Strategies for communicating contraceptive effectiveness

  • Review
  • Intervention

Authors

  • Laureen M Lopez,

    Corresponding author
    1. Family Health International, Behavioral and Biomedical Research, Research Triangle Park, North Carolina, USA
    • Laureen M Lopez, Behavioral and Biomedical Research, Family Health International, P.O. Box 13950, Research Triangle Park, North Carolina, 27709, USA. llopez@fhi.org.

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  • Markus Steiner,

    1. Family Health International, Behavioral and Biomedical Research, Research Triangle Park, North Carolina, USA
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  • David A Grimes,

    1. Family Health International, Behavioral and Biomedical Research, Research Triangle Park, North Carolina, USA
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  • Kenneth F Schulz

    1. Family Health International, Quantitative Sciences, Research Triangle Park, North Carolina, USA
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Abstract

Background

Knowledge of contraceptive effectiveness is crucial to making an informed choice. The consumer has to comprehend the pros and cons of the contraceptive methods being considered. Choice may be influenced by understanding the likelihood of pregnancy with each method and factors that influence effectiveness.

Objectives

To review all randomized controlled trials comparing strategies for communicating to consumers the effectiveness of contraceptives in preventing pregnancy.

Search methods

We searched the computerized databases of MEDLINE, POPLINE, CENTRAL, PsycINFO, EMBASE, ClinicalTrials.gov, and ICTRP. We also examined references lists of relevant articles, and wrote to known investigators for information about other published or unpublished trials.

Selection criteria

We included randomized controlled trials that compared methods for communicating contraceptive effectiveness to consumers. The comparison could be usual practice or an alternative to the experimental intervention.

Data collection and analysis

Data were abstracted by two authors and entered into RevMan. For dichotomous variables, the Mantel-Haenszel odds ratio with 95% confidence intervals (CI) was calculated. For continuous variables, the mean difference was computed.

Main results

Five trials met the inclusion criteria. In one study, knowledge gain favored a slide-and-sound presentation versus a physician's oral presentation (mean difference -19.00; 95% CI -27.52 to -10.48). Another trial showed a table with effectiveness categories led to more correct answers than one based on numbers [ORs were 2.42 (95% CI 1.43 to 4.12) and 2.19 (95% CI 1.21 to 3.97)] or a table with categories and numbers [ORs were 2.58 (95% CI 1.5 to 4.42) and 2.03 (95% CI 1.13 to 3.64)]. One trial examined contraceptive choice: women in the expanded program were more likely to choose sterilization (OR 4.26; 95% CI 2.46 to 7.37) or use a modern contraceptive method (OR 2.35; 95% CI 1.82 to 3.03). No trial had an explicit theoretical base, but each used concepts from common theories or models.

Authors' conclusions

We have limited evidence about what works to help consumers choose an appropriate contraceptive method. For presenting pregnancy risk data, one trial showed that categories were better than numbers. In another trial, audiovisual aids worked better than the usual oral presentation. Strategies for communicating information should be examined in clinical settings and assessed for effect on contraceptive choice and retention of knowledge. To expand the knowledge base of what works in contraceptive counseling, randomized trials could intentionally use and test theories or models.

摘要

背景

溝通避孕效果的策略

需要有避孕效果的知識才能做出知情選擇.消費者必須要了解可考慮的避孕方式的優缺點.了解各方式懷孕可能和影響效果因子後會影響其選擇

目標

回顧所有隨機對照試驗,比較與消費者溝通預防懷孕效果的策略

搜尋策略

搜尋MEDLINE, POPLINE, CENTRAL, PsycINFO, EMBASE, ClinicalTrials.gov, 和 ICTRP這些電腦資料庫. 我們檢視相關文章的文獻清單,並寫信給知名學者請其提供其他發表或未發表的試驗.

