Takaisin Tulosta

Strategies for communicating contraceptive effectiveness

Evidence summaries
Heidi Alenius
Last reviewed as up-to-date 29.1.2024Latest change 29.1.2024

Level of evidence: C

Audiovisual technology-based aids may be more effective for contraceptive use and continuation and in communicating contraceptive effectiveness compared with oral presentations or numbers.

A systematic review and meta-analysis «...»2 assessed technology-based decision aids on contraceptive use, continuation, and patient-reported and decision-making outcomes. 18 studies evaluating 21 decision aids were included. Overall, there were higher odds of contraceptive use and/or continuation among decision aid users compared with controls (odds rati, 1.27, 95% CI 1.05 to 1.55). Use of computer and web-based decision aids was associated with higher odds of contraceptive use and/or continuation (OR 1.36, 95% CI 1.08 to 1.72) than mobile and tablet decision aids (OR 1.27, 95% CI 0.83 to 1.94). Overall, the review provided moderate-level evidence for contraceptive use and continuation, knowledge, and self-efficacy.

Another systematic review and meta-analysis «...»3 included 35 RCTs with a total of 9 790 women. Patient decision aids were evaluated within a wide range of clinical scenarios in obstetrics and gynecology, including contraception. A standardized mean difference (SMD) of 0.2 is considered small, 0.5 moderate, and 0.8 large. When compared with usual clinical practice, the use of patient decision aids reduced decisional conflict (SMD -0.23, 95% CI -0.36, to -0.11; 19 trials; n=4 624) and improved patient knowledge (SMD 0.58, 95% CI 0.44 to 0.71; 17 trials; n=4 375).

A Cochrane review «Strategies for communicating contraceptive effectiveness»1 «Lopez LM, Steiner M, Grimes DA et al. Strategies f...»1 included 7 studies with a total of 4 526 subjects. Two trials provided multiple sessions for participants. Five trials provided one session and focused on testing educational material or media. In one study, knowledge gain favored a slide-and-sound presentation compared with a physician's oral presentation (WMD -19.00; 95% CI -27.52 to -10.48, n=100). In another study (n=461), 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.

Comment: The quality of evidence is downgraded by study quality (several limitations), by indirectness (differences in studied interventions and outcomes), by imprecise results (limited study size for each comparison).

References

  1. Lopez LM, Steiner M, Grimes DA et al. Strategies for communicating contraceptive effectiveness. Cochrane Database Syst Rev 2013;(4):CD006964. «PMID: 23633337»PubMed
  2. Goueth RC, Maki KG, Babatunde A, et al. Effects of technology-based contraceptive decision aids: a systematic review and meta-analysis. Am J Obstet Gynecol 2022;227(5):705-713.e9 «PMID: 35779590»PubMed
  3. Poprzeczny AJ, Stocking K, Showell M, et al. Patient Decision Aids to Facilitate Shared Decision Making in Obstetrics and Gynecology: A Systematic Review and Meta-analysis. Obstet Gynecol 2020;135(2):444-451 «PMID: 31923056»PubMed