title: Strategies for communicating contraceptive effectiveness.
abstract: BACKGROUND
  Knowledge of contraceptive effectiveness is crucial to making an informed choice. The consumer has to comprehend the pros and cons of the contraceptive methods being considered. Choice may be influenced by understanding the likelihood of pregnancy with each method and factors that influence effectiveness.
  
  
  OBJECTIVE
  To review all randomized controlled trials comparing strategies for communicating to consumers the effectiveness of contraceptives in preventing pregnancy.
  
  
  METHODS
  Through February 2013, we searched the computerized databases of MEDLINE, POPLINE, CENTRAL, PsycINFO and CINAHL, ClinicalTrials.gov, and ICTRP. Previous searches also included EMBASE. We also examined references lists of relevant articles. For the initial review, we wrote to known investigators for information about other published or unpublished trials.
  
  
  METHODS
  We included randomized controlled trials that compared methods for communicating contraceptive effectiveness to consumers. The comparison could be usual practice or an alternative to the experimental intervention.Outcome measures were knowledge of contraceptive effectiveness, attitude about contraception or toward any particular contraceptive, and choice or use of contraceptive method.
  
  
  METHODS
  For the initial review, two authors independently extracted the data. One author entered the data into RevMan, and a second author verified accuracy. For the update, an author and a research associate extracted, entered, and checked the data.For dichotomous variables, we calculated the Mantel-Haenszel odds ratio with 95% confidence intervals (CI). For continuous variables, we computed the mean difference (MD) with 95% CI.
  
  
  RESULTS
  Seven trials met the inclusion criteria and had a total of 4526 women. Five were multi-site studies. Four trials were conducted in the USA, while Nigeria and Zambia were represented by one study each, and one trial was done in both Jamaica and India.Two trials provided multiple sessions for participants. In one study that 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), i.e., sterilization, pills, injectable, intrauterine device or barrier method. For the other study, the groups received educational interventions with differing format and intensity. Both groups reportedly had increases in contraceptive use, but they did not differ significantly by six months in consistent use of an effective contraceptive, i.e., sterilization, IUD, injectable, implant, and consistent use of oral contraceptives, diaphragm, or male condoms.Five trials provided one session and focused on testing educational material or media. In one study, knowledge gain favored a slide-and-sound presentation versus a physician's oral presentation (MD -19.00; 95% CI -27.52 to -10.48). In another trial, a table with contraceptive effectiveness categories led to more correct answers than a table based on pregnancy 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 effectiveness categories and pregnancy numbers [ORs were 2.58 (95% CI 1.5 to 4.42) and 2.03 (95% CI 1.13 to 3.64)]. Still another trial provided structured counseling with a flipchart on contraceptive methods. The intervention and usual-care groups did not differ significantly in choice of contraceptive method (by effectiveness category) or in continuation of the chosen method at three months. Lastly, a study with couples used videos to communicate contraceptive information (control, motivational, contraceptive methods, and both motivational and methods videos). The analyses showed no significant difference between the groups in the types of contraceptives chosen.
  
