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Strategies for communicating contraceptive effectiveness

  1. Laureen M Lopez1,*,
  2. Markus Steiner2,
  3. David A Grimes3,
  4. Deborah Hilgenberg4,
  5. Kenneth F Schulz5

Editorial Group: Cochrane Fertility Regulation Group

Published Online: 30 APR 2013

Assessed as up-to-date: 13 FEB 2013

DOI: 10.1002/14651858.CD006964.pub3


How to Cite

Lopez LM, Steiner M, Grimes DA, Hilgenberg D, Schulz KF. Strategies for communicating contraceptive effectiveness. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD006964. DOI: 10.1002/14651858.CD006964.pub3.

Author Information

  1. 1

    FHI 360, Clinical Sciences, Research Triangle Park, North Carolina, USA

  2. 2

    FHI, Clinical Sciences, Research Triangle Park, North Carolina, USA

  3. 3

    University of North Carolina, School of Medicine, Obstetrics and Gynecology, Chapel Hill, North Carolina, USA

  4. 4

    FHI 360, Scientific Affairs, Research Triangle Park, North Carolina, USA

  5. 5

    FHI 360 and UNC School of Medicine, Quantitative Sciences, Research Triangle Park, North Carolina, USA

*Laureen M Lopez, Clinical Sciences, FHI 360, P.O. Box 13950, Research Triangle Park, North Carolina, 27709, USA. llopez@fhi360.org.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 30 APR 2013

SEARCH

 

Background

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

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, as well as the program's emphasis. A study promoting long-acting methods showed that 56% of the women chose intrauterine contraception (Secura 2010). The next most frequent choices were oral contraceptives (12%), the vaginal ring (12%) and a subdermal implant (11%). Intervention studies have found that most women cited method effectiveness as the most important reason for choosing a contraceptive (Steiner 2003; Steiner 2006). A study of hormonal method preferences found that women chose the vaginal ring most often, and the main reasons were convenience and the low likelihood of error (Lete 2007). The pill was second in frequency and was generally chosen for its effectiveness. In earlier studies of preferences for contraceptive characteristics, women identified effectiveness as the most important factor in choosing a contraceptive method (Garcia 1997; Grady 1999). Researchers often take the concept of risk for granted, while health care consumers and providers may not understand enough about probability theory to interpret the available information, as it is often presented numerically (ARHP 2006; Mahajan 2007). Strategies for communicating information about contraceptive effectiveness and risks should be developed and tested formally. For example, the assumption that people understand fractions better than rates impedes communication about risk of chromosomal abnormalities (Van Vliet 2001).

Theories and models of education, communication, or behavioral change can help explain how an intervention works. Many health education interventions have no identified theoretical premise (Bellg 2004; Borrelli 2005). To many professionals, the lack of any theory or principles guiding an educational or psychological intervention is similar to not having a physiologic basis for a medical intervention. O'Connor 2003 reviewed decision aids for making health care choices. The authors discussed the need for learning what types of aids work better with certain groups of people (O'Connor 2003), but they did not address any theoretical basis. DiCenso 2002 abstracted the theoretical basis for interventions to reduce unintended pregnancies among adolescents. Not all the strategies identified included contraceptive effectiveness since they were focused on adolescents.

Since published reports often have insufficient information on the intervention to assess its relevance, Mayo-Wilson 2007 suggested that CONSORT guidelines be expanded to include more intervention information. Even if an intervention has a reasonable premise, it must be implemented with fidelity to the design to be useful. Borrelli 2011 developed a tool to assess the fidelity of health behavior interventions in clinical trials. The framework was intended for assessing current trials and can be useful in reviewing educational interventions. Domains of treatment fidelity include having a curriculum or treatment manual, specifying training of providers, assessing delivery of intervention, and assessing participants' receipt of treatment and ability to use the treatment skills.

This review focuses on randomized controlled trials of ways to communicate contraceptive effectiveness or pregnancy risk to consumers or potential users of the contraceptive methods. Lopez 2011 examined interventions with an explicit theoretical basis for improving contraceptive use. Outcomes for the current review include attitudes toward a particular contraceptive method and knowledge about its effectiveness as well as contraceptive use. Others reviews focused more on contraceptive use than choice. Halpern 2011 studied interventions to improve adherence to hormonal contraceptive regimens. Lopez 2012 reviewed randomized controlled trials (RCTs) of educational interventions to increase contraceptive use among postpartum women.

 

Objectives

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

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

 

Methods

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms
 

Criteria for considering studies for this review

 

Types of studies

We included randomized controlled trials in any language that compared methods for communicating contraceptive effectiveness for contraception to consumers. The comparison could be usual practice or an alternative to the experimental intervention. Studies that focused on sexually transmitted diseases were included if they also addressed contraceptive effectiveness.

 

Types of participants

The participants in the trials were consumers or potential users of the contraceptive methods. They could be females or males.

 

Types of interventions

Interventions could include educational programs or materials and counseling sessions focused on individuals or groups. The content of the program, sessions, or material had to include the effectiveness of more than one type of contraception. Contraceptive methods could be hormonal or non-hormonal.

Trials were excluded if the intervention did not address the relative effectiveness of methods or the report did not provide sufficient information to determine whether effectiveness or pregnancy risk was addressed.

 

Types of outcome measures

  • Knowledge of contraceptive effectiveness
  • Attitude about contraception or toward any particular contraceptive
  • Choice or use of contraceptive method.

 

Search methods for identification of studies

 

Electronic searches

Through February 2013, we searched the computerized databases MEDLINE, POPLINE, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO and CINAHL for studies of communicating contraceptive effectiveness. We also searched for current trials via ClinicalTrials.gov and ICTRP. The search strategy is given in Appendix 1. The previous search strategy also included EMBASE, and is shown in Appendix 2.

 

Searching other resources

We also examined references lists of relevant articles and wrote to known investigators for information about other published or unpublished trials not discovered in our search.

 

Data collection and analysis

 

Selection of studies

We assessed for inclusion all titles and abstracts identified during the literature searches with no language limitations. One author reviewed the search results and identified reports for inclusion or exclusion. A second author also examined the reports identified for appropriate categorization. Specifics for the original review and the updates can be found in Acknowledgements and in Contributions of authors.

 

Data extraction and management

One author abstracted the data and entered the information into RevMan. This included the Characteristics of included studies and Data and analyses. Another author or research associate conducted a second data abstraction and verified correct data entry. No discrepancies occurred. Specifics for the original review and the updates can be found in Acknowledgements and in Contributions of authors.

In addition, we summarized the characteristics of these educational interventions. The framework in Borrelli 2011 helped guide this synthesis. We included basics about the participants and interventions, the outcome measures (whether they assessed participants' understanding and skills regarding the intervention), and the timeframe for outcome assessment.

