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Jones A, Whitesell C, Tadikonda A, Perry MF, Allison BA. "I feel like it gives me what I need to know": A qualitative study on adolescent perceptions of two contraceptive decision aids. Contraception 2023; 128:110277. [PMID: 37659707 PMCID: PMC10999257 DOI: 10.1016/j.contraception.2023.110277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVES We sought to understand how adolescents perceive two commonly used contraceptive decision aids and which elements adolescents identified as most important to them. STUDY DESIGN We conducted a cross-sectional qualitative study of adolescents' perceptions of two decision aids, Your Birth Control Choices designed by the Reproductive Health Access Project and Birth Control: What's Important to You? designed by Power to Decide for Bedsider.org. We conducted semistructured interviews with 20 adolescents (aged 15-19 years) who were assigned female sex at birth and attended a single clinic in North Carolina. Interview questions addressed the decision aids' aesthetic design, informational content, inclusivity, and comprehensibility. We transcribed and analyzed interviews using Dedoose software. We developed a codebook using a combination of a priori and inductive codes followed by content analysis to identify themes. RESULTS All participants agreed that both decision aids could be helpful with contraceptive decision-making and with patient-provider discussions. However, some phrasing and descriptions of contraceptive methods were confusing. Participants preferred realistic imagery, clear explanations of side effects, and details on method use. Participants expressed a preference for the information contained in the detailed Reproductive Health Access Project decision aid, while most favored the aesthetic design and layout of the Bedsider decision aid. CONCLUSIONS Although adolescents expressed sentiments of increased knowledge and empowerment after reviewing the decision aids, this study suggests neither decision aid completely meets adolescent needs and preferences. Additional adaptations are necessary to create adolescent-centered contraceptive decision aids. IMPLICATIONS Adolescents in this study found two contraceptive decision aids as useful adjuncts to conversations with providers. The decision aids improved contraceptive knowledge and may facilitate decision-making. However, neither of the studied decision aids fully met the perceived needs of adolescents. Future adaptations or designs should include additional adolescent-centered content.
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Affiliation(s)
- Anna Jones
- University of Utah, Department of Pediatrics, Salt Lake City, Utah, USA
| | - Callie Whitesell
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | | | - Martha F Perry
- University of North Carolina School of Medicine, Department of Pediatrics, Chapel Hill, North Carolina, USA
| | - Bianca A Allison
- University of North Carolina School of Medicine, Department of Pediatrics, Chapel Hill, North Carolina, USA.
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MacDonald Gibson J, III FS, Wood E, Lockhart S, Bruine de Bruin W. Private Well Testing in Peri-Urban African-American Communities Lacking Access to Regulated Municipal Drinking Water: A Mental Models Approach to Risk Communication. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2022; 42:799-817. [PMID: 34342023 PMCID: PMC9292044 DOI: 10.1111/risa.13799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Majority African-American neighborhoods on the edges of North Carolina municipalities are less likely than white peri-urban neighborhoods to be served by a community system regulated under the Safe Drinking Water Act. These households rely on unregulated private wells, which are at much higher risk of contamination than neighboring community water supplies. Yet, risk awareness of consuming well water is low, and no prior research has tested risk communication interventions for these communities. We present a randomized-controlled trial of an oversized postcard to promote water testing among this audience. The postcard design followed the mental models approach to risk communication. To our knowledge, this is the first U.S. randomized-controlled trial of a mailed communication to promote water testing in any audience and one of few trials of the mental models approach. We evaluated the postcard's effects on self-reported water testing with and without a free water test offer (vs. no-intervention control) via a survey mailed one month after the interventions. The combined communication and free test doubled the odds of self-reported water testing, compared to the control group (p = 0.046). It increased the odds of testing by 65%, compared to the free test alone. Recall of receiving a postcard about water testing increased the odds of self-reported testing twelve-fold (p < 0.001). Although these results suggest that targeted risk information delivered by mail can promote water testing when paired with a free test, the mechanism remains unclear. Additional research on beliefs influencing perceptions about well water may yield interventions that are even more effective.
