January 2007

Document Type


Degree Name



Dept. of Public Health and Preventive Medicine


Oregon Health & Science University


Objective: To investigate whether the knowledge, safety, and health screening behavior of women using an online resource to obtain hormonal contraceptives (HC) without a health care examination was similar to women who obtained HC in the clinic. Methods: Women who accessed HC prescriptions online and those that obtained prescriptions during an office visit were surveyed regarding knowledge and risks of HC. Knowledge of the contraindications to HC use and for awareness of possible dangerous complications of HC was assessed using two multiple choice questions. A score with actual and false contraindications and a score with actual and false dangerous complications associated with HC were calculated from the survey. The two outcomes were the proportion correct out of all contraindications or complications (total score) and proportion correct out of the true contraindications or complications (final score). Tests of equivalence were used to compare the mean scores between the two populations. The criteria for the equivalence of the online population to the clinic population occurred when the bounds of the 95% confidence interval of the mean difference did not exceed one and a half questions difference for the total score and one question difference for the final score Results: Online users (n = 243) were older, more affluent, more educated, and more likely to be insured than clinic patients (n = 161 ). The two populations were equivalent in HC knowledge [ contraindications mean score: clinic 81.1% (77 .2%, 85.0% ), online 85.0% (82.0%, 88.0%); complication mean score: clinic 77.6% (72.7%, 82.6%), online 82.1% (78.8%, 85.5%)]. After restricting the two populations in an analysis based on age, the online population was not worse than the clinic population. Conclusion: Women who self-selected the use of an online resource to obtain HC prescriptions differ demographically from their clinic counterparts. Women who obtain birth control online demonstrate equivalent or better levels of knowledge of potential HC risks as women seen by a provider in clinic. Both approaches at obtaining HC prescriptions appear safe. These results challenge the traditional belief that use of hormonal contraception requires a face-to-face contact with a health care provider.




School of Medicine



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