For the initial review, we looked for a theoretical base for the interventions. We had extracted data on constructs and identified implied theory or models. However, none of the original five trials had an explicit theoretical base. The studies employed a variety of guiding principles or concepts, which may have their basis in behavioral theories or models. Since they were not explicit, we removed this table for the 2012 update. Theory-based interventions for improving contraceptive use were examined in Lopez 2011.

 

Assessment of risk of bias in included studies

Studies were examined for methodological quality, according to recommended principles (Higgins 2011). Factors considered were study design, randomization method, allocation concealment, blinding, and losses to follow-up and early discontinuation. Adequate methods for allocation concealment include a centralized telephone system and the use of sequentially-numbered, opaque, sealed envelopes (Schulz 1995; Schulz 2002). High losses to follow-up threaten validity (Strauss 2011). Limitations in design were presented in Risk of bias in included studies, and were considered in interpreting the results.

 

Measures of treatment effect

For continuous variables, the mean difference (MD) was computed with 95% confidence interval (CI) using a fixed-effect model. RevMan uses the inverse variance approach (Higgins 2011). The measures could include mean scores for the assessment of knowledge or change in the mean scores. For dichotomous outcomes, the Mantel-Haenszel odds ratio (OR) with 95% CI was calculated using a fixed-effect model. An example would be the proportion of women who chose a specific contraceptive method. Fixed effect and random effects give the same result if no heterogeneity exists, as when a comparison includes only one study.

 

Assessment of heterogeneity

Given the diversity of interventions, we did not conduct meta-analysis for pooled estimates. We assessed sources of heterogeneity without pooling the data and noted heterogeneity due to differences in interventions, study design, and populations.

 

Data synthesis

Following GRADE principles, we assessed the quality of evidence (Balshem 2011). When a meta-analysis is not viable due to varied interventions, a summary of findings table is not feasible. Therefore, we did not conduct a formal GRADE assessment, i.e., an evidence profile and summary of findings table (Guyatt 2011).

Given the differences across studies, we first summarized characteristics of the interventions and the outcome assessments. We assessed the quality of evidence for this review based on the Risk of bias in included studies and the characteristics summary; we then summarized the evidence quality results. Quality could be high, moderate, low, or very low. RCTs were considered to be high quality then downgraded for each of the following:

  • allocation: no information on randomization sequence generation or allocation concealment, or no concealment;
  • outcome measure: no assessment of contraceptive method choice or use, or did not have independent assessment or record linkage;
  • follow-up length: outcome measured during or immediately after intervention
  • loss to follow-up greater than 20%.

We did not downgrade on the basis of blinding. Due to the differences between interventions, blinding of investigators and participants to assignment was difficult, although blinding of outcome assessors was more feasible.

 

Results

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms
 

Description of studies

See: Characteristics of included studies; Characteristics of excluded studies; Characteristics of ongoing studies.

 

Results of the search

The 2012 to 2013 search produced 238 references. This includes 175 unduplicated citations from the electronic databases, 1 from a reference list, and 63 found in ClinicalTrials.gov and ICTRP. Two new trials were included (Langston 2010; Stephenson 2011). Four trials (with five reports) were excluded. One ongoing trial was added (Madden 2011); details can be found in Characteristics of ongoing studies.

 

Included studies

Seven trials met the inclusion criteria and had a total of 4526 women. Five trials were multi-site studies. Four trials were conducted in the USA, Nigeria and Zambia were represented by one study each, and one trial was done in both Jamaica and India. Four studies took place in clinical settings (Marshall 1984; Omu 1989; Langston 2010; Stephenson 2011), while three provided the intervention in the community (Kraft 2007; Steiner 2003; Steiner 2006).

Most of the studies provided one-session interventions (Marshall 1984; Steiner 2003; Steiner 2006; Langston 2010; Stephenson 2011). Marshall 1984 compared five different media for providing the same contraception information. Steiner 2003 and Steiner 2006 each tested three educational tools with different formats for similar contraception information. Langston 2010 provided structured counseling using a flipchart developed by the World Health Organization (WHO) or usual care. Omu 1989 was focused on sterilization acceptance but also provided education regarding "all methods of contraception." The experimental group had four sessions while the control group received standard counseling in one session. Two trials had couples-based interventions (Kraft 2007; Stephenson 2011). Kraft 2007 reported on the contraception outcomes from an HIV and STD risk reduction trial. Three intervention sessions were provided for the experimental group while the comparison group had one information session. Stephenson 2011 compared different video presentations provided to HIV serodiscordant and concordant couples. More detail on the interventions can be found in Characteristics of included studies.

Outcomes of interest from the included trials were as follows:

  • Marshall 1984 - contraceptive knowledge gained from pretest to post-test; satisfaction with the educational medium.
  • Omu 1989 - choice of contraceptive method; attitude toward sterilization.
  • Steiner 2003 and Steiner 2006 - responses to two questions about contraceptive effectiveness asked while viewing the educational material; women's perceptions of the information (amount and whether easy to understand).
  • Kraft 2007 - use of effective contraceptives; psychosocial factors affecting contraceptive use. Assessment was six months after the intervention.
  • Langston 2010 - choice of very effective contraceptive method and method initiation at enrollment visit and after the intervention; continuation at three months. Very effective methods included those with one-year pregnancy rates less than 1% for typical use.
  • Stephenson 2011 - uptake of modern contraception at randomization visit and after the intervention.

 

Excluded studies

For the 2012 update, we excluded four additional trials (Akman 2010; Carneiro 2011; Garbers 2012; Vogt 2012). See Characteristics of excluded studies for reasons.

 

Risk of bias in included studies

Two trials were published in the 1980s and five from 2003 to 2011.

 

Allocation

Three trials had adequate concealment of allocation (Steiner 2003; Steiner 2006; Langston 2010). Three trials did not provide information on how the randomization sequence was generated or whether allocation was concealed before assignment (Marshall 1984; Omu 1989; Stephenson 2011). In Kraft 2007, participants drew slips of paper with their assignments on them.

 

Blinding

In two trials, the physician-providers were reportedly blinded to the study arms (Marshall 1984; Langston 2010). However, one group received the additional intervention prior to seeing the physician, so the blinding may have been incomplete. Kraft 2007 was open. Stephenson 2011 was single blind, but no details were provided. One trial did not mention any blinding of participants or assessors (Omu 1989). The randomization sequence was reportedly concealed from staff managing the study in Steiner 2003 and Steiner 2006.

