Personal Home Monitoring of Fertility Received Positive Evaluation

Natural Family Planning
Richard J. Fehring, DNSC, R.N.
Reprinted from "Current Medical Research"
(Summer/Fall 2002), DDP / NFP, USCCB,
Washington, D.C.
Reproduced with Permission

Acceptability of a method of family planning and in particular natural family planning is an important dimension to assess and evaluate. The developers of Persona (Unipath, Ltd.) a hand held urinary hormone monitoring device, were interested in the acceptability of this new technology for home fertility monitoring and as a means of naturally avoiding pregnancy. Researchers from the department of psychology at the University of Florida recently reported on the acceptability of the use of the Persona in a longitudinal study.1 The authors of the study held the position that one method of family planning or NFP does not fit all. They wanted to find those couples who would be best suited for personal home monitoring using the Persona monitor, to determine to what extent participants would accept home monitoring of fertility, and how that acceptability might change over time.

Six hundred eighty English women participated in efficacy trials of the Persona monitor. The monitor measures metabolites of urinary estrogen and LH. It provides the user with a green light that indicates low fertility and a red light that indicates high fertility. The 680 participants were recruited through press advertising. They had to be willing to avoid pregnancy for at least 15 months and to be accepting of an unplanned pregnancy. The participants were between the ages of 18-45 years, had menstrual cycles between 23 and 35 days in length, were sexually active, had not used hormonal contraception for at least three menstrual cycles and had experienced at least three menstrual cycles after a pregnancy. The women were provided the Persona monitors without training and were asked to use them for 1 year.

Acceptability was conceptualized for this study as perception of accuracy and trust. Accuracy was measured on a 1-7 scale with 1 = inaccurate and 7 = accurate. Perception of accuracy was asked of both the green light (infertile) and the red light (fertile) days that were provided by the home monitors. Trust in the monitor was evaluated with a 101 point scale with 0 = no trust and 100 = complete trust. The researchers also assessed contextual measures, i.e., women's education, number of children, and length of relationship as predictors of acceptability. Acceptability data were collected at the end of menstrual cycle 1, 3, 6, and 13. At cycle 1, there were 680 women participants, at cycle 3, 603 participants, at cycle 6, 480 participants, and by cycle 13, only 250 participants who provided data.

Acceptability -- perceived accuracy

The mean perceived accuracy of the red (fertile) and green (infertile) light days ranged from 5.25 to 6.30 on a 7-point scale. On average the mean perceived accuracy was consistently higher for the green days than the red days. The authors indicated that people are usually more critical when they are told they cannot do something (i.e., have intercourse if they are avoiding pregnancy) then when they may proceed as desired. Based on paired t-test analysis, the participants perceived the accuracy of the red light days to be significantly higher at cycle 6 (M = 5.64) than at cycle 1 (M = 5.29) (t = 3.71, p < 0.005) and the accuracy of the green light days to be marginally statistically higher at cycle 6 (M = 6.09) than at cycle 1 (M = 5.95) (t = 1.82, p = 0.07). Therefore, perceived accuracy in home monitoring with the Persona monitor increased over time.

Acceptability -- perceived trust

Overall trust in the Persona monitor was high. The mean trust scores ranged from 87.35 to 94.23 on a scale of 0-100. The mean trust scores also significantly increased from cycle 1 (M = 87.35) to cycle 6 (M = 91.74) (t = 6.17, p < 0.005). Therefore, trust in the use of the Persona for avoiding pregnancy also increased over time.

Acceptability -- contextual variables

Based on regression analysis, the researchers determined that the number of years in relationship, the number of children, and the education level of the participants influenced trust over time. Those participants who lived with their partners longer reported significantly higher trust than those who lived with their partners for shorter periods (t = 2.21, p < 0.03). Those who had less education developed more trust in the monitor over time than those who had more education (t = -1.98, p < 0.05) and the more children the participants had the more they developed trust in the monitor (t = 1.94, p = 0.05). In addition, the less educated participants rated the monitor more accurate than the more educated and those in longer relationships rated the monitor more accurate than those in shorter relationships. Another finding was that women who did not have children or did not want any children and those women with an already large family (i.e., 4 or more children) were the least likely to be positive about the monitor or to report an increase in acceptability.

Comments

The authors concluded that the participants, in terms of initial acceptability of the Persona monitor, were very positive and that acceptability (i.e., perceived accuracy and trust) became more positive over time. Those women in stable unions, less education, and 1-3 children rated the use of the monitor more positively and their ratings of acceptability increased over time. The authors speculated that those in new relationships were still in the discovery mode and in the process of reassuring themselves that the relationships will last. The authors did not indicate whether these relationships were marital unions or not. They also speculated that the more educated participants needed more evidence to be convinced of accuracy than those who were less educated -- i.e., they reserved their judgments until more evidence of the monitor's success in helping them to avoid was in.

The authors also felt that the women who had no children or wanted no children and those who had 4 or more children probably were more adamant in not wanting more children than those with 1-3 children. NFP experts have called these categories of users "limiters" and "spacers" respectively. The authors ended by saying that the use of personal hormone monitoring for avoiding pregnancy seems to be an attractive alternative for NFP especially for those with religious or personal preferences opposed to other forms of family planning.

The fact that 430 women participants discontinued the use of the monitor by the 13th cycle is also an indication of acceptability. Some wished to achieve a pregnancy. I wondered how many of participants were in marital relationships and how many were not. I would think that a marriage would provide more stability to a relationship and thus yield more trust. The fact that the participants were not instructed in the use of the monitor or provided any NFP fertility teaching did result in an unbiased group of participants. It would be interesting to repeat such a study within the context of an NFP program that includes an introduction and follow-up. It is commendable that this was a longitudinal study. Persona users were followed and assessed over time and on the variables of trust and accuracy. Longitudinal studies like this need to be conducted on the current methods of NFP and especially in comparing different methods of NFP. It is especially important to compare psycho logical variables among the different systems of NFP. NFP researchers also need to determine which NFP methods are more acceptable to specific types of users. As the University of Florida researchers indicated, the choice of a family planning method is not a simple matter and there is no single method of family planning that is best for everyone. (RJF)

Endnote:

1 Severy, L.H., Klein, C.T., & McNulty, J. Acceptability of personal hormone monitoring for contraception: longitudinal and contextual variables. The Journal of Social Psychology. 142 (2002): 87-96. [Back]

Top