structured education method will allow the healthcare providers to better disseminate information and there will be uniformity of the information being delivered to the patients (Moos, Bartholomew, & Lohr, 2003). Offering advice and recommendations that are backed with evidence, will be vital and helpful to the patients since the proposed contraceptive method would be suitable and in line with the patient's need or desire.

In 2016, the clinic reported 76 out of 1,000 women had an unintended pregnancy. This is 30% higher than the national average for the country. Seeing at how high the figure is, there is need to look for interventions that will assist in reducing the numbers. It has been earlier established that contraceptive counseling can be quite effective in reducing the rate of unintended pregnancy. However, even after the clinic adopted a contraceptive counseling the rates have not reduced as expected. It has been discovered that there is further need to have structured education on contraceptive. This would ensure that the healthcare providers follow the same procedures and educate the patients using the same methods. A majority of the patients who visit the clinic with unintended pregnancy have stated they were not aware of contraceptives and the…

Implementing Structured Contraception Counseling to Increase the Contraception Knowledge of Women of Childbearing Age Seen in a Private Obstetrics and Gynecology Clinic: A Quality Improvement Project

Abstract

This is an evidence-based project that is aimed implementing a structured contraceptive counseling at our clinical setting. The number of unintended pregnancies that have been reported at our clinic have been on the rise lately, and this is a great concern since it puts pressure on the women and their families. We have analyzed several studies and they all point to the fact that structured contraceptive counseling is beneficial to the providers and to the clients. By using structured contraceptive counseling, it is possible to increase the knowledge of women on contraceptive, which is currently lacking within our clinical setting. The contraceptive counseling being conducted at out clinic is not structured and some of the providers tend to forget what they taught the client, which results in the client not receiving the appropriate information. Having a structured contraceptive counseling has been shown to be more effective and offers the client an opportunity to ask questions and seek clarification for what they did not understand. This paper is aims to demonstrate the efficacy of using a structured contraceptive counseling method and the benefits that will be gained from using such a method. As shown in our literature review, there are numerous methods that a clinic can adopt that are all aimed at implementing a structured education method. We have made recommendations based on our analysis and we recommend that the clinic implement audio-visual and shared decision-making methods.

Section One: Introduction and Overview of the Problem

A wide variety of contraceptive methods are available in the United states for women to select in order to prevent or reduce the number of unwanted pregnancies. However, the number of unintended pregnancy rates have remained high and it is estimated that approximately 49% of pregnancies within a year are unintended. The number of unintended pregnancies is most high amongst women who are aged <25 years (Abdel-Tawab & Roter, 2002; Zapata et al., 2015). The high frequency of unintended pregnancy places a huge burden on the women, their families, and the healthcare system. It is also indicated that unintended pregnancy is experienced disproportionately amongst women from ethnic and racial minority groups, and women of lower socioeconomic statuses, which could be a contributor to their cycle of disadvantage. There is knowledge that some contraceptive methods are more effective than others, and the choice of method could be a contributor to unintended pregnancies (Zapata et al., 2015). There has been a slight reduction in the number of unintended pregnancies as was dem.......regnancies in 2001 was 48% (approximately 1.5 million pregnancies) and all occurred in a month that women reported to have been using contraception. This was in comparison to 51% in 1994 (Zapata et al., 2015).

The high frequency of unintended pregnancy is mainly associated with nonuse of contraceptive methods, incorrect and inconsistent use of methods, and use of less effective methods. The disparities in unintended pregnancy are also contributed to by racial and ethnic differences in the use of contraceptive methods. The lack of knowledge and failure to understand or remember what has been taught regarding contraceptive usage is also a contributor of unintended pregnancy. The increase in unintended pregnancy rates results in an increase in the terminations rates, which currently stand at 47% at the clinic (Zapata et al., 2015). The number of women who present to their healthcare providers with unintended pregnancies has continued to be high (Abdel-Tawab & Roter, 2002). A majority of the women state that if they had known more about contraceptives they would have prevented the pregnancy. Many of the women have indicated they would have used a contraceptive method if they had the information (Dehlendorf, Kimport, Levy, & Steinauer, 2014). However, the information that most women receive form their healthcare providers in regards to contraceptives is insufficient and inconsistent. The impact that the information has on a woman's choice of contraception is determined by age, preference, and recommendation by the healthcare provider (Cuwell & Adams Hillard, 2008). It has been noted that a majority of the contraceptive methods that women choose is influenced by provider counseling. Therefore, there is evidence that most women are listening to the advice they receive from their providers, but they must be finding it hard to recall what the provider advised or taught them on the contraceptive method. Without proper information women are left to figure contraceptives out for themselves and this results in usage problems as reported by the women who visit the clinic.

At the Obstetrics (OB) and gynecology (GYN) clinic there are four healthcare providers who provide their own versions of contraceptive education and counseling. There is no standard method that is employed for delivery of education. Without a standardized method of contraceptive education delivery, there are some conflicting information that could be confusing the women who visit the clinic. Some the providers have a preference to a particular type of contraceptive (Dehlendorf, Kimport, et al., 2014), which they will advocate for irrespective of the desires of the women. This could result in failure by the women to follow the guidelines for using the contraceptive since they feel they do not like or understand the method. Contraceptive method selection should be done with the client and after they have understood the different methods available. Education should be targeted to instill knowledge and not just to push for a particular method (Dehlendorf, Levy, Kelley, Grumbach, & Steinauer, 2013). If there could be a standardized method of delivering education, the four healthcare providers would be offering the same information to the women and this would increase the retention rate for the information being taught. With diverse information being provided the women get confused and they end up not understanding or remembering how and when to use contraceptives.

It is for this reason that we are seeking to implement a method for contraceptive education that will assist in preventing the negative patient outcomes that are being experienced at the clinic. The method to be implemented will provide an effective method for increasing the patients contraceptive knowledge in the hopes that the education will increase their usage of contraceptives (Dehlendorf et al., 2013). With a better approach to contraceptive education patients will be more comfortable and there might be interactive sessions so that the patients can ask questions (Culwell & Adams Hillard, 2008). This would reinforce the education and they are likely to remember what they learn and apply the knowledge to reduce cases of unintended pregnancies.

Reducing the rates of unintended pregnancies due to a lack of knowledge regarding the use of contraceptive is what we intend to reduce with this project. Delivering contraceptive education in a manner that is suitable for the women who visit the clinic and ensuring that the four healthcare providers are offering the same education in the prescribed manner will definitely have a positive outcome on the population served by the clinic. Any reduction in the rates of unintended pregnancies is beneficial not only for the clinic, but also for the women (Culwell & Adams Hillard, 2008; Dehlendorf, Tharayil, et al., 2014). The project aims to implement a structured education system that will be used for the delivery of contraceptive education. Using the structured education method will allow the healthcare providers to better disseminate information and there will be uniformity of the information being delivered to the patients (Moos, Bartholomew, & Lohr, 2003). Offering advice and recommendations that are backed with evidence, will be vital and helpful to the patients since the proposed contraceptive method would be suitable and in line with the patient's need or desire.

In 2016, the clinic reported 76 out of 1,000 women had an unintended pregnancy. This is 30% higher than the national average for the country. Seeing at how high the figure is, there is need to look for interventions that will assist in reducing the numbers. It has been earlier established