 

Incomplete outcome data

Losses to follow-up were only relevant for the three trials with multiple sessions or follow-up data (Omu 1989; Kraft 2007; Langston 2010). Omu 1989 lost 8% by the six-week postpartum visit. By the last session, Kraft 2007 reportedly lost less than 10% of the intervention group and none from the control group that had only one session. However, Kraft 2007 lost 22% overall by the six-month follow-up. By three months, Langston 2010 lost 17% of the intervention group and 16% of the usual care group. In addition, Langston 2010 excluded 28 women after randomization because of second trimester pregnancy, completed spontaneous abortion or ectopic pregnancy.

Three trials provided one session with assessment at that visit (Marshall 1984; Steiner 2003; Steiner 2006). Stephenson 2011 also had one session for each group, but has data on follow-up to be reported later.

 

Effects of interventions

No trials could be combined in a meta-analysis due to differences in the interventions. Furthermore, measurements were taken in differing time frames so the results are not comparable across studies. Although the study designs were similar in Steiner 2003 and Steiner 2006, different educational tools were tested.

 

Multiple educational sessions

Two trials provided several sessions for the intervention group (Omu 1989; Kraft 2007).

 

Contraceptive method choice, use, and continuation

Omu 1989 measured contraceptive 'choice' as an outcome. Several differences were found between women in the expanded program, which emphasized voluntary sterilization, and those in the standard information group. By the end of the intervention, women in the expanded program were more likely to be sterilized (OR 4.26; 95% CI 2.46 to 7.37) ( Analysis 1.1). By six weeks postpartum, those in the expanded program were more likely to use a 'clinical' or 'modern' contraceptive (OR 2.35; 95% CI 1.82 to 3.03) ( Analysis 1.2), i.e., sterilization, pills, injectable, intrauterine device or barrier method. They were less likely to use no contraceptive method (OR 0.44; 95% CI 0.32 to 0.61) ( Analysis 1.3).

Kraft 2007 was a couples-based intervention for preventing HIV and STDs with a three-session intervention group and a one-session information group. Reportedly, by the six-month follow-up, the two groups did not differ significantly in consistent use of an effective contraceptive, defined as sterilization, IUD, injectable (Depo Provera), implant (Norplant), as well as consistent use of OCs, diaphragms, or male condoms. Use among both groups reportedly increased over time.

 

Attitudes or perceptions about contraception or particular method

Psychosocial issues were assessed in two trials that included contraceptive information (Omu 1989; Kraft 2007). Omu 1989 had several questions on attitudes or beliefs about sterilization. The women in the expanded program were more likely to agree that sterilization was safe (OR 9.15; 95% CI 6.77 to 12.36), that a woman would still be strong after sterilization (OR 9.67; 95% CI 7.14 to 13.10), that sex drive would not change (OR 11.02; 95% CI 8.08 to 15.03), and that a woman's status would not change (OR 9.19; 95% CI 6.86 to 12.31) ( Analysis 1.4). In Kraft 2007, the study groups were not significantly different for the psychosocial variables and relationship factors at six months. These included perceived pregnancy risk ( Analysis 2.1), importance of not becoming pregnant ( Analysis 2.2), expectations for partner's support for contraception ( Analysis 2.3), and participation in contraceptive decision making ( Analysis 2.4).

 

Single session testing media

Five trials provided one session for each study group and were mainly focused on testing educational material or media (Marshall 1984; Steiner 2003; Steiner 2006; Langston 2010; Stephenson 2011).

 

Contraceptive method choice, use, and continuation

Stephenson 2011 focused on HIV serodiscordant or concordant couples. Videos were shown to the four study groups (contraceptive methods, motivational, and control videos). The study groups were not significantly differences in the types of contraceptives chosen after the video and offer of free contraceptives ( Analysis 3.1 to  Analysis 3.3). However, within groups, choices shifted from nearly 80% using condoms to more use of oral contraceptives (35% to 40%) and injectables (37% to 41%), as well as implants (10% to 13%).

In Langston 2010, structured counseling was provided using a contraceptive flipchart. The intervention and comparison groups did not differ significantly in choice of contraceptive method (very effective, effective, or less effective method) ( Analysis 4.1). The investigators used WHO definitions of method effectiveness: very effective had one-year typical use pregnancy rates less than 1% (sterilization, IUDs, implants); effective had typical pregnancy rates of 1% to 9% (pills, rings, patches, injections). They defined less effective methods as having a pregnancy rate of 10% or higher (condoms, withdrawal, periodic abstinence, no method). The study groups did not differ significantly in continuation of the chosen method at three months ( Analysis 4.2).

 

Understanding of effectiveness or preference for educational method

Comprehension of contraceptive effectiveness was addressed in three trials that focused on providing contraceptive information (Marshall 1984; Steiner 2003; Steiner 2006). These studies tested educational media or tools and also examined preferences for each educational method. Marshall 1984 compared different media for communicating contraception information. Knowledge gain was less for an oral presentation by the physician-provider compared to a 'slide-and-sound presentation with unfamiliar voice' (MD -19.00; 95% CI -27.52 to -10.48) ( Analysis 5.1). The other groups did not differ significantly in knowledge gain. For satisfaction with the educational method, the study groups in Marshall 1984 did not differ significantly ( Analysis 5.2).

Steiner 2003 compared three tables of contraceptive effectiveness information: 1) numeric risk of pregnancy; 2) categories of method effectiveness (more effective, effective for most users, and less effective for most users); and 3) both categories and numbers (see Characteristics of included studies). Use of the categories table showed a greater change in women who understood that hormone injections were more effective than pills compared to the numeric table (OR 2.42; 95% CI 1.43 to 4.12) ( Analysis 6.1) and compared to the table with categories and numbers (OR 2.58; 95% CI 1.50 to 4.42) ( Analysis 6.2). The categories table also showed a greater increase in those who understood that combined pills were more effective than condoms compared to the other tables: OR 2.19 (95% CI 1.21 to 3.97) ( Analysis 6.1) and OR 2.03 (95% CI 1.13 to 3.64) ( Analysis 6.2), respectively. Fewer women with the categories table thought the tool was hard to understand compared to women with the numbers table (OR 0.29; 95% CI 0.13 to 0.63) ( Analysis 6.4) or to women with the categories and numbers table (OR 0.38; 95% CI 0.17 to 0.85) ( Analysis 6.6).