  
  CONCLUSIONS
  These trials varied greatly in the types of participants and interventions to communicate contraceptive effectiveness. Therefore, we cannot say overall what would help consumers choose an appropriate contraceptive method. For presenting pregnancy risk data, one trial showed that effectiveness categories were better than pregnancy numbers. In another trial, audiovisual aids worked better than the usual oral presentation. Strategies should be tested in clinical settings and measured for their effect on contraceptive choice. More detailed reporting of intervention content would help in interpreting results. Reports could also include whether the instruments used to assess knowledge or attitudes were tested for validity or reliability. Follow-up should be incorporated to assess retention of knowledge over time. The overall quality of evidence was considered to be low for this review, given that five of the seven studies provided low or very low quality evidence.
authors: Clinical Sciences, FHI 360, Research Triangle Park, North Carolina, USA. llopez@fhi360.org.
authors: Laureen M
authors: LM
authors: Lopez
authors: Markus
authors: M
authors: Steiner
authors: David A
authors: DA
authors: Grimes
authors: Deborah
authors: D
authors: Hilgenberg
authors: Kenneth F
authors: KF
authors: Schulz
mesh_terms: D001290:Attitude; D003142:Communication; D003267:Contraception / Q000379:methods* / Q000523:psychology; D003270:Contraceptive Agents; D003376:Counseling / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015397:Program Evaluation; D016032:Randomized Controlled Trials as Topic; D013245:Sterilization, Reproductive / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D003270:Contraceptive Agents
references: Am J Obstet Gynecol. 2006 Jul;195(1):85-91
references: 16626610
references: Psychol Bull. 1992 May;111(3):455-74
references: 1594721
references: Patient Educ Couns. 2007 Mar;65(3):361-8
references: 17125957
references: Contraception. 2008 May;77(5):377-81
references: 18402856
references: Patient Educ Couns. 1999 Nov;38(3):227-39
references: 10865688
references: Patient Educ Couns. 2010 Dec;81(3):362-7
references: 20869187
references: J Consult Clin Psychol. 2005 Oct;73(5):852-60
references: 16287385
references: Ann Fam Med. 2009 Sep-Oct;7(5):436-45
references: 19752472
references: Am J Public Health. 2007 Apr;97(4):630-3
references: 17329641
references: Health Psychol. 2004 Sep;23(5):443-51
references: 15367063
references: Res Nurs Health. 1983 Dec;6(4):175-82
references: 6558739
references: Am J Prev Med. 2007 Jan;32(1):1-10
references: 17218187
references: Sex Transm Infect. 2000 Aug;76(4):277-81
references: 11026883
references: J Clin Epidemiol. 2011 Apr;64(4):401-6
references: 21208779
references: Perspect Sex Reprod Health. 2007 Mar;39(1):21-8
references: 17355378
references: Cochrane Database Syst Rev. 2011 Apr 13;(4):CD004317
references: 21491389
references: BJOG. 2001 Jun;108(6):649-50
references: 11426902
references: Am J Obstet Gynecol. 2003 Aug;189(2):473-81
references: 14520221
references: Contraception. 1996 Jun;53(6):357-61
references: 8773423
references: Contraception. 2002 Mar;65(3):237-43
references: 11929646
references: Cochrane Database Syst Rev. 2012 Aug 15;(8):CD001863
references: 22895923
references: Cochrane Database Syst Rev. 2003;(2):CD001431
references: 12804407
references: Perspect Sex Reprod Health. 2004 Jul-Aug;36(4):162-9
references: 15321783
references: Obstet Gynecol. 2003 Oct;102(4):709-17
references: 14551000
references: Lancet. 2007 Apr 14;369(9569):1243
references: 17434385
references: Fam Plann Perspect. 2000 Sep-Oct;32(5):227-35
references: 11030260
references: Hum Reprod. 2006 Sep;21(9):2296-303
references: 16751644
references: Womens Health Issues. 2008 Nov-Dec;18(6):471-81
references: 18926726
references: Womens Health Issues. 2007 Jan-Feb;17(1):52-60
references: 17321948
references: J Int Med Res. 2010 Jul-Aug;38(4):1243-9
references: 20925996
references: JAMA. 1995 Feb 1;273(5):408-12
references: 7823387
references: Contraception. 2007 Aug;76(2):77-83
references: 17656174
references: Lancet. 2002 Feb 16;359(9306):614-8
references: 11867132
references: Psychol Bull. 2005 Nov;131(6):856-97
references: 16351327
references: BMJ. 2002 Jun 15;324(7351):1426
references: 12065267
references: Contraception. 2011 Oct;84(4):377-83
references: 21920193
references: Eur J Contracept Reprod Health Care. 2012 Apr;17(2):135-43
references: 22200343
references: Contraception. 2012 Nov;86(5):536-42
references: 22445439
references: Fam Plann Perspect. 1990 May-Jun;22(3):115-21
references: 2379568
references: Eur J Contracept Reprod Health Care. 2009 Feb;14(1):46-54
references: 19241301
references: Public Health Nurs. 2008 Mar-Apr;25(2):115-25
references: 18294180
references: Am J Obstet Gynecol. 2010 Aug;203(2):115.e1-7
references: 20541171
references: J Public Health Dent. 2011 Winter;71(s1):S52-S63
references: 21499543
references: J Womens Health (Larchmt). 2011 Apr;20(4):567-74
references: 21410332
references: BMJ. 2002 Jun 15;324(7351):1430
references: 12065268
references: J Adv Nurs. 2007 Nov;60(4):389-401
references: 17919161
references: Am J Obstet Gynecol. 2008 Jun;198(6):630.e1-8
references: 18395692
references: BMJ. 1998 Mar 14;316(7134):805-11
references: 9549449
references: Cochrane Database Syst Rev. 2011 Mar 16;(3):CD007249
references: 21412901
references: J Fam Pract. 1984 Nov;19(5):659-63
references: 6208312
references: Contraception. 2012 Oct;86(4):383-90
references: 22402258
references: Fam Plann Perspect. 1999 Jul-Aug;31(4):168-75
references: 10435215
references: AIDS Care. 2000 Jun;12(3):273-8
references: 10928203
references: J Clin Epidemiol. 2011 Apr;64(4):383-94
references: 21195583