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Affiliation(s)
- Jacqueline MacDonald Gibson
- Department of Environmental and Occupational HealthSchool of Public Health, Indiana UniversityBloomingtonINUSA
| | | | | | | | - Wändi Bruine de Bruin
- Sol Price School of Public Policy and Department of PsychologyUniversity of Southern CaliforniaLos AngelesCAUSA
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Carlsson N, Johansson A. Adapting healthcare services to a more intense way of tobacco prevention in child health care: A comparison between active and passive spreading. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2021. [DOI: 10.1080/20479700.2019.1664706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Noomi Carlsson
- Department of Public Health & Healthcare, Regional Executive Office, Jönköping, Sweden
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Tahaineh L, Alkyam MM, Al‐Sawalha NA, Jaber D, Albsoul‐Younes AM. Evaluation of the clinical pharmacist's role in educating women about the benefits and risks of combined oral contraceptive pills in Jordan. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2020. [DOI: 10.1111/jphs.12337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Linda Tahaineh
- Department of Clinical PharmacyCollege of Pharmacy, Jordan University of Science and Technology (JUST) Irbid Jordan
| | - Mayssam M. Alkyam
- Department of Clinical PharmacyCollege of Pharmacy, Jordan University of Science and Technology (JUST) Irbid Jordan
| | - Nour A. Al‐Sawalha
- Department of Clinical PharmacyCollege of Pharmacy, Jordan University of Science and Technology (JUST) Irbid Jordan
| | - Deema Jaber
- Department of Clinical PharmacySchool of PharmacyZarqa University Zarqa Jordan
| | - Abla M. Albsoul‐Younes
- Department of Biopharmaceutics and Clinical PharmacyFaculty of PharmacyThe University of Jordan (JU) Amman Jordan
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Sharma AE, Frederiksen BN, Malcolm NM, Rollison JM, Carter MW. Community Education and Engagement in Family Planning: Updated Systematic Review. Am J Prev Med 2018; 55:747-758. [PMID: 30342637 PMCID: PMC6753778 DOI: 10.1016/j.amepre.2018.06.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/20/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Abstract
CONTEXT Community education and engagement are important for informing family planning projects. The objective of this study was to update two prior systematic reviews assessing the impact of community education and engagement interventions on family planning outcomes. EVIDENCE ACQUISITION Sixteen electronic databases were searched for studies relevant to a priori determined inclusion/exclusion criteria in high development settings, published from March 2011 through April 2016, updating two reviews that included studies from 1985 through February 2011. EVIDENCE SYNTHESIS Nine relevant studies were included in this updated review related to community education, in addition to 17 from the prior review. No new community engagement studies met inclusion criteria, as occurred in the prior review. Of new studies, community education modalities included mass media, print/mail, web-based, text messaging, and interpersonal interventions. One study on mass media intervention demonstrated a positive impact on reducing teen and unintended pregnancies. Three of four studies on interpersonal interventions demonstrated positive impacts on medium-term family planning outcomes, such as contraception and condom use. Three new studies demonstrated mostly positive, but inconsistent, results on short-term family planning outcomes. CONCLUSIONS Findings from this systematic review update are in line with a previous review showing the positive impact of community education using traditional modalities on short-term family planning outcomes, identifying additional impacts on long-term outcomes, and highlighting new evidence for education using modern modalities, such as text messaging and web-based education. More research is necessary to provide a stronger evidence base for directing community education and engagement efforts in family planning contexts. THEME INFORMATION This article is part of a theme issue entitled Updating the Systematic Reviews Used to Develop the U.S. Recommendations for Providing Quality Family Planning Services, which is sponsored by the Office of Population Affairs, U.S. Department of Health and Human Services.
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Affiliation(s)
- Anjana E Sharma
- Department of Family and Community Medicine, University of California, San Francisco, California.
