To evaluate the efficacy, knowledge of fertility, and acceptability of a web-based natural family planning (NFP) education and service program.
Design
A 6-month repeated measure longitudinal evaluation pilot study.
Setting
A university based online website.
Participants
The website was piloted with 468 volunteer women seeking NFP services. Of these participants, 222 used the automatic online fertility charting system to avoid pregnancy. The 222 charting participants had a mean age of 29.9 years (SD=5.6), 2.2 children (SD=1.9), 37% were postpartum, and 47% had regular menstrual cycle lengths.
Intervention
Nurse-managed web-based NFP education and service program.
Outcomes
Pregnancies were confirmed by an online self-assessed pregnancy evaluation form. A 10-item fertility quiz and 10-item acceptability survey was administered online.
Results
Among the 222 users avoiding pregnancy, at 6 months of use, there were two correct-use unintended pregnancies that provided a pregnancy rate of 2% and seven total unintended pregnancies providing a typical use pregnancy rate of 7%. Mean knowledge of fertility increased significantly from time of registration (8.96, SD=1.10) to 1 month of use (9.46, SD=.10), t=4.60, p<.001). Acceptability increased nonsignificantly from 1 month of use (45.6; SD=8.98) to 6 months of use (48.4; SD=8.77).
Conclusion
The nurse-managed online NFP system seems to provide adequate knowledge of fertility and help participants meet pregnancy intentions. Acceptability of such a system of NFP is still in question.
Fehring online natural family planning education program evaluation, web-based NFP service pregnancy avoidance efficacy, internet-based fertility charting correct use typical use pregnancy rate, nurse-managed natural family planning online pilot study, online fertility awareness education knowledge acceptability, natural family planning web-based program postpartum women, Marquette method online NFP education longitudinal evaluation, fertility knowledge assessment online charting system, natural family planning avoiding pregnancy effectiveness 2% rate, technology-based NFP education acceptability survey
PMID 21488954 21488954 DOI 10.1111/j.1552-6909.2011.01237.x 10.1111/j.1552-6909.2011.01237.x
Cite this article
Fehring, R. J., Schneider, M., & Raviele, K. (2011). Pilot evaluation of an internet-based natural family planning education and service program. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 40(3), 281-291. https://doi.org/10.1111/j.1552-6909.2011.01237.x
Fehring RJ, Schneider M, Raviele K. Pilot evaluation of an internet-based natural family planning education and service program. J Obstet Gynecol Neonatal Nurs. 2011;40(3):281-291. doi:10.1111/j.1552-6909.2011.01237.x
Fehring, R. J., et al. "Pilot evaluation of an internet-based natural family planning education and service program." Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, vol. 40, no. 3, 2011, pp. 281-291.
Fehring RJ et al., 2008·MCN Am J Matern Child Nurs
To determine the effectiveness of the Marquette Method (MM) of natural family planning (NFP) as a method of avoiding pregnancy. This was a 12-month retrospective evaluation of the MM system of NFP. Two hundred and four women (mean age, 28.6 years) and their male partners (mean age, 30.3 years) who sought to learn a method for avoiding pregnancy with the MM from four clinical sites were taught to track their fertility by self-observation of cervical mucus, by use of an electronic monitor that measures urinary levels of estrone-3-glucuronide and luteinizing hormone, and by use of basal body temperature. All unintended pregnancies were evaluated by professional nurses as to whether they were intended or not. Pregnancy rates over 12 months of use were determined by survival analysis. There were a total of 12 unintended pregnancies, only 1 with correct use. The 12-month "correct use" pregnancy rate was 0.6 (i.e., 99.4% effective) and the "typical use" (total pregnancy rate) was 10.6 (i.e., 89.4% effective) per 100 users.
When used correctly, the MM system of NFP is an effective means of avoiding pregnancy. The efficacy of the MM system includes proper preparation of the professional nurse NFP teachers.
Fehring RJ et al., 2017·J Obstet Gynecol Neonatal Nurs
To analyze the effectiveness of an online, nurse-managed natural family planning (NFP) program among breastfeeding women and subgroups of these women.
Longitudinal comparative cohort study.
A university-based online NFP education program and menstrual cycle charting system. Women (N = 816) with a mean age of 30.3 years (standard deviation = 4.5) who registered to use the online NFP system and indicated they were breastfeeding. Participants tracked their fertile times with an electronic hormone fertility monitor (EHFM), cervical mucus monitoring, or both. All unintended pregnancies were evaluated by professional nurses. The correct use pregnancy rates were 3 per 100 users over 12 cycles of use, and typical rates were 14 per 100 at 12 cycles of use. At 12 cycles of use, total pregnancy rates were 16 per 100 for electronic hormone fertility monitor users (n = 380), 81 per 100 among mucus-only users (n = 45), and 14 per 100 for electronic hormone fertility monitor plus mucus users (n = 391). Use of a nurse-managed online NFP program for women can be effective to help women avoid pregnancy while breastfeeding, especially with correct and consistent use.
Fertility AwarenessPerimenopause UseNatural Family PlanningSurvival Analysis
Fehring RJ et al., 2014·J Obstet Gynecol Neonatal Nurs
To determine the efficacy of using natural family planning (NFP) methods to avoid unintended pregnancy among women of perimenopause age (i.e., age 40-55 years).
A secondary analysis of subset data from two prospective observational cohort studies.
A university based in-person and online NFP service program. One hundred and sixty couples who used either a website or an in-person NFP service to learn how to avoid pregnancy from January 2001 to November 2012. A prospective 12-month effectiveness study among 160 women (between ages 40-55) who used NFP to avoid pregnancy. The women used either a hormonal fertility monitor, cervical mucus monitoring, or both to estimate the fertile phase of their menstrual cycles. Survival analysis was used to determine the pregnancy rate over 12 months of use. There were a total of five unintended pregnancies among the participants. The typical use pregnancy rate was six per 100 women over 12 months. The monitor alone participants (n = 35) had a 12-month pregnancy rate of three, the participants (n = 73) who used mucus alone had a pregnancy rate of four, and the participants (n = 42) who used the fertility monitor plus mucus had a pregnancy rate of six. Natural family planning methods can be effective for older women to avoid an unintended pregnancy with correct use and adequate instructions. The pregnancy rate most likely was affected by diminished fertility and motivation to limit family size.
Fertility AwarenessElectronic Hormonal MonitoringCorrect and Typical Use RatesCervical Mucus Monitoring
Fehring RJ et al., 2007·J Obstet Gynecol Neonatal Nurs
To determine the effectiveness of an electronic hormonal fertility monitor plus cervical mucus monitoring to avoid pregnancy.
A 12-month prospective clinical efficacy trial. One hundred ninety five (195) women (mean age 29.8 years) seeking to avoid pregnancy with a natural method at 5 clinical sites in 4 cities. Each participant was taught to track fertility by self-observation of cervical mucus and an electronic monitor that measures urinary levels of estrone-3-glucuronide and luteinizing hormone. Correctand typical-use unintended pregnancy rates. There were a total of 26 unintended pregnancies, 3 with correct use. With 1,795 months of use, the correct-use pregnancy rate was 2.1% per 12 months of use (i.e., 97.9% effective in avoiding pregnancy when rules of the method were always followed) and the imperfect-use pregnancy rate was 14.2% per 12 months of use (i.e., 85.8% effective in avoiding pregnancy when rules of the method were not always followed and all unintended pregnancies and months of use were included in the calculations). Correct use of an electronic hormonal fertility monitor with cervical mucus observations can be as effective as other fertility awareness-based methods of natural family planning. Comparative studies are needed to confirm this conclusion.