title: Motivational interviews to improve contraceptive use in populations at high risk of unintended pregnancy: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Effective contraceptive use has the potential to prevent around 230 million births each year. An estimated 222 million women want to delay pregnancy or cease childbearing, but are not actively using contraception. Lack of education is a known barrier for effective contraceptive use. Motivational interviews are presumed to improve effective contraceptive use, but studies to date report varied findings. Some studies demonstrate an improvement and others report no effect.
  
  
  METHODS
  A systematic review of evidence on the impact of motivational interviews on contraceptive use in women of childbearing age was carried out using MEDLINE, EMBASE, BNI, Cochrane library, CINHAL, African Index Medicus, Web of Science, the Reproductive Health Library, and the Science Citation Index (inception-January 2013) without language restriction. Search terms included 'motivational interview* AND contraception OR family planning OR maternal OR pregnancy'. Randomised controlled trials comparing the effect of motivational interviews with standard practice on effective contraception use in women of reproductive age were included. The outcome measures were use of effective contraception or use of high-level contraception, and subsequent births or pregnancies. The random effects model was used to pool the risk ratios from individual studies.
  
  
  RESULTS
  Eight randomised controlled trials were included in the review with a total of 3424 women at high risk of pregnancy. Meta-analysis showed an increase in effective contraceptive use with motivational interviews when compared with control (RR 1.32 95%CI 1.11, 1.56: P=0.002) in the period of zero to four months post intervention. No difference in effective contraceptive use was shown at four to eight months (RR 1.10, 95%CI 0.93, 1.32: P=0.27), and between eight to twelve months (RR 1.18 95%CI 0.96, 1.46: P=0.12). No evidence of effect in the reduction of subsequent pregnancies or births at twelve to twenty-four months was seen with motivational interviews (RR 0.80 95%CI 0.51, 1.26: P=0.34).
  
  
  CONCLUSIONS
  Motivational interviews significantly increase effective contraceptive use immediately after and up to four months post-intervention. The effect without reinforcement is short lasting as no evidence of effect is seen after four months post-intervention.
authors.affiliation: School of Health and Population Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. Electronic address: a.wilson.5@bham.ac.uk.
authors.forename: Amie
authors.initials: A
authors.lastname: Wilson
authors.affiliation: School of Health and Population Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Krishnarajah
authors.initials: K
authors.lastname: Nirantharakumar
authors.affiliation: School of Health and Population Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Ewa G
authors.initials: EG
authors.lastname: Truchanowicz
authors.affiliation: Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Sri Lanka.
authors.forename: Rajendra
authors.initials: R
authors.lastname: Surenthirakumaran
authors.affiliation: School of Health and Population Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: MacArthur
authors.affiliation: School of Clinical & Experimental Medicine, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Arri
authors.initials: A
authors.lastname: Coomarasamy
mesh_terms: D000293:Adolescent; D000328:Adult; D003268:Contraception Behavior; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D062405:Motivational Interviewing; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D011275:Pregnancy, Unwanted; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D013997:Time Factors; D055815:Young Adult
keywords: Contraception; Family planning; Motivational interviews; Pregnancy