| | | | | | | | - Marion W Carter
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Pazol K, Zapata LB, Dehlendorf C, Malcolm NM, Rosmarin RB, Frederiksen BN. Impact of Contraceptive Education on Knowledge and Decision Making: An Updated Systematic Review. Am J Prev Med 2018; 55:703-715. [PMID: 30342633 PMCID: PMC10521032 DOI: 10.1016/j.amepre.2018.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/02/2018] [Accepted: 07/16/2018] [Indexed: 01/01/2023]
Abstract
CONTEXT Educational interventions can help individuals increase their knowledge of available contraceptive methods, enabling them to make informed decisions and use contraception correctly. This review updates a previous review of contraceptive education. EVIDENCE ACQUISITION Multiple databases were searched for articles published March 2011-November 2016. Primary outcomes were knowledge, participation in and satisfaction/comfort with decision making, attitudes toward contraception, and selection of more effective methods. Secondary outcomes included contraceptive behaviors and pregnancy. Excluded articles described interventions that had no comparison group, could not be conducted feasibly in a clinic setting, or were conducted outside the U.S. or similar country. EVIDENCE SYNTHESIS A total of 24,953 articles were identified. Combined with the original review, 37 articles met inclusion criteria and described 31 studies implementing a range of educational approaches (interactive tools, written materials, audio/videotapes, and text messages), with and without healthcare provider feedback, for a total of 36 independent interventions. Of the 31 interventions for which knowledge was assessed, 28 had a positive effect. Fewer were assessed for their effect on attitudes toward contraception, selection of more effective methods, contraceptive behaviors, or pregnancy-although increased knowledge was found to mediate additional outcomes (positive attitudes toward contraception and contraceptive continuation). CONCLUSIONS This systematic review is consistent with evidence from the broader healthcare field in suggesting that a range of interventions can increase knowledge. Future studies should assess what aspects are most effective, the benefits of including provider feedback, and the extent to which educational interventions can facilitate behavior change and attainment of reproductive health goals. THEME INFORMATION This article is part of a theme issue entitled Updating the Systematic Reviews Used to Develop the U.S. Recommendations for Providing Quality Family Planning Services, which is sponsored by the Office of Population Affairs, U.S. Department of Health and Human Services.
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Affiliation(s)
- Karen Pazol
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Lauren B Zapata
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christine Dehlendorf
- Department of Family and Community Medicine, University of California, San Francisco (UCSF), San Francisco, California; Obstetrics, Gynecology and Reproductive Sciences, UCSF, San Francisco, California; Epidemiology and Biostatistics, UCSF, SanFrancisco, California
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Akour A, Bardaweel S, Awwad O, Al-Muhaissen S, Hussein R. Impact of a pharmacist-provided information booklet on knowledge and attitudes towards oral contraception among Jordanian women: an interventional study. EUR J CONTRACEP REPR 2018; 22:459-464. [PMID: 29300110 DOI: 10.1080/13625187.2017.1412425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Jordan has high rate of unintended pregnancy, which is largely attributed to limited knowledge and misconceptions about contraceptive methods, namely oral contraceptive pills (OCPs). The aim of this study was to examine the effect of a pharmacist-provided information booklet on increasing the knowledge of Jordanian women about safe and effective OCP use. METHODS This was a randomised interventional study. One hundred and sixty women who had used OCPs at least once in their lifetime were randomised to receive conventional counselling (control group) or a pharmacist-provided booklet (intervention group). Knowledge about and attitude towards OCP use were assessed before and immediately after the intervention, and at three-month follow-up. RESULTS The mean knowledge score (out of 5) of women in the intervention group improved significantly from 1.76 at baseline (standard deviation [SD] 1.25) to 5.00 (p < .000) directly after the intervention, which then slightly decreased to 4.93 (SD 0.31; p = .033) at follow-up. The baseline mean knowledge score of the control group was 1.29 (SD 1.12) and did not significantly increase over time. It was also considerably lower than that of the intervention group both immediately after the intervention and at follow-up. As regards mean attitude score (out of 6), the control group demonstrated no changes from baseline, whereas the intervention group improved significantly from 5.15 (SD 1.63) to 5.50 (SD 1.36; p = .014). CONCLUSIONS Provision of an information booklet by pharmacists to women in Jordan using OCPs is highly recommended. Studies with a larger sample size and from different regions of Jordan are recommended.
