This study explores differences in the use of CycleProGo™ (CPG), a fertility-tracking app developed by Couple to Couple League (CCL), between those exposed to it as a part of natural family planning (NFP) instruction versus those who find it on their own. An anonymous data set of 17,543 CPG accounts opened between April 2013 and June 2016 was used for analysis. Nonmember users opened the most accounts (58 percent, n = 10,134), CCL members represented 38 percent (n = 6,758) of new accounts, and 207 CCL teachers (4 percent) were using CPG for personal charting. Significantly more nonmember accounts had zero days of use after the initial opening compared to CCL member accounts (61 percent vs. 23 percent, respectively, χ(2) = 2,405.9, p < .001). Conversely, significantly more CCL member accounts were used for ninety days or longer than nonmember accounts (47 percent vs. 13 percent, respectively, χ(2) = 2,404.2, p < .001). CCL students-those who began using the app as part of a formal NFP teaching curriculum-were more likely to use the app for > six cycles compared to nonmembers. In accounts with at least one complete cycle, CCL students were the most diligent at daily recording (95 percent of cycle days with observation recorded) followed by CCL members (88 percent) and nonmembers (76 percent). CCL teachers had the lowest frequency of cycle days with a recorded observation (73 percent). Within each cohort, accounts with > six recorded cycles had a lower proportion of cycle days with an observation recorded, likely reflecting increasing knowledge of their personal fertility patterns. Long-term users who had no known formal training in NFP still had the lowest proportion cycle days with a fertility observation. We conclude formal NFP instruction increases the probability of long-term app use, and regardless of training, long-term users will likely record observations on about 70 percent of cycle days.
Summary
"CycleProGo™ users with NFP training were more persistent and diligent about daily data input than those without training."
CycleProGo app, fertility tracking persistence, NFP method training, Couple to Couple League, natural family planning apps, sympto-thermal method digital, user engagement fertility apps, fertility awareness education, app-based cycle tracking, NFP instruction effectiveness
PMID 32431448 32431448 DOI 10.1177/0024363919870435 10.1177/0024363919870435 Manhart et al. 2020, Manhart 2020
Cite this article
Manhart, M. D. (2020). A Comparison of User Behaviors for a Fertility-Tracking App: Does Training in an NFP Method Improve Persistence and Use?. The Linacre Quarterly, 87(1), 53-59. https://doi.org/10.1177/0024363919870435
Manhart MD. A Comparison of User Behaviors for a Fertility-Tracking App: Does Training in an NFP Method Improve Persistence and Use?. Linacre Q. 2020;87(1):53-59. doi:10.1177/0024363919870435
Manhart, M. D. "A Comparison of User Behaviors for a Fertility-Tracking App: Does Training in an NFP Method Improve Persistence and Use?." The Linacre Quarterly, vol. 87, no. 1, 2020, pp. 53-59.
Sub-Saharan Africa has one of the highest fertility rates in the world, which is further promoted by the low utilisation of modern contraceptive methods. Yet, many communities claim to have traditional methods of family planning that pre-date the introduction of modern contraceptives, implying that contraception is a culturally acceptable norm. It was therefore postulated that the study population would have a high level of awareness and practice of natural methods of family planning. We aimed to obtain an insight into the extent and correctness of knowledge about natural family planning methods, and its practice as a guide to the general acceptance of contraception as a concept. Pre-tested structured questionnaires were administered to women of childbearing age in households properly numbered for primary healthcare activities. The level of awareness of natural family planning methods was significantly less than awareness for modern methods of contraception. The awareness rate for rhythm method, lactational amenorrhoea method and coitus interruptus was 50.7%, 42.1% and 36.1%, respectively. For all three national family planning methods, there is a steady decline between awareness, correct description of method and utilisation, a difference that was statistically significant in all cases. The sociodemographic factors of the responders had varying influence on utilisation of all three natural family planning methods studied. Rural dwellers practised the lactational amenorrhoea method significantly more often than urban dwellers. Significantly more Muslims than Christians with four children or more practised coitus interruptus or the rhythm method, while the use of lactational amenorrhoea method was significantly increased with the number of living children in both religious groups. There is a relatively low level of awareness of natural family planning methods in the study population, poor utilisation and wrong use of methods. Therefore, improving the correct level of information on natural family planning methods is likely to improve the use of both natural family planning and modern contraceptive methods.
Effective use of natural family planning is strongly dependent upon adequate instruction. The Creighton Model Fertility Care System (CrMS) has a standardized protocol for instruction of new users that includes individual follow-up visits in the first year of use. This study evaluated the number of follow-up visits completed by new CrMS users from eight CrMS centers in the United States. Four follow-up visits were completed by 75.7% of women. Women who continued instruction were more likely to be educated, Catholic, and white, and to have a more challenging reproductive status (discontinuing oral contraceptives, or breastfeeding). These results suggest that the number of follow-up visits needed varies among new CrMS users. Future research should address the optimal length of instruction for adequate use of the CrMS by women with different characteristics and needs.
Five programs of instruction in the ovulation method (OM) in diverse geographic and cultural settings are described, and characteristics of approximately 200 consecutive OM acceptors in each program are examined. Major findings include: the religious background and family size of acceptors are variable, as is the level of previous contraceptive use. Acceptors are drawn from a wide range of socioeconomic and religious backgrounds; however, family planning intention was similarly distributed in all five countries. In sum, the ovulation method is accepted by persons from a variety of backgrounds within and between cultural setting.
fertility-awareness/effectiveness/typical-and-perfect-useresearch-methods/measurement-and-statistics/outcome-definitionscontraception/comparative-studies/contraception-versus-fertility-awareness
Open Access
Fertility awareness-based methods (FABMs), also known as natural family planning (NFP), enable couples to identify the days of the menstrual cycle when intercourse may result in pregnancy ("fertile days"), and to avoid intercourse on fertile days if they wish to avoid pregnancy. Thus, these methods are fully dependent on user behavior for effectiveness to avoid pregnancy. For couples and clinicians considering the use of an FABM, one important metric to consider is the highest expected effectiveness (lowest possible pregnancy rate) during the correct use of the method to avoid pregnancy. To assess this, most studies of FABMs have reported a method-related pregnancy rate (a cumulative proportion), which is calculated based on all cycles (or months) in the study. In contrast, the correct use to avoid pregnancy rate (also a cumulative proportion) has the denominator of cycles with the correct use of the FABM to avoid pregnancy. The relationship between these measures has not been evaluated quantitatively. We conducted a series of simulations demonstrating that the method-related pregnancy rate is artificially decreased in direct proportion to the proportion of cycles with intermediate use (any use other than correct use to avoid or targeted use to conceive), which also increases the total pregnancy rate. Thus, as the total pregnancy rate rises (related to intermediate use), the method-related pregnancy rate falls artificially while the correct use pregnancy rate remains constant. For practical application, we propose the core elements needed to assess correct use cycles in FABM studies.
Fertility awareness-based methods (FABMs) can be used by couples to avoid pregnancy, by avoiding intercourse on fertile days. Users want to know what the highest effectiveness (lowest pregnancy rate) would be if they use an FABM correctly and consistently to avoid pregnancy. In this simulation study, we compare two different measures: (1) the method-related pregnancy rate; and (2) the correct use pregnancy rate. We show that the method-related pregnancy rate is biased too low if some users in the study are not using the method consistently to avoid pregnancy, while the correct use pregnancy rate obtains an accurate estimate. SHORT In FABM studies, the method-related pregnancy rate is biased too low, but the correct use pregnancy rate is unbiased.