選擇標準

我們納入隨機對照試驗,比較溝通避孕效果的策略.對照組可能是一般情況或其他避孕方法

資料收集與分析

資料由兩位作者擷取並輸入RevMan. 二元變數採MantelHaenszel 計算其勝算比(odds ratio)和其95% 信賴區間(CI). 連續變項則計算平均差

主要結論

5個試驗符合納入條件. 其中一個試驗顯示幻燈片和有音效的報告比醫師口頭解說較能增進知識的吸收(平均差為 −19.00; 95% 信賴區間 −27.52 至 −10.48). 另一個試驗顯示成效分類表比數據更能增進受試者對相關問題正確的回答 [勝算比(OR) 2.42 (95% 信賴區間 1.43 至 4.12) 和 2.19 (95% 信賴區間 1.21 至 3.97)] 或成效數據分類表 [勝算比為2.58 (95% 信賴區間 1.5 至 4.42) 和2.03 (95% 信賴區間 1.13 至 3.64)]. 一個比較避孕選擇試驗顯示: 參與擴大方案的女性較會選擇絕育 (勝算比 4.26; 95% 信賴區間 2.46 至 7.37) 或新的避孕方法(勝算比 2.35; 95% 信賴區間 1.82 至 3.03). 沒有試驗具有明確的理論基礎,而用常用的方式或理論或模式.

作者結論

我們有有限證據顯示甚麼可幫助消費者選擇適當的避孕方式.在顯示懷孕風險方面,一個研究認為分類比案例數目更有用.另個試驗顯示聲音和影像輔助比口頭解說更有用.溝通資訊的策略應於臨床環境檢視,並評估避孕選擇的效果和獲得相關知識.為了增加何為有效避孕諮詢的知識,應刻意採隨機試驗並檢測學說和模式

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

告知使用者避孕方式的效果:為了做出較好的生育控制選擇,使用者必需要知道避孕方式的效果.避孕方式的優缺點很重要.消費者會根據避孕效果選擇避孕方式.使用者也必須了解什麼會影響生育控制方式的效果.我們用電腦搜尋告知使用者避孕效果的隨機試驗.我們寫信給學者以尋找其他試驗.新的告知計畫或方式可與一般情況或其他計畫或方式比較.我們找到5個試驗. 一個研究顯示: 比起醫師口頭解說,婦女由幻燈片和有音效的報告吸收更多知識. 另個試驗顯示分類比數據更能表現婦女使用某種避孕方式後仍可能懷孕的人數.一個試驗檢視避孕方式選擇,與傳統諮詢組相比,試驗組女性較會選擇絕育或新的避孕方法.沒有試驗依據學習理論.但每個試驗使用常用的方式或理論或模式..我們對幫助使用者選擇生育控制方式的瞭解不多. 應於臨床環境檢視如何告知使用者避孕選擇,試驗應研究生育控制方法的選擇,和多少使用者事後仍記得.試驗可採用和檢測理論以瞭解甚麼方式的生育控制諮詢有用.

Plain language summary

Informing consumers about how well birth control works

To make a good choice for birth control, people have to know how well different methods work. The pros and cons of the methods are important. People may choose birth control based on how well the method prevents pregnancy. Consumers also need to know what affects the usefulness of the birth control method.

We did a computer search for randomized trials of ways to inform people about how well birth control methods prevent pregnancy. We wrote to researchers to find other trials. The new program or way to inform people could be compared to the usual practice or to another program or means of informing people.

We found five trials. In one study, women learned more from a slide-and-sound format than from having a doctor talk to them. Another trial found that categories were better than numbers in showing how many women might get pregnant with each method. One trial looked at the choice of birth control method. Women in the test program more often chose to be sterilized or to use modern birth control than women with the usual counseling. No trial was clearly based on any learning theory. However, each study used parts of common theories or models.

Little is known about helping consumers choose their method of birth control. Ways to inform people about birth control options should be tested in clinics. Trials should look at the choice of birth control method, along with how much consumers remember later. Trials could use and test theories to learn what works in birth control counseling.

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