Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands.
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organisation, Geneva, Switzerland.
Glob Public Health. 2020 Aug;15(8):1182-1199. doi: 10.1080/17441692.2020.1744679. Epub 2020 Apr 30.
Inconsistent contraceptive use and risky sexual behaviour perpetuate the burden of sexually transmitted diseases, especially in low- and middle-income countries (LMIC). Psychosocial interventions (PSI) can contribute to change sexual behaviour, however, their overall effectiveness is unclear. We thus conducted a meta-analysis of the effectiveness of PSIs to increase condom and contraceptive use in LMICs. Seven databases were searched systematically for randomised trials comparing a PSI with a control condition. Risk ratios of 31 eligible studies were pooled in random-effects analyses for condom and contraceptive use and unprotected sex, using sensitivity analyses to further investigate the results. Risk of bias was assessed using the Cochrane tool, and heterogeneity and publication bias were assessed. PSIs increased condom use by about 6% at post-test and 8% at follow-up as compared to control conditions. Contraceptive use was increased by about 14% at post-test. There were no effects on unprotected sex. Results suggest that PSIs have the potential to increase contraceptive and, to a smaller degree, condom use in LMICs. The reliability of these results is partly limited by heterogeneity and the risk of publication bias. PSIs were further found to provide substantial benefits to the exposed populations beyond the targeted outcomes.
避孕方法使用不一致和危险性行为使性传播疾病负担持续存在，尤其是在中低收入国家（LMIC）。心理社会干预（PSI）可以有助于改变性行为，但它们的总体效果尚不清楚。因此，我们对 PSI 增加 LMIC 地区使用避孕套和避孕药具的有效性进行了荟萃分析。系统地在 7 个数据库中搜索了比较 PSI 与对照条件的随机试验。使用敏感性分析进一步探讨结果，对 31 项合格研究的风险比进行了随机效应分析，以评估避孕套和避孕药具使用和无保护性行为的情况。使用 Cochrane 工具评估偏倚风险，并评估异质性和发表偏倚。与对照组相比，PSI 在测试后增加了约 6%的避孕套使用，在随访时增加了约 8%。避孕药具的使用增加了约 14%。对无保护性行为没有影响。结果表明，PSI 有可能增加 LMIC 地区的避孕药具使用，在较小程度上增加避孕套使用。这些结果的可靠性部分受到异质性和发表偏倚的风险的限制。此外，PSI 还为暴露人群提供了除目标结果之外的实质性益处。
