Electronic interventions for changing knowledge, attitudes or practices regarding contraception: a systematic review

Dewart, Courtney; Serpico, Jaclyn; Steiner, Markus J.; Gallo, Maria F

doi:10.1016/j.contraception.2019.04.004

Cited by 17 publications

(13 citation statements)

References 33 publications

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“…Digital interventions such as Contraception Choices can meet a need for convenient, trustworthy online information and support for contraception decisionmaking. 35,36 Our findings clearly show that the website was popular and well received by users and healthcare providers. Given the strikingly positive feedback about the website from women, the high level of intervention engagement (over four-fifths viewed the website) and low 'contamination' in the control group (only 7% of the control group reported seeing the website), the lack of difference in primary outcomes between groups was surprising.…”

Section: Discussionmentioning

confidence: 54%

“…In this study, we did not aim to assess such a development in clinical practice, but an area for future research is to examine whether it could lead to more efficient or satisfying consultations, for both patients and clinicians, with potentially better clinical or health service outcomes. 38 Electronic interventions for contraception which offer tailored material, increased frequency of intervention administration, and/or structured follow-up with a healthcare provider appear important for longer-term impact: 35 high quality evidence is needed on the effectiveness of different intervention designs, and cost-effectiveness of different models of intervention delivery.…”

Section: Discussionmentioning

confidence: 99%

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An interactive website for informed contraception choice: randomised evaluation of Contraception Choices

et al. 2020

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Objective Improving use of effective contraception to prevent unintended pregnancy is a global priority, but misperceptions and concerns about contraception are common. Our objective was to evaluate an interactive website to aid informed choice of contraception. Methods The Contraception Choices website is an interactive digital intervention which offers tailored advice to aid contraception decision-making ( www.contraceptionchoices.org ). In a parallel single-blind trial, we randomised 927 women aged 15–30 years from six clinic settings to access the intervention website (n = 464) or to a waiting-list control group (n = 463). The study was initially a feasibility trial, evolving into an evaluation of efficacy, with two primary outcomes at six months: long-acting reversible contraception (LARC) use, and satisfaction with contraceptive method. Secondary outcomes included self-reported pregnancy and sexually transmitted infection diagnoses. Free-text comments on the 3 and 6 month outcome surveys were analysed thematically. Findings There was no significant difference between intervention and control groups in the proportion of women using LARC [30.4% intervention versus 31.0% control; adjusted odds ratio 0.87 (95% confidence interval 0.60 to 1.28)]; satisfaction with contraceptive method [82.6% versus 82.1%; adjusted ordinal odds ratio 0.93 (95% CI 0.69 to 1.25)]; self-reported pregnancy [3.3% versus 4.1%; adjusted odds ratio 0.90 (95% CI 0.45 to 1.79)] nor sexually transmitted infection [5.3% versus 4.7%; adjusted odds ratio 0.72 (95% CI 0.55 to 2.36)]. Highly positive free-text comments from intervention participants indicated that the website facilitates contraception choice and can help women feel better prepared before consultation with healthcare providers. Interpretation The Contraception Choices website was popular for its design, trustworthy information and decision aids but it was not associated with significant differences in use of LARC or satisfaction with contraceptive method. An interactive website can aid contraception choice, but interventions that address factors beyond women’s control, such as access to services, and partner, family or community influences are needed to complement this approach. Research in context Preventing unintended pregnancy through effective use of contraception is essential for women’s health, but choosing between different contraceptive methods can be challenging, and the opportunity for adequate discussion during routine consultations is often constrained. Evidence before this study We conducted two systematic literature reviews: 1) Factors influencing contraception choice, uptake and use: a meta-synthesis of systematic reviews; and 2) Effectiveness of interactive digital interventions (IDI) for contraception choice, uptake and use. For the first review we searched PubMed, CDSR, Epistemonikos, DoPHER, DARE, NHS Economic Evaluation Database, Campbell Library, NIHR Health Technology Assessment, and Health Evidence Canada databases for systematic reviews which addressed contraceptive choice, uptake or use, from 2000 to 2017. PROSPERO registration number: CRD42017081521 https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=81521 . We synthesised the findings of 18 systematic reviews of mostly moderate or high quality. They highlighted the importance of women’s knowledge, beliefs, perceptions of side effects and health risks, as well as relationship status, social network, economic and healthcare factors on contraception choice and use. For the second review, we searched 23 electronic databases, trials registers and reference lists for randomised controlled trials of IDI for contraception, including CENTRAL, MEDLINE, EMBASE, CINAHL, ERIC, ASSIA and PsycINFO, from start date to June 2017. PROSPERO registration number: CRD42017081636. We found only five randomised trials of IDI, all from the USA. Risk of bias prevented synthesis of results. www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=81636 . Added value of this study Women’s common concerns about contraception – fear of hormones, weight gain, cancer, infertility, mood changes, breaks from contraception and changes in bleeding patterns – underpinned development of a new interactive website ( www.contraceptionchoices.org ). Contraception Choices addresses women’s concerns through succinct text; Q and A format ( Frequently Asked Questions, Did you Know?; videos of women and health professionals); an effectiveness infographic, and an interactive decision aid ( What’s right for me?). In an online randomised trial with 927 women attending clinics, we found no association of the Contraception Choices intervention with the primary outcomes – satisfaction with contraceptive method and uptake of long-acting reversible methods at 6 months. Nor did we find an association with secondary adverse outcomes – sexually transmitted infections or pregnancy. Comments from women indicated that the website can meet young women’s need for information on the benefits and drawbacks of contraception, help them to make informed decisions, and feel better prepared before healthcare consultations. Contraception Choices is now available on the NHS website: www.nhs.uk/conditions/contraception/which-method-suits-me Implications of all the available evidence Interactive digital interventions (websites) can aid contraception choice, but other intervention research is needed to address wider influences on unintended pregnancy, including partner views, friends, family, the media, wider society and experiences with healthcare professionals. Future research could examine the impact of the website in different settings, e.g. schools or different countries. We hypothesise that use of the website during contraceptive consultations might improve the efficiency or quality of consultation, for both patients and healthcare providers. Appropriate methodology and time-scale for evaluating digital health interventions remains a key question.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