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Affiliation(s)
- Amal Akour
- a Department of Clinical Pharmacy and Biopharmaceutics, School of Pharmacy , University of Jordan , Amman , Jordan
| | - Sanaa Bardaweel
- b Department of Pharmaceutical Sciences, School of Pharmacy , University of Jordan , Amman , Jordan
| | - Oriana Awwad
- a Department of Clinical Pharmacy and Biopharmaceutics, School of Pharmacy , University of Jordan , Amman , Jordan
| | - Suha Al-Muhaissen
- c Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy , University of Jordan , Amman , Jordan
| | - Rand Hussein
- d Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy , University of Sharjah , Sharjah , United Arab Emirates
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Boase N, White M, Gaze W, Redshaw C. Evaluating the Mental Models Approach to Developing a Risk Communication: A Scoping Review of the Evidence. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2017; 37:2132-2149. [PMID: 28314068 DOI: 10.1111/risa.12789] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 11/04/2016] [Accepted: 12/29/2016] [Indexed: 06/06/2023]
Abstract
Risk communication is fundamental in ensuring people are equipped with the knowledge needed to navigate varied risks. One generally well-regarded framework for the development of such communications is the mental models approach to risk communication (MMARC). Developed during the 1990s, the MMARC has been applied to a range of health, technological, and environmental risks. However, as yet, we know of no attempt to collate and review articles that evaluated communications developed using the MMARC. This article took a first step at addressing this gap by conducting a scoping review that aimed to begin to explore the fidelity with which the approach has been applied, explore whether there appeared to be sufficient studies to warrant a future systematic review, and identify future research questions. Although the initial search found over 100 articles explicitly applying the MMARC, only 12 of these developed a risk-related communication that was tested against a control (and thus included in the current review). All studies reported a positive effect of the MMARC versus control communication for at least some of the outcome measures (knowledge being the most prevalent). However, there was wide variation between studies including type of control, outcomes assessed, and only five studies reported adopting a randomized design. The review highlights both the need for greater fidelity in the way future studies operationalize the MMARC approach, and suggests that a full-scale systematic review of the MMARC literature appears justified, especially given the possibility of a large gray literature in this area.
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Affiliation(s)
- Nick Boase
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, UK
| | - Mathew White
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, UK
| | - William Gaze
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, UK
| | - Clare Redshaw
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, UK
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Abstract
BACKGROUND The explicit use of theory in research helps expand the knowledge base. Theories and models have been used extensively in HIV-prevention research and in interventions for preventing sexually transmitted infections (STIs). The health behavior field uses many theories or models of change. However, many educational interventions addressing contraception have no explicit theoretical base. OBJECTIVES To review randomized controlled trials (RCTs) that tested a theoretical approach to inform contraceptive choice and encourage or improve contraceptive use. SEARCH METHODS To 1 November 2016, we searched for trials that tested a theory-based intervention for improving contraceptive use in PubMed, CENTRAL, POPLINE, Web of Science, ClinicalTrials.gov, and ICTRP. For the initial review, we wrote to investigators to find other trials. SELECTION CRITERIA Included trials tested a theory-based intervention for improving contraceptive use. Interventions addressed the use of one or more methods for contraception. The reports provided evidence that the intervention was based on a specific theory or model. The primary outcomes were pregnancy and contraceptive choice or 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 unadjusted dichotomous outcomes, we calculated the Mantel-Haenszel odds ratio (OR) with 95% confidence interval (CI). Cluster randomized trials used various methods of accounting for the clustering, such as multilevel modeling. Most reports did not provide information to calculate the effective sample size. Therefore, we presented the results as reported by the investigators. We did not conduct meta-analysis due to varied interventions and outcome measures. MAIN RESULTS We included 10 new trials for a total of 25. Five were conducted outside the USA. Fifteen randomly assigned individuals and 10 randomized clusters. This section focuses on nine trials with high or moderate quality evidence and an intervention effect. Five based on social cognitive theory addressed preventing adolescent pregnancy and were one to two years long. The comparison was usual care or education. Adolescent mothers with a home-based curriculum had fewer second births in two years (OR 0.41, 95% CI 0.17 to 1.00). Twelve months after a school-based curriculum, the intervention group was more likely to report using an effective contraceptive method (adjusted OR 1.76 ± standard error (SE) 0.29) and using condoms during last intercourse (adjusted OR 1.68 ± SE 0.25). In alternative schools, after five months the intervention group reported more condom use during last intercourse (reported adjusted OR 2.12, 95% CI 1.24 to 3.56). After a school-based risk-reduction program, at three months the intervention group was less likely to report no condom use at last intercourse (adjusted OR 0.67, 95% CI 0.47 to 0.96). The risk avoidance group (abstinence-focused) was less likely to do so at 15 months (OR 0.61, 95% CI 0.45 to 0.85). At 24 months after a case management and peer-leadership program, the intervention group reported more consistent use of hormonal contraceptives (adjusted relative risk (RR) 1.30, 95% CI 1.06 to 1.58), condoms (RR 1.57, 95% CI 1.28 to 1.94), and dual methods (RR 1.36, 95% CI 1.01 to 1.85).Four of the nine trials used motivational interviewing (MI). In three studies, the comparison group received handouts. The MI group more often reported effective contraception use at nine months (OR 2.04, 95% CI 1.47 to 2.83). In two studies, the MI group was less likely to report using ineffective contraception at three months (OR 0.31, 95% CI 0.12 to 0.77) and four months (OR 0.56, 95% CI 0.31 to 0.98), respectively. In the fourth trial, the MI group was more likely than a group with non-standard counseling to initiate long-acting reversible contraception (LARC) by one month (OR 3.99, 95% CI 1.36 to 11.68) and to report using LARC at three months (OR 3.38, 95% CI 1.06 to 10.71). AUTHORS' CONCLUSIONS The overall quality of evidence was moderate. Trials based on social cognitive theory focused on adolescents and provided multiple sessions. Those using motivational interviewing had a wider age range but specific populations. Sites with low resources need effective interventions adapted for their settings and their typical clients. Reports could be clearer about how the theory was used to design and implement the intervention.
