Web contraception decision tool did not reduce decisional conflict in Spanish trial

A cluster randomised clinical trial conducted in 43 contraceptive counselling units across Spain between 2019 and 2021 found no evidence that a web-based Decision Support Tool (DST) reduced women’s decisional conflict compared with usual contraceptive counselling. Decisional conflict was low in both study groups, and after accounting for the clustering of patients by professional, the difference between groups was not statistically significant. The trial, published in BMC Medical Informatics and Decision Making, was prospectively registered as ISRCTN58279944 on 15 April 2019.

Seventy-one professionals were randomly assigned to the intervention or control group and together recruited 895 women. Participants in the intervention group (n = 478) received professional counselling supported by the DST, after brief training in its use, while those in the control group (n = 417) received the same professional counselling without the tool, representing usual care. Decisional conflict, a prespecified secondary outcome of the trial, was measured with O’Connor’s 16-item Decisional Conflict Scale (DCS).

After adjusting for baseline covariates and accounting for the clustering effect by professional, the adjusted mean difference in total decisional conflict between the groups was 2.2 points, with a 95% confidence interval of −1.9 to 6.3 and a p-value of 0.297. None of the DCS subscales showed a statistically significant difference either, with all subscale p-values at or above 0.13.

A notable finding of the study was the considerable variability between the professionals delivering the counselling. The intraclass correlation coefficient (ICC) was 0.37 for the total DCS score and ranged from 0.24 to 0.34 for the subscales, meaning a substantial portion of the residual variability in decisional conflict was attributable to the providers offering the counselling rather than to the tool itself. The results remained unchanged in a three-level sensitivity analysis that modelled this clustering structure explicitly.

The authors conclude that the DST may be more useful as a complement to professional counselling than as a substitute for it. The trial’s background notes that choosing a contraceptive method is a complex decision in which decisional conflict can occur, potentially leading to poor adherence and unplanned pregnancies, which motivated the evaluation of whether the web-based tool could reduce such conflict. Within this trial, however, the digital addition to counselling did not measurably improve the decisional experience of the women receiving it.

Subject of Research: A cluster randomised trial evaluating whether a web-based contraception decision support tool reduced women's decisional conflict in Spain.

Article Title: Web-based contraception decision support tool and women’s decisional conflict: a cluster randomised trial in Spain

Article References: Reyes-Martí, L., Valls-Fonayet, F., Cuesta-Martínez, R., Roca-Biosca, A., Rubio-Rico, L., & de Molina-Fernandez, M. I. (2026). Web-based contraception decision support tool and women’s decisional conflict: a cluster randomised trial in Spain. BMC Medical Informatics and Decision Making. https://doi.org/10.1186/s12911-026-03914-2

Image Credits: AI Generated

DOI: 10.1186/s12911-026-03914-2

Keywords: contraception, decision support tool, decisional conflict, cluster randomised trial, Spain, digital health, counselling, women's health, shared decision-making, clinical trial, Web-based, decision