Strategies to improve adherence and continuation of shorter‐term hormonal methods of contraception

Background Worldwide, hormonal contraceptives are among the most popular reversible contraceptives. Despite high perfect‐use effectiveness rates, typical‐use effectiveness rates for shorter‐term methods such as oral and injectable contraceptives are much lower. In large part, this disparity reflects...

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Veröffentlicht in:Cochrane database of systematic reviews 2019-04, Vol.2019 (4), p.CD004317-CD004317
Hauptverfasser: Mack, Natasha, Crawford, Tineke J, Guise, Jeanne‐Marie, Chen, Mario, Grey, Thomas W, Feldblum, Paul J, Stockton, Laurie L, Gallo, Maria F
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Sprache:eng
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Zusammenfassung:Background Worldwide, hormonal contraceptives are among the most popular reversible contraceptives. Despite high perfect‐use effectiveness rates, typical‐use effectiveness rates for shorter‐term methods such as oral and injectable contraceptives are much lower. In large part, this disparity reflects difficulties in ongoing adherence to the contraceptive regimen and low continuation rates. Correct use of contraceptives to ensure effectiveness is vital to reducing unintended pregnancy. Objectives To determine the effectiveness of strategies aiming to improve adherence to, and continuation of, shorter‐term hormonal methods of contraception compared with usual family planning care. Search methods We searched to July 2018 in the following databases (without language restrictions): The Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 7), PubMed via MEDLINE, POPLINE, Web of Science, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP). Selection criteria We included randomized controlled trials (RCTs) comparing strategies aimed to facilitate adherence and continuation of shorter‐term hormonal methods of contraception (such as oral contraceptives (OCs), injectable depot medroxyprogesterone acetate (DMPA or Depo‐Provera), intravaginal ring, or transdermal patch) with usual family planning care in reproductive age women seeking to avoid pregnancy. Data collection and analysis We used standard methodological procedures recommended by Cochrane. Primary outcomes were continuation or discontinuation of contraceptive method, rates of discontinuation due to adverse events (menstrual disturbances and all other adverse events), and adherence to method use as indicated by missed pills and on‐time/late injections. Pregnancy was a secondary outcome. Main results We included 10 RCTs involving 6242 women. Six trials provided direct in‐person counseling using either multiple counseling contacts or multiple components during one visit. Four trials provided intensive reminders of appointments or next dosing, of which two provided additional educational health information as well as reminders. All trials stated 'usual care' as the comparison. The certainty of the evidence ranged from very low to moderate. Main limitations were risk of bias (associated with poor reporting of methodological detail, lack of blinding, and incomplete outcome data), inconsistency, indirectness, and imprecision. Continuation of hormonal contraceptive metho
ISSN:1465-1858
1465-1858
1469-493X
DOI:10.1002/14651858.CD004317.pub5