In Steiner 2006, three charts with contraceptive effectiveness information were tested: 1) three categories of effectiveness stratified by typical or consistent users; 2) four categories of effectiveness with numbers of pregnancies; and 3) a continuum of effectiveness by numbers of pregnancies (see Characteristics of included studies). The groups with each chart did not differ significantly in change in comprehension of relative contraceptive effectiveness ( Analysis 7.1;  Analysis 7.2). Steiner 2006 also examined preferences for each educational chart. Women with the categories chart were more likely to feel the chart provided enough information to choose a method compared to those with the chart of stratified categories (OR 1.97; 95% CI 1.13 to 3.44) ( Analysis 7.3) and that the chart was easy to understand (OR 1.47; 95% CI 1.03 to 2.10) ( Analysis 7.3). The categories-chart group did not differ significantly from the continuum-chart group for these perception items ( Analysis 7.4).

 

Discussion

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms
 

Summary of main results

Within studies, some methods of communicating contraceptive effectiveness appeared to work better than others. However, since the interventions differed across trials, we cannot determine the most useful approach. Two trials had multiple sessions for participants. In Omu 1989, women in the enhanced intervention group were more likely to choose a more effective contraceptive method than women in the standard counseling group (Omu 1989). For Kraft 2007, the groups received educational interventions of differing intensity. Both reportedly had increased contraceptive use, but use did not differ significantly between the groups.

The dominant delivery mode was a single information session. Five studies tested approaches to communicating contraceptive information in one session. Three trials had no follow-up, so we do not know if the knowledge was retained or whether the intervention affected contraceptive choice. In Marshall 1984, a slide-and-sound presentation resulted in more knowledge gain than the traditional oral presentation by a physician. Satisfaction was similar regardless of the medium used for communicating. In Steiner 2003, understanding of contraceptive effectiveness was better with a table focused on effectiveness categories than one with pregnancy numbers, and more women preferred the categories table. However, in Steiner 2006, comprehension was similar regardless of the type of chart viewed. More women in the group with the effectiveness categories chart liked their chart compared to women with an effectiveness chart stratified by typical or correct use. The other two trials had some follow-up. Langston 2010 provided structured counseling with a flipchart on contraceptive methods. The intervention and usual-care groups did not differ significantly in choice of contraceptive method (by effectiveness category) or in continuation of the chosen method at three months. Stephenson 2011 used videos to communicate contraceptive information to couples. The analyses showed no significant differences in the types of contraceptives chosen. The report only had baseline data; manuscripts are reportedly in progress with pregnancy and contraceptive use data.

Many of the trials focused on testing educational tools, and none had an explicit theoretical base. However, Omu 1989 mentioned perceived benefits from the Health Belief Model (Janz 2002). The intervention in Kraft 2007 specifically addressed the constructs of positive expectations, norms, and self-efficacy (i.e., confidence in one's ability to perform a certain behavior). These concepts are elements of Bandura's Social Cognitive Theory (Baranowski 2002). In Stephenson 2011, one study arm received a motivational video. The report did not mention what motivational principles were used, e.g., the Information-Motivation-Behavior Skills Model (Fisher 1992). The limited use of theory or models in these trials contrasts with the extensive use in HIV research (Albarracín 2005; Fishbein 2000). Behavioral science has also been incorporated more formally into interventions for preventing sexually transmitted diseases (Aral 2007). More intentional use of theory may help expand the knowledge base of what works in contraceptive counseling.

 

Overall completeness and applicability of evidence

Given the limited number of studies, not all regions and settings were represented. Four trials were conducted in the USA, while Nigeria and Zambia were represented by one study each, and one trial was done in both Jamaica and India. Four studies took place in clinical settings, while three provided the intervention in the community.

We cannot meaningfully compare the varied types of interventions, outcome measures, and assessment timeframes ( Table 1). Interventions included providing structured counseling in a post-abortion setting, showing charts of contraceptive methods to women in a shopping center, and conducting multiple risk-reduction sessions with HIV serodiscordant or concordant couples. Most of the reports did not provide specifics about how contraceptive effectiveness was presented, e.g., categories of relative effectiveness or tables of specific numbers. Outcomes ranged from understanding a chart the woman was viewing to consistent use of an effective contraceptive method. Further, some studies had follow-up of three to six months while others assessed outcomes immediately after the intervention.

 

Quality of the evidence

The quality of evidence is based on the evidence from the included studies. The assessment addresses the utility of the evidence for this review as well as design features. The overall quality is considered to be low ( Table 2), given that five of the seven studies provided low or very low quality evidence for this review. Of the remaining two trials, the evidence was considered high quality from one and moderate quality from the other. The primary differences for the higher-quality studies included assessing contraceptive uptake or use as well as measuring the outcome during follow-up.

None of the studies mentioned whether the instruments used to assess knowledge or attitudes had been tested for validity or reliability. The interventions in four trials appeared to be primarily method-driven, as the studies tested tools or media to communicate contraceptive information (Marshall 1984; Steiner 2003; Steiner 2006; Langston 2010).

 

Potential biases in the review process

The evidence quality summary was developed post hoc. While it was based on information already extracted, we may have been biased in selecting the criteria for downgrading trials.

 

Authors' conclusions

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

 

Implications for practice

Health care providers routinely communicate contraceptive information to their patients. Due to the many types of interventions here, we cannot say overall what would best help consumers choose an appropriate contraceptive method. For presenting pregnancy risk data, one trial found that categories of method effectiveness were better, or more preferred, than numbers of pregnancies. Another trial indicated that audiovisual aids worked better than the usual oral presentation by a physician. One trial showed that an enhanced counseling program led to more women choosing sterilization, which was emphasized, or a modern method of contraception.

 
Implications for research

These trials varied greatly in the types of participants and interventions to communicate contraceptive effectiveness. More detailed reporting of intervention content would help in interpreting results. Reporting should include whether the instruments used to assess knowledge or attitudes were tested for validity or reliability. Strategies for communicating information should be tested in clinical settings and measured for their effect on contraceptive choice. Follow-up should be incorporated to assess retention of knowledge over time.

 

Acknowledgements

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

Carol Manion of FHI 360 helped with the literature searches in 2008 and 2010.

