Brief teaching methods to improve contraceptive use among young people

Background

Young people up to age 25 have high rates of unplanned pregnancy. They need modern birth control methods and services. We wanted to find ways to educate young people about birth control that are brief enough for clinic use.

Methods

To 7 March 2016, we ran computer searches for randomized and non-randomized studies. The teaching strategy could involve up to three sessions of 15 to 60 minutes plus follow-up. The effort had to address an effective method of birth control. Main outcomes were pregnancy and birth control use.

Results

We found 11 studies from 1983 to 2015 that included 8338 women. Ten studies were from the USA and one was from China. We focused here on the five studies that showed some effect. Two tested special counseling. At one year, teens with special counseling for their age used birth control more effectively than those with standard counseling.

Two studies used audiovisual tools plus counseling. One trial provided a slide-tape presentation on sexual health for young men. At one year, the treatment group was more likely than the control group to use an effective contraceptive and have a partner who used oral contraceptives (OCs). The other used a computer program for decision-making for young women. At one year, more women in the intervention group at one site used OCs compared with the control group.

Two other studies showed some effect. In one, young women with phone follow-up and counseling were more likely to have consistent OC use at three months and six months than the group with counseling only. Also at three months, they were more likely to report condom use at last sex. One trial that assigned sites compared an enhanced package of birth control services after abortion versus standard care. At six months, the enhanced-service group was more likely to use effective contraception and use condoms consistently and correctly.

Authors' conclusions

Few studies tested brief teaching methods for young people. About half of the studies had some effect, but they differed in methods and in ages and life situations of the young people. More intense strategies could work better, but would be difficult for many clinics to use. Overall, study quality was low.

Authors' conclusions: 

Few studies tested brief strategies for young people. We noted heterogeneity across studies in participants' ages and life situations. Of five studies with some effect, one provided moderate-quality evidence; four were older studies with low-quality evidence. More intensive strategies could be more effective, but would also be challenging for many clinics to implement.

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Background: 

Global high rates of unplanned pregnancy and abortion among young women demonstrate the need for increased access to modern contraceptive services. In sub-Saharan Africa, the birth rate for those aged 15 to 19 years is 121 per 1000. In the USA, 6% of teens aged 15 to 19 years became pregnant in 2010. Most pregnancies among young women to age 25 are unintended.

Objectives: 

The aim was to identify brief educational interventions for improving contraceptive use among young people that are feasible for implementing in a clinic or similar setting with limited resources.

Search strategy: 

To 7 March 2016, we searched for studies in CENTRAL, PubMed, POPLINE, Web of Science, ClinicalTrials.gov and ICTRP.

Selection criteria: 

We considered randomized controlled trials (RCTs) that assigned individuals or clusters as well as non-randomized studies (NRS). We included young people to age 25.

The intervention had to be sufficiently brief for a clinic, i.e. one to three sessions of 15 to 60 minutes plus potential follow-up. The strategy had to emphasize one or more effective methods of contraception. Primary outcomes were pregnancy and contraceptive use.

Data collection and analysis: 

We assessed titles and abstracts identified during the searches. One author extracted and entered the data into Review Manager; a second author verified accuracy. We examined studies for methodological quality.

For dichotomous outcomes, we calculated the Mantel-Haenszel odds ratio (OR) with 95% confidence interval (CI). For continuous variables, we computed the mean difference (MD) with 95% CI. We used adjusted measures for cluster RCTs, typically ORs, that the investigators reported. For NRS, which need to control for confounding, we also used reported adjusted measures. We did not conduct meta-analysis due to varied interventions and outcome measures.

Main results: 

We found 11 studies, published from 1983 to 2015, that included a total of 8338 participants. Ten were from the USA and one was from China. We focused here on intervention effects for our primary outcomes. Five studies showed some effect on contraceptive use. Of three RCTs that examined innovative counseling, one showed an intervention effect. At one year, adolescents with developmental counseling were more likely to use contraception effectively than those with standard counseling (OR 48.38, 95% CI 5.96 to 392.63).

Three studies used an audiovisual tool plus counseling; two reported some effect on contraceptive use. An NRS with young men, aged 15 to 18, examined a slide-tape presentation plus reproductive health consultation. At one year, the intervention group was more likely than the standard-care group to report using an effective contraceptive and having a partner who used oral contraceptives (OCs), both at last intercourse (reported adjusted OR 1.51 and 1.66, respectively). Another study utilized a computer program for contraceptive decision-making plus standard counseling for women to age 20. At one year, fewer women in the intervention group at one site had not used OCs compared with the counseling-only group (3.4% versus 8.8%; reported P = 0.05).

Three RCTs provided phone follow-up after counseling, one of which showed an effect on contraceptive use among women age 16 to 24. Women who received counseling plus phone calls to encourage contraceptive use were more likely than the counseling-only group to report consistent OC use at three months (OR 1.41, 95% CI 1.06 to 1.87) and six months (OR 1.39, 95% CI 1.03 to 1.87). Also at three months, they were more likely to report condom use at last sex (OR 1.45, 95% CI 1.03 to 2.03).

Two cluster randomized trials trained providers on contraceptive methods and counseling. One trial with an intervention effect tested comprehensive contraceptive services for women to age 25, postabortion. At six months, the comprehensive-service group was more likely than the standard-care group to use an effective contraceptive (reported adjusted OR 2.03, 95% CI 1.04 to 3.98) and to use condoms consistently and correctly (reported adjusted OR 5.68, 95% CI 3.39 to 9.53).

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