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A systematic review of the effectiveness of counselling strategies for modern contraceptive methods: what works and what doesn't?

ABSTRACT: AIM:The aim of this systematic review was to synthesise the evidence on the comparative effectiveness of different counselling strategies for modern contraception on contraceptive behaviour and satisfaction, and to examine their advantages and disadvantages. METHODS:Six electronic databases (Medline, Embase, Global Health, Popline, CINAHL Plus, and Cochrane Library) were searched to identify publications comparing two or more contraceptive counselling strategies and reporting quantitative results on contraceptive use, uptake, continuation or switching, or client satisfaction. Studies of women or couples from any country, published in English since 1990 were considered. RESULTS:A total of 63 publications corresponding to 61 studies met the inclusion criteria. There was substantial heterogeneity in study settings, interventions and outcome measures. Interventions targeting women initiating a method (including structured counselling on side effects) tended to show positive effects on contraceptive continuation. In contrast, the majority of studies of provider training and decision-making tools for method choice did not find evidence of an effect. Additional antenatal or postpartum counselling sessions were associated with increased postpartum contraceptive use, regardless of their timing in pregnancy or postpartum. Dedicated pre-abortion contraceptive counselling was associated with increased use only when accompanied by broader contraceptive method provision. Male partner or couples counselling was effective at increasing contraceptive use in two of five studies targeting non-users, women initiating implants or seeking abortion. High-quality evidence is lacking for the majority of intervention types. CONCLUSIONS:The evidence base and quality of studies are limited, and further research is needed to determine the effectiveness of many counselling interventions in different settings.

SUBMITTER: Cavallaro FL

PROVIDER: S-EPMC7569400 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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A systematic review of the effectiveness of counselling strategies for modern contraceptive methods: what works and what doesn't?

Cavallaro Francesca L FL Benova Lenka L Owolabi Onikepe O OO Ali Moazzam M

BMJ sexual & reproductive health 20191211 4

<h4>Aim</h4>The aim of this systematic review was to synthesise the evidence on the comparative effectiveness of different counselling strategies for modern contraception on contraceptive behaviour and satisfaction, and to examine their advantages and disadvantages.<h4>Methods</h4>Six electronic databases (Medline, Embase, Global Health, Popline, CINAHL Plus, and Cochrane Library) were searched to identify publications comparing two or more contraceptive counselling strategies and reporting quan ...[more]

PMID: 31826883

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Project description:Background: A major challenge in providing mental health interventions for young people is making such interventions accessible and appealing to those most in need. Online and app-based forms of therapy for mental health are burgeoning. It is therefore crucial to identify features that are most effective and engaging for young users. Objectives: This study reports a systematic review and meta-analysis of digital mental health interventions and their effectiveness in addressing anxiety and depression in young people to determine factors that relate to outcomes, adherence, and engagement with such interventions. Methods: A mixed methods approach was taken, including a meta-analysis of 9 randomized controlled trials that compared use of a digital intervention for depression in young people to a no-intervention control group, and 6 comparing the intervention to an active control condition. A thematic analysis and narrative synthesis of 41 studies was also performed. Results: The pooled effect size of digital mental health interventions on depression in comparison to a no-intervention control was small (Cohen's d = 0.33, 95% CI 0.11 to 0.55), while the pooled effect size of studies comparing an intervention group to an active control showed no significant differences (Cohen's d = 0.14, 95% CI -.04 to 0.31). Pooled effect sizes were higher when supervision was involved (studies with no-intervention controls: Cohen's d = 0.52, 95% CI 0.23 to 0.80; studies with active control: Cohen's d = 0.49, 95% CI -0.11, 1.01). Engagement and adherence rates were low. Qualitative analysis revealed that users liked interventions with a game-like feel and relatable, interactive content. Educational materials were perceived as boring, and users were put off by non-appealing interfaces and technical glitches. Conclusions: Digital interventions work better than no intervention to improve depression in young people when results of different studies are pooled together. However, these interventions may only be of clinical significance when use is highly supervised. Digital interventions do not work better than active alternatives regardless of the level of support. Future interventions need to move beyond the use of digital educational materials, considering other ways to attract and engage young people and to ensure relevance and appeal.