 

Data and analyses

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms
Download statistical data

 
Comparison 1. Expanded counseling and education program versus standard family planning information

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Woman's contraceptive use: sterilized by 6 weeks postpartum11012Odds Ratio (M-H, Fixed, 95% CI)4.26 [2.46, 7.37]

 2 Woman's contraceptive use: modern contraceptive method at 6 weeks postpartum11012Odds Ratio (M-H, Fixed, 95% CI)2.35 [1.82, 3.03]

 3 Woman's contraceptive use: no contraceptive method at 6 weeks postpartum11012Odds Ratio (M-H, Fixed, 95% CI)0.44 [0.32, 0.61]

 4 Woman's attitudes at 6 weeks postpartum1Odds Ratio (M-H, Fixed, 95% CI)Subtotals only

    4.1 Agreed sterilization was safe
11012Odds Ratio (M-H, Fixed, 95% CI)9.15 [6.77, 12.36]

    4.2 Believed woman would still be strong after sterilization
11012Odds Ratio (M-H, Fixed, 95% CI)9.67 [7.14, 13.10]

    4.3 Agreed sex drive would not change after sterilization
11012Odds Ratio (M-H, Fixed, 95% CI)11.02 [8.08, 15.03]

    4.4 Agreed women's status would not change
11012Odds Ratio (M-H, Fixed, 95% CI)9.19 [6.86, 12.31]

 
Comparison 2. Couples intervention to reduce risk for unintended pregnancy versus standard care

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Perceived pregnancy risk (at 6 months)1221Mean Difference (IV, Fixed, 95% CI)0.0 [-0.23, 0.23]

 2 Perceived importance of not becoming pregnant (at 6 months)1220Mean Difference (IV, Fixed, 95% CI)0.01 [-0.32, 0.34]

 3 Positive expectations for partner's support for contraception (at 6 months)1220Mean Difference (IV, Fixed, 95% CI)0.07 [-0.25, 0.39]

 4 Participation in contraceptive decision making (at 6 months)1190Mean Difference (IV, Fixed, 95% CI)0.09 [-0.17, 0.35]

 
Comparison 3. Couples intervention for long-term contraceptive use (videos)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Contraceptive chosen: methods video versus control video1Odds Ratio (M-H, Fixed, 95% CI)Subtotals only

    1.1 Condoms or none
1767Odds Ratio (M-H, Fixed, 95% CI)0.99 [0.54, 1.82]

    1.2 Oral contraceptives or injectables
1767Odds Ratio (M-H, Fixed, 95% CI)0.79 [0.57, 1.09]

    1.3 Implant, IUD, or tubal sterilization
1767Odds Ratio (M-H, Fixed, 95% CI)0.91 [0.62, 1.33]

 2 Contraceptive chosen: motivational video versus methods video1Odds Ratio (M-H, Fixed, 95% CI)Subtotals only

    2.1 Condoms or none
1763Odds Ratio (M-H, Fixed, 95% CI)0.94 [0.52, 1.70]

    2.2 Oral contraceptives or injectables
1763Odds Ratio (M-H, Fixed, 95% CI)1.17 [0.83, 1.64]

    2.3 Implant, IUD, or tubal sterilization
1763Odds Ratio (M-H, Fixed, 95% CI)0.84 [0.57, 1.24]

 3 Contraceptive chosen: motivational+methods videos versus methods video1Odds Ratio (M-H, Fixed, 95% CI)Subtotals only

    3.1 Condoms or none
1735Odds Ratio (M-H, Fixed, 95% CI)1.21 [0.68, 2.14]

    3.2 Oral contraceptives or injectables
1735Odds Ratio (M-H, Fixed, 95% CI)0.83 [0.59, 1.15]

    3.3 Implant, IUD, or tubal sterilization
1735Odds Ratio (M-H, Fixed, 95% CI)1.18 [0.81, 1.71]

 
Comparison 4. Structured counseling versus usual care

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Contraceptive chosen1Odds Ratio (M-H, Fixed, 95% CI)Subtotals only

    1.1 Very effective method
1222Odds Ratio (M-H, Fixed, 95% CI)0.74 [0.44, 1.26]

    1.2 Effective method
1222Odds Ratio (M-H, Fixed, 95% CI)1.40 [0.81, 2.40]

    1.3 Less effective method
1222Odds Ratio (M-H, Fixed, 95% CI)0.94 [0.36, 2.47]

 2 Continuation at 3 months1172Odds Ratio (M-H, Fixed, 95% CI)1.34 [0.66, 2.72]

    2.1 Very effective method
1100Odds Ratio (M-H, Fixed, 95% CI)1.76 [0.63, 4.92]

    2.2 Effective method
172Odds Ratio (M-H, Fixed, 95% CI)1.03 [0.38, 2.79]

 
Comparison 5. Personalized audiovisual education materials versus nonpersonalized materials

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Knowledge gain1Mean Difference (IV, Fixed, 95% CI)Subtotals only

    1.1 Slide and sound with familiar versus unfamiliar voice
140Mean Difference (IV, Fixed, 95% CI)-2.75 [-10.82, 5.32]

    1.2 Oral presentation versus slide and sound with unfamiliar voice
140Mean Difference (IV, Fixed, 95% CI)-19.0 [-27.52, -10.48]

    1.3 Oral presentation versus pamphlet
140Mean Difference (IV, Fixed, 95% CI)-5.0 [-13.10, 3.10]

    1.4 Combined methods versus slide and sound with familiar voice
140Mean Difference (IV, Fixed, 95% CI)3.0 [-4.82, 10.82]

 2 Satisfaction excellent1Odds Ratio (M-H, Fixed, 95% CI)Subtotals only

    2.1 Slide and sound with familiar versus unfamiliar voice
140Odds Ratio (M-H, Fixed, 95% CI)2.85 [0.78, 10.47]

    2.2 Oral presentation versus slide and sound with unfamiliar voice
140Odds Ratio (M-H, Fixed, 95% CI)1.0 [0.29, 3.48]

    2.3 Oral presentation versus pamphlet
140Odds Ratio (M-H, Fixed, 95% CI)0.82 [0.24, 2.84]

    2.4 Combined methods versus slide and sound with familiar voice
140Odds Ratio (M-H, Fixed, 95% CI)1.29 [0.32, 5.17]

 
Comparison 6. Communicating pregnancy risk (three tables)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Change in comprehension: categories versus numbers1Odds Ratio (M-H, Fixed, 95% CI)Subtotals only

    1.1 Knew hormone injections were more effective than pills
1289Odds Ratio (M-H, Fixed, 95% CI)2.42 [1.43, 4.12]

    1.2 Knew combined pills were more effective than condoms
1289Odds Ratio (M-H, Fixed, 95% CI)2.19 [1.21, 3.97]

 2 Change in comprehension: categories versus categories+numbers1Odds Ratio (M-H, Fixed, 95% CI)Subtotals only

    2.1 Knew hormone injections were more effective than pills
1286Odds Ratio (M-H, Fixed, 95% CI)2.58 [1.50, 4.42]

    2.2 Knew combined pills were more effective than condoms
1286Odds Ratio (M-H, Fixed, 95% CI)2.03 [1.13, 3.64]

 3 Perception that table provided enough information to choose: categories versus numbers1289Odds Ratio (M-H, Fixed, 95% CI)0.58 [0.32, 1.06]

 4 Perception that table was difficult to understand: categories versus numbers1289Odds Ratio (M-H, Fixed, 95% CI)0.29 [0.13, 0.63]

