UCL Social Research Institute, University College London, London, UK.
Department of Pediatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India.
Eur J Contracept Reprod Health Care. 2023 Apr;28(2):83-91. doi: 10.1080/13625187.2022.2162337. Epub 2023 Feb 20.
To review the highest level of available evidence, a systematic map identified systematic reviews that evaluated the effectiveness of interventions to improve contraception choice and increase contraception use.
Systematic reviews published since 2000 were identified from searches of nine databases. Data were extracted using a coding tool developed for this systematic map. Methodological quality of included reviews was assessed using AMSTAR 2 criteria.
Fifty systematic reviews reported evaluations of interventions for contraception choice and use addressing three domains (individual, couples, community); Meta-analyses in 11 of the reviews mostly addressed interventions for individuals. We identified 26 reviews covering High Income Countries, 12 reviews covering Low Middle-Income Countries and the rest a mix of both. Most reviews (15) focussed on psychosocial interventions, followed by incentives (6) and m-health interventions (6). The strongest evidence from meta-analyses is for the effectiveness of motivational interviewing, contraceptive counselling, psychosocial interventions, school-based education, and interventions promoting contraceptive access, demand-generation interventions (community and facility based, financial mechanisms and mass media), and mobile phone message interventions. Even in resource constrained settings, community-based interventions can increase contraceptive use. There are gaps in the evidence on interventions for contraception choice and use, and limitations in study designs and lack of representativeness. Most approaches focus on individual women rather than couples or wider socio-cultural influences on contraception and fertility. This review identifies interventions which work to increase contraception choice and use, and these could be implemented in school, healthcare or community settings.
为了回顾现有最高水平的证据，我们进行了系统制图，以确定评估改善避孕措施选择和增加避孕措施使用的干预措施有效性的系统评价。
从九个数据库中搜索，确定了 2000 年后发表的系统评价。使用为本次系统制图开发的编码工具提取数据。使用 AMSTAR 2 标准评估纳入的综述的方法学质量。
五十篇系统评价报告了针对避孕措施选择和使用的干预措施评估，涵盖了三个领域（个体、夫妇、社区）；11 篇综述中的元分析主要针对个人干预措施。我们确定了 26 篇涵盖高收入国家的综述，12 篇涵盖中低收入国家的综述，其余综述涵盖了这两者的混合。大多数综述（15 篇）重点关注心理社会干预，其次是激励措施（6 篇）和移动健康干预（6 篇）。来自元分析的最强证据是动机访谈、避孕咨询、心理社会干预、学校教育以及促进避孕措施获取、需求生成干预（社区和机构基础、金融机制和大众媒体）和手机短信干预的有效性。即使在资源有限的环境中，社区为基础的干预措施也可以增加避孕措施的使用。在避孕措施选择和使用的干预措施方面，证据存在差距，研究设计存在局限性且缺乏代表性。大多数方法都侧重于个体女性，而不是夫妇或更广泛的社会文化对避孕和生育的影响。本次综述确定了可增加避孕措施选择和使用的干预措施，这些措施可在学校、医疗保健或社区环境中实施。