Project description:The use of modern contraceptive methods (MCMs) has been stagnant for the last decade in Pakistan. The second most populous province, Sindh reports 25% of MCMs use. Various factors including demographics and health services utilization are associated with the uptake of family planning services. This research aimed to identify and assess specific predictors of MCMs among women aged 15-49 in two districts of Sindh-Matiari and Badin. A cross-sectional household survey was conducted from October 2020- December 2020. In total, 1684 Married Women of Reproductive Age (MWRA) 15-49 years were interviewed. For the selection of eligible respondents, a two-stage stratified cluster sampling strategy was used. Univariate and multivariable logistic regression was used to determine the predictors for the use of MCM. Use of modern methods of contraceptive was 26.1% (n = 441). Statistically significant socio demographic predictors of MCM included: number of children 4 or more (AOR: 5.23; 95%CI: 2.78-9.84), mother having primary education (AOR: 1.73; 95% CI: 1.26-2.36), and husband having middle education (AOR: 1.69; 95% CI: 1.03-2.76). Maternal health services indicators included: postnatal care of mother (AOR: 1.46; 95% CI: 1.09-2.05); women who were visited by Lady Health Workers in their postnatal period and were counselled on family planning (AOR: 1.83; 95% CI: 1.38-2.42). Since the primary purpose of using modern contraceptive methods is for limiting pregnancies, there is a potential to promote awareness about the benefits of birth spacing as part of implementing a more integrated approach to family planning. The integration of family planning services within maternal and newborn child healthcare services effectively promote the voluntary adoption of modern contraceptive methods. The role of Lady Health Workers in family planning counseling and service provision and uptake is important in the context of Sindh and should be fostered further by opportunities for capacity building and their empowerment.

Project description:BackgroundThe slow pace of fertility decline in Africa relative to other parts of the world has important implications for the region's economic development. Modern contraceptive use is seen as important population control and family planning strategy by governments worldwide. This paper examines the socioeconomic determinants of modern contraceptive use and choice among Ghanaian men and women.MethodsWe use the most recent and nationally representative Ghana Demographic and Health Survey conducted in 2014. The analysis is observational, with no causal implications. Bivariate and multivariate methods are used to analyse the data. We first use logistic regression to explore the correlates of modern contraceptive use among Ghanaian men and women. Second, we explore the socioeconomic factors influencing the choice of modern contraceptive methods among contraceptive users using multinomial logistic regression. We classify the modern methods of contraception into three groups: long-acting reversible contraceptives (LARC), short-acting contraceptives (SAC), and permanent contraceptives.ResultsMarital status proves to be the most significant predictor for both men and women, with women in monogamous unions having a greater propensity to use modern methods of contraception (OR = 1.4, p < 0.00). We also find that different factors affect the use and choice of modern methods of contraception among men and women in Ghana. Muslim men had a higher likelihood than Catholics to choose the permanent (sterilisation) method (OR = 11.9, p < 0.05), while their female counterparts were 0.25 times less likely to choose sterilisation over SAC (p < 0.05). Moreover, women who ever tested for HIV had higher use of LAC than the SAC ((RRR = 1.6, p < 0.01). The modern contraceptive users (women) with at most basic education were more likely than those with tertiary education to choose LAC over SAC. Finally, rural women with health insurance were 0.75 times (p < 0.01) less likely to use modern methods of contraception.ConclusionsThe paper reiterates the need to intensify and sustain public health education on the health benefits of using modern methods of contraception among the adult population. The paper suggests that including family planning services on Ghana's national health insurance benefits package is commendable. It can promote modern contraceptive use and curtail unwarranted population growth.

Project description:BackgroundProviding post-abortion care service is a widely accepted to reduce maternal morbidity and mortality by promoting, preventing and treating maternal and neonatal health, identifying the utilization and its factor of post abortion contraceptive is crucial. Therefore we tried to review post abortion contraceptive utilization and its factors in Ethiopia.MethodsA review was performed by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic and a comprehensive literature searching mechanism were used without any restriction, through Google scholar, PubMed, EMBASE, Scopus, Web of Sciences, and Grey literature databases for reporting utilization of post abortion family planning. Pilo-tested were performed in random sample studies and a standardized data extraction form was used. All statistical analyses were done using STATA version 14 software for windows, and meta-analysis was used with a random-effects method. The results are presented using texts, tables and forest plots with measures of effect and 95% confidence interval.ResultsAmong 1221 records, 11 studies were taken in the meta-analysis with 4336 Participants that full fill the inclusion criteria. The pooled prevalence of post abortion contraceptive in Ethiopia was 74.56% (95% CI (73.31%, 75.81%)). Married women (OR 2.01 (95% CI (1.52, 2.66), I2: 0.0%)), women who were counseled (OR 5.36 (95% CI (3.10, 9.29), I2: 79.5%)), women whose educational level tertiary and above (OR 2.28 (95% CI (1.66, 3.17), I2: 0.0%)), women who had ever used contraceptive (OR 3.76 (95% CI (2.19, 6.47), I2: 67.8%)) and those women's age 15-24 years old (OR 8.35 (95% CI (2.74, 14.74), I2: 87.4)) were statistically significant.ConclusionAccording to World Health Organization (WHO) guideline, "after a miscarriage or induced abortion, the recommended minimum interval to next pregnancy is at least 6 months in order to reduce risks of adverse maternal and perinatal outcomes".. According to this post abortion contraceptive utilization in Ethiopia is not optimal. Marital status, education, Counsel, previously exposed and age were significantly associated. Therefore, the Ministry of Health should work target fully to address those problems to maintain maternal and child health in Ethiopia.

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A systematic review of the effectiveness of counselling strategies for modern contraceptive methods: what works and what doesn't?

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A systematic review of the effectiveness of counselling strategies for modern contraceptive methods: what works and what doesn't?

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