Reporting non-recommended use of condoms and withdrawal in a study of a natural system of family planning

The Creighton Model Fertility Care System (CrM) teaches women and couples to identify the potentially fertile phase of the menstrual cycle (i.e., the fertile window). The CrM encourages couples to abstain from genital contact when they intend to avoid pregnancy. However, couples sometimes use condoms or withdrawal as additional methods that were not recommended. We were interested in how often this occurs and how completely it is reported.

We conducted the CrM Effectiveness, Intentions, Behaviors Assessment (CEIBA) study to assess the factors impacting the actual use and effectiveness of the CrM. This particular analysis aimed to evaluate the reporting of condom use and withdrawal during the CEIBA study. We analyzed data from Creighton Model Chart (238 Couples), Creighton Model Follow-up Forms (284 couples), CEIBA Start of Cycle Questionnaire (287 couples), CEIBA Exit Questionnaires (270 couples). We calculated descriptive statistics and generated kappa statistics using the Landis and Koch definitions (95% CI) for couple concordance for withdrawal and condom use reporting.

The mean age for the women was 27.1 ±4.2 years, with the majority (82%) of the participants being non-Hispanic white. In the CEIBA exit questionnaire, 27%, 22% and 38% of couples reported using condoms, withdrawal and either condom or withdrawal respectively at some point during the study. In the Follow-up form, 5%, 3% and 7% of couples were documented to have used condoms, withdrawals and either condoms or withdrawals, respectively. There was substantial agreement in exit questionnaire for woman and man reporting condom use (κ = 0.80; 95% confidence interval (CI): 0.69-0.90), but a fair agreement for woman and man reporting withdrawal (κ = 0.39, 95% confidence interval (CI): 0.20-0.58). Comparing follow up form and exit questionnaire, there was a poor agreement between couples reporting either condom or withdrawal (κ = -0.10, 95% CI: -0.10 - -0.04). There was also a fair agreement between couples reporting either condom use or withdrawal when comparing the CEIBA start of cycle and exit questionnaires (κ = 0.38, 95% CI: 0.27 – 0.49). When comparing the CrM chart and the exit questionnaires, there was also a fair agreement between couples reporting either condom use or withdrawal (κ = 0.39, 95%CI: 0.26 – 0.51). About twice as many reported condom or withdrawal use on the exit questionnaire (n=90) as CrM chart (n=31) or start of cycle questionnaires (n=43).

On the exit questionnaires, there was a substantial within-couple agreement between women and men for reporting condom use but less/fair agreement for withdrawal.