 5 Perception that table provided enough information to choose: categories versus categories+numbers1286Odds Ratio (M-H, Fixed, 95% CI)0.60 [0.33, 1.08]

 6 Perception that table was difficult to understand: categories versus categories+numbers1286Odds Ratio (M-H, Fixed, 95% CI)0.38 [0.17, 0.85]

 
Comparison 7. Communicating pregnancy risk (three charts)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Change in comprehension: categories versus stratified1Odds Ratio (M-H, Fixed, 95% CI)Subtotals only

    1.1 Knew pills were more effective than condoms
1598Odds Ratio (M-H, Fixed, 95% CI)1.36 [0.95, 1.93]

    1.2 Knew IUDs were more effective than hormone injections
1598Odds Ratio (M-H, Fixed, 95% CI)1.22 [0.85, 1.77]

 2 Change in comprehension: categories versus continuum1Odds Ratio (M-H, Fixed, 95% CI)Subtotals only

    2.1 Knew pills were more effective than condoms
1600Odds Ratio (M-H, Fixed, 95% CI)1.07 [0.76, 1.51]

    2.2 Knew IUDs were more effective than hormone injections
1600Odds Ratio (M-H, Fixed, 95% CI)1.11 [0.77, 1.59]

 3 Perceptions of chart: categories versus stratified1Odds Ratio (M-H, Fixed, 95% CI)Subtotals only

    3.1 Provided enough information to choose
1598Odds Ratio (M-H, Fixed, 95% CI)1.97 [1.13, 3.44]

    3.2 Was easy to understand
1598Odds Ratio (M-H, Fixed, 95% CI)1.47 [1.03, 2.10]

 4 Perceptions of chart: categories versus continuum1Odds Ratio (M-H, Fixed, 95% CI)Subtotals only

    4.1 Provided enough information to choose
1600Odds Ratio (M-H, Fixed, 95% CI)1.62 [0.91, 2.87]

    4.2 Was easy to understand
1600Odds Ratio (M-H, Fixed, 95% CI)0.91 [0.65, 1.27]

 

Appendices

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms
 

Appendix 1. Search 2012 to 2013

 

MEDLINE via PubMed (01 Jan 2010 to Feb 12 Nov 2013)

("Contraception"[MeSH] OR contracept*) AND (decision OR choice OR choose OR counsel* OR educat* OR communicat* OR information disseminat*) NOT (cancer OR polycystic)
Field: Title/Abstract
Limits: Clinical Trial

 

CENTRAL (01 Jan 2010 to 20 Nov 2012)

contracept* in Title, Abstract or Keywords
AND decision OR choice OR choose OR counsel* OR communicat* OR educat* OR information disseminat* in Title, Abstract or Keywords
NOT cancer OR polycystic OR postmenopaus* in Title, Abstract or Keywords

 

POPLINE (2009 to 26 Nov 2012)

Global: (contraceptive effectiveness AND communication) NOT HIV
Filter by keywords: Interventions; Research report

 

PsycINFO and CINAHL (01 Jan 2010 to 22 Aug 2012)

(contraception or contraceptive or contraceptives or birth control) AND efficacy AND (communicat* or decision or choice or choose or counsel* or information disseminat*)

 

ClinicalTrials.gov (01 Jan 2010 to 22 Aug 2012)

Search terms: decision OR choice OR choose OR counsel OR counseling OR educate OR educating OR communicating OR communicate OR information dissemination
Study type: Interventional studies
Intervention: (contraception OR contraceptive) NOT abortion
Conditions: NOT (cancer OR polycystic OR HIV OR Turner OR postmenopausal)

 

ICTRP (01 Jan 2010 to 22 Aug 2012)

Title: decision OR choice OR choose OR counsel OR counseling OR educate OR educating OR communicating OR communicate OR information dissemination
Condition: contraception OR contraceptive

 

Appendix 2. Previous searches, 2007 and 2010

 

MEDLINE via PubMed (through 10 Mar 2010)

("Contraception"[MeSH] OR contracept*) AND (decision OR choice OR choose OR counsel* OR educat* OR communicat* OR information disseminat*) NOT (cancer OR polycystic)
Field: Title/Abstract
Limits: Clinical Trial, Randomized Controlled Trial

 

CENTRAL (through 17 Mar 2010)

contracept* in Title, Abstract or Keywords
AND decision OR choice OR choose OR counsel* OR communicat* OR educat* OR information disseminat* in Title, Abstract or Keywords
NOT cancer OR polycystic OR postmenopaus* in Title, Abstract or Keywords

 

POPLINE (through 06 Apr 2010)

contraceptive effectiveness & communication

 

EMBASE (through 05 Apr 2010)

contracept? AND efficacy AND (decision OR choice OR choos? OR counsel? OR communicat? OR information()disseminat?)

 

PsycINFO and CINAHL (through 05 Apr 2010)

(contraception or contraceptive or contraceptives or birth control) AND efficacy AND (communicat* or decision or choice or choose or counsel* or information disseminat*)

 

ClinicalTrials.gov (through 25 Mar 2010)

Search terms: decision OR choice OR choose OR counsel OR counseling OR educate OR educating OR communicating OR communicate OR information dissemination
Study type: Interventional studies
Intervention: (contraception OR contraceptive) NOT abortion
Conditions: NOT (cancer OR polycystic OR HIV OR Turner OR postmenopausal)

 

ICTRP (through 25 Mar 2010)

Title: decision OR choice OR choose OR counsel OR counseling OR educate OR educating OR communicating OR communicate OR information dissemination
Condition: contraception OR contraceptive

 

What's new

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

Last assessed as up-to-date: 13 February 2013.


DateEventDescription

13 February 2013New citation required but conclusions have not changedAdded two new trials (Langston 2010; Stephenson 2011).

Added summaries of intervention characteristics ( Table 1) and evidence quality ( Table 2).

Removed information on implied theories or models. No trial had an explicit theory base.

12 February 2013New search has been performedSearches updated. One ongoing trial added (Madden 2011). Two trials excluded (Akman 2010; Vogt 2012).



 

History

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

Protocol first published: Issue 1, 2008
Review first published: Issue 2, 2008


DateEventDescription

14 April 2010New search has been performedSearches were updated. No new trials were included; several new ones were excluded. A trial in progress was added (Westhoff 2010).

15 April 2008AmendedConverted to new review format.

1 December 2007New citation required and conclusions have changedSubstantive amendment



 

Contributions of authors

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

L Lopez conducted the primary data abstraction, drafted the review, updated the searches into 2013, and incorporated the new studies. D Grimes developed the idea, did the secondary data abstraction for the initial review, and edited the manuscript. M Steiner provided content expertise and reviewed the manuscript. In 2012, D Hilgenberg reviewed search results and did the secondary data abstraction. K Schulz provided statistical expertise and reviewed the manuscript.