An interactive website for informed contraception choice: randomised evaluation of Contraception Choices

et al. 2020

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“…The emerging attitude shift in the way young men and women engage with health information in our study, which ultimately filters through to their decision making choices around implant use, is inspired by a recent, global and rapid change in young person's access to diverse external information via the internet and social media [43,44]. Such altered exposure provoked the younger men in our study to proactively seek out biomedical information from health workers to inform their decisions and in doing so by-passed the more inflexible pathways that determine information access and acceptability for their elders.…”

Section: Decision-making Around Contraceptionmentioning

confidence: 99%

Community attitudes and gendered influences on decision making around contraceptive implant use in rural Papua New Guinea

et al. 2020

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Background: Despite targeted interventions to improve contraceptive implant acceptability and uptake in rural Papua New Guinea (PNG), ongoing use of this method remains limited. Previous literature has suggested community attitudes and intrinsic factors within the decision-making process may be negatively impacting on implant uptake, however these elements have not previously been studied in detail in this context. We set out to explore community attitudes towards the contraceptive implant and the pathways to decision making around implant use in a rural community on Karkar Island, PNG. Methods: We conducted 10 focus-group (FGD) and 23 in-depth interviews (IDI) using semi-structured topic guides. Key sampling characteristics included age, exposure or non-exposure to implants, marital status, education and willingness to participate in discussion. Four FGDs were held with women, four with men and two with mixed gender. IDIs were carried out with five women (current implant users, former implant users, implant never users), five men, five religious leaders (Catholic and non-Catholic), four village leaders and four health workers. Two indepth interviews (four participants) were analysed as dyads and the remaining participant responses were analysed individually. Results: Men were supportive of their wives using family planning but there was a community-wide lack of familiarity about the contraceptive implant which influenced its low uptake. Men perceived family planning to be 'women's business' but remained strongly influential in the decision making processes around method use. Young men were more receptive to biomedical information than older men and had a greater tendency towards wanting to use implants. Older men preferred to be guided by prominent community members for decisions concerning implants whilst young men were more likely to engage with health services directly.

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“…Videos in particular can be made accessible and relevant to specific populations by modifying video content, dissemination platforms and language use. Health-related videos can impact health behaviours such as treatment adherence,9 and can influence contraceptive knowledge, method choice and reduce rates of unintended pregnancy 10 11. However, video interventions for contraception have rarely been promoted to young people independent of a health provider interaction or outside healthcare settings 10 11…”

Section: Introductionmentioning

confidence: 99%

Can an online educational video broaden young women’s contraceptive choice? Outcomes of the PREFER pre-post intervention study

Mazza

Buckingham

McCarthy

et al. 2022

BMJ Sex Reprod Health

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IntroductionContraceptive knowledge mediates access and use. We aimed to assess whether an online educational video describing all methods and their benefits, side effects and mode of action increased young women’s contraceptive knowledge and their long-acting reversible contraception (LARC) preference and uptake.MethodWe used Facebook advertising to recruit young women aged 16–25 years. Participants completed the pre-video survey (S1), watched the 11-min video, then completed surveys immediately after (S2) and 6 months later (S3). Outcomes were analysed using McNemar tests and multivariate logistic regression (generalised estimating equations).ResultsA total of 322 participants watched the video, completed S1 and S2, and 88% of those completed S3. At S1 only 6% rated their knowledge about every method as high. Knowledge improved at S2 for all methods (OR 10.0, 95% CI 5.9 to 17.1) and LARC (OR 4.2, 95% CI 3.1 to 5.7). LARC preference increased at S2 (OR 1.7, 95% CI 1.4 to 2.1) and S3 (OR 1.4, 95% CI 1.2 to 1.7), as did LARC uptake at S3 (OR 1.3, 95% CI 1.11 to 1.5). LARC uptake was driven by a 4.3% (n=12) absolute increase in intrauterine device (IUD) use, but there was no change in contraceptive implant use (p=0.8). The use of non-prescription methods such as condoms and withdrawal did not change (OR 0.92, 95% CI 0.76 to 1.11).ConclusionsMany young women in Australia do not feel well informed about their contraceptive options. The contraceptive education video, delivered via social media, increased their self-reported contraceptive knowledge and IUD preference immediately after viewing, and their IUD uptake 6 months later. Focus should be given to how young women navigate contraceptive access after internet-based education, and strategies to increase access to preferred methods.

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Electronic interventions for changing knowledge, attitudes or practices regarding contraception: a systematic review

Cited by 17 publications

References 33 publications

An interactive website for informed contraception choice: randomised evaluation of Contraception Choices

An interactive website for informed contraception choice: randomised evaluation of Contraception Choices

Community attitudes and gendered influences on decision making around contraceptive implant use in rural Papua New Guinea

Can an online educational video broaden young women’s contraceptive choice? Outcomes of the PREFER pre-post intervention study

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