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Affiliation(s)
- Laureen M Lopez
- FHI 360Clinical and Epidemiological Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Thomas W Grey
- FHI 360Social and Behavioral Health Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Mario Chen
- FHI 360Biostatistics359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Elizabeth E. Tolley
- FHI 360Social and Behavioral Health Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Laurie L Stockton
- University of North CarolinaSchool of Media and JournalismCarroll Hall 386Chapel HillNorth CarolinaUSA27599‐3365
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Abstract
BACKGROUND The explicit use of theory in research helps expand the knowledge base. Theories and models have been used extensively in HIV-prevention research and in interventions for preventing sexually transmitted infections (STIs). The health behavior field uses many theories or models of change. However, educational interventions addressing contraception often have no stated theoretical base. OBJECTIVES Review randomized controlled trials (RCTs) that tested a theoretical approach to inform contraceptive choice; encourage contraceptive use; or promote adherence to, or continuation of, a contraceptive regimen. SEARCH METHODS Through June 2013, we searched computerized databases for trials that tested a theory-based intervention for improving contraceptive use (MEDLINE, POPLINE, CENTRAL, PsycINFO, ClinicalTrials.gov, and ICTRP). Previous searches also included EMBASE. For the initial review, we wrote to investigators to find other trials. SELECTION CRITERIA Trials tested a theory-based intervention for improving contraceptive use. We excluded trials focused on high-risk groups and preventing sexually transmitted infections or HIV. Interventions addressed the use of one or more contraceptive methods for contraception. The reports provided evidence that the intervention was based on a specific theory or model. The primary outcomes were pregnancy, contraceptive choice or use, and contraceptive adherence or continuation. DATA COLLECTION AND ANALYSIS The primary author evaluated abstracts for eligibility. Two authors extracted data from included studies. For the dichotomous outcomes, the Mantel-Haenszel odds ratio (OR) with 95% CI was calculated using a fixed-effect model. Cluster randomized trials used various methods of accounting for the clustering, such as multilevel modeling. Most reports did not provide information to calculate the effective sample size. Therefore, we presented the results as reported by the investigators. No meta-analysis was conducted due to differences in interventions and outcome measures. MAIN RESULTS We included three new trials for a total of 17. Ten randomly assigned individuals and seven were cluster-randomized. Eight trials showed some intervention effect.Two of 12 trials with pregnancy or birth data showed some effect. A theory-based group was less likely than the comparison group to have a second birth (OR 0.41; 95% CI 0.17 to 1.00) or to report a pregnancy (OR 0.24 (95% CI 0.10 to 0.56); OR 0.27 (95% CI 0.11 to 0.66)). The theoretical bases were social cognitive theory (SCT) and another social cognition model.Of 12 trials with data on contraceptive use (non-condom), six showed some effect. A theory-based group was more likely to consistently use oral contraceptives (OR 1.41; 95% CI 1.06 to 1.87), hormonal contraceptives (reported relative risk (RR) 1.30; 95% CI 1.06 to 1.58) or dual methods (reported RR 1.36; 95% CI 1.01 to 1.85); to use an effective contraceptive method (reported effect size 1.76; OR 2.04 (95% CI 1.47 to 2.83)) or use more habitual contraception (reported P < 0.05); and were less likely to use ineffective contraception (OR 0.56; 95% CI 0.31 to 0.98). Theories and models included the Health Belief Model (HBM), SCT, SCT plus another theory, other social cognition, and motivational interviewing (MI).For condom use, a theory-based group had favorable results in 5 of 11 trials. The main differences were reporting more consistent condom use (reported RR 1.57; 95% CI 1.28 to 1.94) and more condom use during last sex (reported results: risk ratio 1.47 (95% CI 1.12 to 1.93); effect size 1.68; OR 2.12 (95% CI 1.24 to 3.56); OR 1.45 (95% CI 1.03 to 2.03)). The theories were SCT, SCT plus another theory, and HBM.Nearly all trials provided multiple sessions or contacts. SCT provided the basis for seven trials focused on adolescents, of which five reported some effectiveness. Two others based on other social cognition models had favorable results with adolescents. Of six trials including adult women, five provided individual sessions. Some effect was seen in two using MI and one using the HBM. Two based on the Transtheoretical Model did not show any effect. AUTHORS' CONCLUSIONS Eight trials provided evidence of high or moderate quality. Family planning researchers and practitioners could adapt the effective interventions, although most provided group sessions for adolescents. Three were conducted outside the USA. Clinics and low-resource settings need high-quality evidence on changing behavior. Thorough use of single theories would help in identifying what works, as would better reporting on research design and intervention implementation.
