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Reprod Health. 2017 Sep 6;14(1):110. doi: 10.1186/s12978-017-0374-6.

Relationship between self-efficacy and patient knowledge on adherence to oral contraceptives using the Morisky Medication Adherence Scale (MMAS-8).

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Chapman University School of Pharmacy, 9401 Jeronimo Rd, Irvine, California, 92618, USA.
Ohio Northern University Raabe College of Pharmacy, 525 S Main St, Ada, OH, 45810, USA.
College of Pharmacy, University of Minnesota, 232 Life Sciences, 1110 Kirby Dr, Duluth, MN, 55812, USA.
UCLA Fielding School of Public Health, 650 Charles E. Young Dr. South, 16-035 Center for Health Sciences, Los Angeles, CA, 90095-1772, USA.



Preconception care, including family planning, is a vital component of healthcare for women of reproductive age. An average female spends the majority of her reproductive life trying to prevent a pregnancy. In order to prevent unintended pregnancy, women often rely on the use of hormonal contraceptives. In the United States, the majority of hormonal contraceptive users are prescribed oral contraceptive pills (OCPs). Reduced adherence to OCPs decreases their ability to prevent pregnancy. The study aimed to measure OCP adherence among female college students, and explore the relationship between OCP adherence, knowledge, and self-efficacy.


This cross-sectional study recruited a random sample of female college students to participate in an online survey. OCP adherence was based on the 8-item Morisky Medication Adherence Scale (MMAS-8). Secondary reporting of medication adherence included participant reports of the number of missed OCP doses in the previous month and typical month of use.


Of the 5000 invited, 1559 (31.3%) completed the survey. Of those responding, 670 (41.3%) reported use of OCPs. A total of 293 (44.3%) OCP users met criteria for low adherence, 241 (36.4%) met criteria for medium adherence, and 128 (19.3%) met criteria for high adherence. Those with high adherence had higher self-efficacy (P < 0.001) and perceived knowledge (p < 0.001). After controlling for other factors, self-efficacy (b = .37) and perceived knowledge (b = .09) remained associated with OCP adherence.


Less than 20% of respondents met the criteria for high adherence to OCPs. Self-efficacy and knowledge were associated with higher OCP adherence. Targeted interventions from healthcare providers, health educators, and other adherence related media to increase the knowledge and self-efficacy of patients using OCPs may improve adherence rates. Additional research is needed to evaluate the impact of innovative interventions focused on social and behavioral patient factors, like knowledge and self-efficacy, on adherence to OCPs.


College students; Knowledge; Oral contraceptive adherence; Oral contraceptive pill; Self-efficacy

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