 

Declarations of interest

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

M Steiner of FHI 360 is the lead author of two trials included in this review (Steiner 2003; Steiner 2006). At the time of the initial review, all authors were employed by FHI 360 where the Steiner trials were conducted.

Omu 1989 also involved personnel at FHI 360 but did not include any of the authors of this review.

 

Sources of support

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms
 

Internal sources

  • No sources of support supplied

 

External sources

  • National Institute of Child Health and Human Development, USA.
    Funding to FHI 360 for conducting the review (LML, DAG, MS, KFS)
  • U.S. Agency for International Development, USA.
    Funding to FHI 360 for conducting the review (LML, DAG, MS, KFS)

* Indicates the major publication for the study

References

References to studies included in this review

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Characteristics of studies
  18. References to studies included in this review
  19. References to studies excluded from this review
  20. References to ongoing studies
  21. Additional references
Kraft 2007 {published and unpublished data}
  • Kraft JM, Harvey SM, Thorburn S, Henderson JT, Posner SF, Galavotti C. Intervening with couples: assessing contraceptive outcomes in a randomized pregnancy and HIV/STD risk reduction intervention trial. Womens Health Issues 2007;17(1):52-60.
Langston 2010 {published data only}
  • Langston AM, Rosario L, Westhoff CL. Structured contraceptive counseling--a randomized controlled trial. Patient Education and Counseling. 2010/09/28 2010; Vol. 81, issue 3:362-7.
  • Westhoff C. Randomized controlled trial of structured contraceptive counseling in adult women. http://clinicaltrials.gov/ct2/show/NCT00746993 (accessed 25 Mar 2010). [: NCT00746993]
  • World Health Organization. Decision-making tool for family planning clients and providers. http://www.who.int/reproductivehealth/publications/family_planning/9241593229index/en/index.html (accessed 08 Jan 2012).
Marshall 1984 {published data only}
Omu 1989 {published data only}
  • Omu AE, Weir SS, Janowitz B, Covington DL, Lamptey PR, Burton NN. The effect of counseling on sterilization acceptance by high-parity women in Nigeria. International Family Planning Perspectives 1989;15(2):66-71.
Steiner 2003 {published data only}
  • Steiner MJ, Dalebout S, Condon S, Dominik R, Trussell J. Understanding risk: a randomized controlled trial of communicating contraceptive effectiveness. Obstetrics & Gynecology 2003;102(4):709-17.
Steiner 2006 {published and unpublished data}
  • Steiner MJ, Trussell J, Mehta N, Condon S, Subramaniam S, Bourne D. Communicating contraceptive effectiveness: a randomized controlled trial to inform a World Health Organization family planning handbook. American Journal of Obstetrics and Gynecology 2006;195(1):85-91.
Stephenson 2011 {published data only}
  • Allen 2007. Preventing unplanned pregnancies in HIV infected Zambian couples. http://clinicaltrials.gov/ct2/show/NCT 00067522 (accessed 31 Jul 2012). [: NCT00067522]
  • Stephenson R, Vwalika B, Greenberg L, Ahmed Y, Vwalika C, Chomba E, et al. A randomized controlled trial to promote long-term contraceptive use among HIV-serodiscordant and concordant positive couples in Zambia. Journal of Women's Health. 2011/03/18 2011; Vol. 20, issue 4:567-74.

References to studies excluded from this review

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Characteristics of studies
  18. References to studies included in this review
  19. References to studies excluded from this review
  20. References to ongoing studies
  21. Additional references
Akman 2010 {published data only}
  • Akman M, Tüzün S, Uzuner A, Başgul A, Kavak Z. The influence of prenatal counselling on postpartum contraceptive choice. Journal of International Medical Research. 2010/10/12 2010; Vol. 38, issue 4:1243-9.
Barnet 2009 {published data only}
  • Barnet B, Liu J, DeVoe M, Duggan AK, Gold MA, Pecukonis E. Motivational intervention to reduce rapid subsequent births to adolescent mothers: a community-based randomized trial. Annals of Family Medicine 2009;7(5):436-45.
Bashour 2008 {published data only}
Bolam 1998 {published data only}
  • Bolam A, Manandhar DS, Shrestha O, Ellis M, Costello AM. The effects of postnatal health education for mothers on infant care and family planning practices in Nepal: a randomised controlled trial. BMJ 1998;316(7134):805-11.
Carneiro 2011 {published data only}
  • Carneiro Gomes Ferreira A L, Impieri Souza A, Evangelista Pessoa R, Braga C. The effectiveness of contraceptive counseling for women in the postabortion period: an intervention study. Contraception 2011;84(4):377-83.
Chewning 1999 {published data only}
  • Chewning B, Mosena P, Wilson D, Erdman H, Potthoff S, Murphy A, et al. Evaluation of a computerized contraceptive decision aid for adolescent patients. Patient Education and Counseling 1999;38(3):227-39.
Danielson 1990 {published data only}
  • Danielson R, Marcy S, Plunkett A, Wiest W, Greenlick MR. Reproductive health counseling for young men: what does it do?. Family Planning Perspectives 1990;22(3):115-21.
Floyd 2007 {published data only}
  • Floyd RL, Sobell M, Velasquez MM, Ingersoll K, Nettleman M, Sobell L, et al. Preventing alcohol-exposed pregnancies. A randomized controlled trial. American Journal of Preventive Medicine 2007;32:1-10.
Garbers 2012 {published data only}
  • Garbers S, Meserve A, Kottke M, Hatcher R, Chiasson M A. Tailored health messaging improves contraceptive continuation and adherence: results from a randomized controlled trial. Contraception 2012;86(5):536-42.
  • Garbers S, Meserve A, Kottke M, Hatcher R, Ventura A, Chiasson M A. Randomized controlled trial of a computer-based module to improve contraceptive method choice. Contraception 2012;86(4):383-90.
Harvey 2004 {published data only}
  • Harvey SM, Henderson JT, Thorburn S, Beckman LJ, Casillas A, Mendez L, et al. A randomized study of a pregnancy and disease prevention intervention for Hispanic couples. Perspectives on Sexual and Reproductive Health 2004;36(4):162-9.
Lazcano Ponce 2000 {published data only}
  • Lazcano Ponce EC, Sloan NL, Winikoff B, Langer A, Coggins C, Heimburger A, et al. The power of information and contraceptive choice in a family planning setting in Mexico. Sexually Transmitted Infections 2000;76(4):277-81.
Lee 2007 {published data only}
Lei 1996 {published data only}
  • Lei Z-W, Wu SC, Garceau RJ, Jiang S, Yang Q-Z, Wang W-L, et al. Effect of pretreatment counseling on discontinuation rates in Chinese women given depo-medroxyprogesterone acetate for contraception. Contraception 1996;53(6):357-61.
Marcy 1983 {published data only}
McBride 2000 {published data only}
Melnick 2008 {published data only}
  • Melnick AL, Rdesinski RE, Creach ED, Choi D, Harvey SM. The influence of nurse home visits, including provision of 3 months of contraceptives and contraceptive counseling, on perceived barriers to contraceptive use and contraceptive use self-efficacy. Women’s Health Issues 2008;18(6):271-81.
Nobili 2007 {published data only}
  • Nobili MP, Piergrossi S, Brusati V, Moja EA. The effect of patient-centered contraceptive counseling in women who undergo a voluntary termination of pregnancy. Patient Education and Counseling 2007;65(3):361-8.
Peipert 2008 {published data only}
  • Peipert JF, Redding CA, Blume JD, Allsworth JE, Matteson KA, Lozowski F, et al. Tailored intervention to increase dual-contraceptive method use: a randomized trial to reduce unintended pregnancies and sexually transmitted infections. American Journal of Obstetrics and Gynecology 2008;198:630.e1-8.
Petersen 2007 {published data only}
Saeed 2008 {published data only}
Schunmann 2006 {published data only}
  • Schunmann C, Glasier A. Specialist contraceptive counselling and provision after termination of pregnancy improves uptake of long-acting methods but does not prevent repeat abortion: a randomized trial. Human Reproduction 2006;21(9):2296-303.
Shlay 2003 {published data only}
  • Shlay JC, Mayhugh B, Foster M, Maravi ME, Baron AE, Douglas JM Jr. Initiating contraception in sexually transmitted disease clinic setting: a randomized trial. American Journal of Obstetrics and Gynecology 2003;189(2):473-81.
Smith 2002 {published data only}
Vogt 2012 {published data only}
  • Vogt C, Schaefer M. Knowledge matters--impact of two types of information brochure on contraceptive knowledge, attitudes and intentions. European Journal of Contraception and Reproductive Health Care. 2011/12/28 2012; Vol. 17, issue 2:135-43.
Wight 2002 {published data only}
  • Wight D, Raab GM, Henderson M, Abraham C, Buston K, Hart G, et al. Limits of teacher delivered sex education: interim behavioural outcomes from randomised trial. BMJ 2002;324(7351):1430.
Zhu 2009 {published data only}
  • Zhu JL, Zhang W-H, Cheng Y, Xu J, Xu X, Gibson D, et al. Impact of post-abortion family planning services on contraceptive use and abortion rate among young women in China: a cluster randomized trial. European Journal of Contraception and Reproductive Health Care 2009;14(1):46-54.