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Affiliation(s)
- Laureen M Lopez
- Clinical Sciences, FHI 360, P.O. Box 13950, Research Triangle Park, North Carolina, USA, 27709
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Carlsson N, Johansson A, Abrahamsson A, Andersson Gäre B. How to minimize children's environmental tobacco smoke exposure: an intervention in a clinical setting in high risk areas. BMC Pediatr 2013; 13:76. [PMID: 23672646 PMCID: PMC3660282 DOI: 10.1186/1471-2431-13-76] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 05/02/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite the low prevalence of daily smokers in Sweden, children are still being exposed to environmental tobacco smoke (ETS), primarily by their smoking parents. A prospective intervention study using methods from Quality Improvement was performed in Child Health Care (CHC). The aim was to provide nurses with new methods for motivating and supporting parents in their efforts to protect children from ETS exposure. METHOD Collaborative learning was used to implement and test an intervention bundle. Twenty-two CHC nurses recruited 86 families with small children which had at least one smoking parent. Using a bundle of interventions, nurses met and had dialogues with the parents over a one-year period. A detailed questionnaire on cigarette consumption and smoking policies in the home was answered by the parents at the beginning and at the end of the intervention, when children also took urine tests to determine cotinine levels. RESULTS Seventy-two families completed the study. Ten parents (11%) quit smoking. Thirty-two families (44%) decreased their cigarette consumption. Forty-five families (63%) were outdoor smokers at follow up. The proportion of children with urinary cotinine values of >6 ng/ml had decreased. CONCLUSION The intensified tobacco prevention in CHC improved smoking parents' ability to protect their children from ETS exposure.
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Affiliation(s)
- Noomi Carlsson
- Department of Clinical and Experimental Medicine, Division of Paediatrics, Faculty of Health Sciences, Linköping University, SE-581 83, Linköping, Sweden
- Department of Public Health and Medical Care, Jönköping County Council, Box 1024, SE-551 11 Jönköping, Sweden
| | - AnnaKarin Johansson
- Department of Medicine and Health, Division of Nursing Science, Faculty of Health Sciences, Linköping University, SE-581 83, Linköping, Sweden
| | - Agneta Abrahamsson
- Department of Health and Society, University College of Kristianstad, SE-291 88, Kristianstad, Sweden
| | - Boel Andersson Gäre
- Department of Clinical and Experimental Medicine, Division of Paediatrics, Faculty of Health Sciences, Linköping University, SE-581 83, Linköping, Sweden
- Futurum – the Academy for Healthcare, Jönköping County Council, SE-551 85, Jönköping, Sweden
- The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Box 1026, SE-551 11 Jönköping,Sweden
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Lopez LM, Steiner M, Grimes DA, Hilgenberg D, Schulz KF. Strategies for communicating contraceptive effectiveness. Cochrane Database Syst Rev 2013:CD006964. [PMID: 23633337 DOI: 10.1002/14651858.cd006964.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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. OBJECTIVES To review all randomized controlled trials comparing strategies for communicating to consumers the effectiveness of contraceptives in preventing pregnancy. SEARCH 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. SELECTION CRITERIA 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. DATA COLLECTION AND ANALYSIS 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. MAIN 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. AUTHORS' 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.
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Affiliation(s)
- Laureen M Lopez
- Clinical Sciences, FHI 360, Research Triangle Park, North Carolina, USA.
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