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

Abstract

AimThe 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.MethodsSix 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.ResultsA 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.ConclusionsThe evidence base and quality of studies are limited, and further research is needed to determine the effectiveness of many counselling interventions in different settings.

Discontinuation and Switching of Postpartum Contraceptive Methods Over Twelve Months in Burkina Faso and the DRC: A Secondary Analysis of the Yam-Daabo trial

“…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 on providers training and decision-making tools for method choice did not nd evidence of an effect [15].…”

“…In the literature, few studies focused on the effect of family planning interventions on discontinuation and switching. We found three systematic reviews which concluded to a low level of evidence on the effect of the strategies to improve continuation of hormonal methods of contraception [13][14][15]. Halpern et al, in 2013, reported that only three trials showed some bene t of strategies to improve adherence and continuation.…”

Discontinuation and switching of postpartum contraceptive methods over twelve months in Burkina Faso and the DRC: a secondary analysis of the Yam-Daabo trial

“…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 on providers training and decision-making tools for method choice did not nd evidence of an effect [16].…”

“…In the literature, few studies focused on the effect of family planning interventions on discontinuation and switching. We found three systematic reviews which concluded to a low level of evidence on the effect of the strategies to improve continuation of hormonal methods of contraception [14][15][16]. Halpern et al, in 2013, reported that only three trials showed some bene t of strategies to improve adherence and continuation.…”

Missed Opportunities in Contraceptive Counselling: Findings from a European Survey-based Study with Simulated Patient Consultation

“…Current recommendations for optimal contraceptive counselling practice include an open dialogue between HCPs and women seeking contraception, with shared decision-making [1,[3][4][5]. In an effort to optimise this interaction between HCPs and women, numerous structured contraceptive counselling tools have been developed [6,7]. The "Contraception: HeLping for wOmen's choicE" (CHLOE) questionnaire, for example, elicits information on the woman, any relevant health conditions, and the woman's needs and preferences, which is then shared with the HCP to facilitate choice of the most appropriate contraceptive option [7].…”