Additional references

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Characteristics of studies
  18. References to studies included in this review
  19. References to studies excluded from this review
  20. References to ongoing studies
  21. Additional references
Albarracín 2005
  • Albarracín D, Gillette JC, Earl AN, Glasman LR, Durantini MR. A test of major assumptions about behavior change: a comprehensive look at the effects of passive and active HIV-prevention interventions since the beginning of the epidemic. Psychological Bulletin 2005;131(6):856-97.
Aral 2007
  • Aral SO, Douglas JM, Lipshutz JA. Behavioral interventions for prevention and control of sexually transmitted diseases. New York (NY): Springer Science+Business Media, LLC, 2007.
ARHP 2006
  • Association of Reproductive Health Professionals. Helping Your Patients Decide: Making Informed Health Choices about Hormonal Contraception. Washington (DC): ARHP, 2006.
Balshem 2011
  • Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. Journal of Clinical Epidemiology 2011;64(4):401-6.
Baranowski 2002
  • Baranowski T, Perry CL, Parcel GS. How individuals, environments, and health behavior interact. Social Cognitive Theory. In: Glanz K, Rimer RK, Lewis FM editor(s). Health Behavior and Health Education. Theory, Research, and Practice. 3rd Edition. San Francisco (CA): Jossey-Bass, 2002:165-84.
Bellg 2004
  • Bellg AJ, Borrelli B, Resnick B, Hecht J, Minicucci DS, Ory M, et al. Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH Behavior Change Consortium. Health Psychology 2004;23(5):443-51.
Borrelli 2005
  • Borrelli B, Sepinwall D, Ernst D, Bellg AJ, Czajkowski S, Breger R, et al. A new tool to assess treatment fidelity and evaluation of treatment fidelity across 10 years of health behavior research. Journal of Consulting and Clinical Psychology 2005;73(5):852-60.
Borrelli 2011
  • Borrelli B. The assessment, monitoring, and enhancement of treatment fidelity in public health clinical trials. Journal of Public Health Dentistry. 2011/04/19 2011; Vol. 71, issue s1:S52-63.
DiCenso 2002
  • DiCenso A, Guyatt G, Willan A, Griffith WL. Interventions to reduce unintended pregnancies among adolescents: systematic review of randomized controlled trials. BMJ 2002;324(7351):1426.
Fishbein 2000
Fisher 1992
Garcia 1997
  • Garcia SG, Snow R, Aitken I. Preferences for contraceptive attributes: voices of women in Cuidad Juárez, Mexico. International Family Planning Perspectives 1997;23(2):52-8.
Grady 1999
  • Grady WR, Klepinger DH, Nelson-Wally A. Contraceptive characteristics: the perceptions and priorities of men and women. Family Planning Perspectives 1999;31(4):168-75.
Guyatt 2011
  • Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. Journal of Clinical Epidemiology 2011;64(4):383-94.
Halpern 2011
Higgins 2011
  • Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org. John Wiley & Sons, Ltd, (accessed 26 Mar 2012).
Janz 2002
  • Janz NK, Champion VL, Strecher VJ. The Health Belief Model. In: Glanz K, Rimer BK, Lewis FM editor(s). Health Behavior and Health Education. Theory, Research, and Practice. 3rd Edition. San Francisco (CA): Jossey-Bass, 2002:45-66.
Lete 2007
  • Lete I, Doval JL, Pérez-Campos E, Sánchez-Borrego R, Correa M, de la Viuda E, et al. Factors affecting women's selection of a combined hormonal contraceptive method: the TEAM-06 Spanish cross-sectional study. Contraception 2007;76(2):77-83.
Lopez 2011
Lopez 2012
Mahajan 2007
Mayo-Wilson 2007
  • Mayo-Wilson E. Reporting implementation in randomized trials: proposed additions to the consolidated standards of reporting trials statement. American Journal of Public Health 2007;97(4):630-3.
O'Connor 2003
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