School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
Cochrane Database Syst Rev. 2023 Jul 17;7(7):CD011159. doi: 10.1002/14651858.CD011159.pub3.
Contraception provides significant benefits for women's and children's health, yet many women have an unmet need for contraception. Rapid expansion in the use of mobile phones in recent years has had a dramatic impact on interpersonal communication. Within the health domain text messages and smartphone applications offer means of communication between clients and healthcare providers. This review focuses on interventions delivered by mobile phone and their effect on use of contraception.
To evaluate the benefits and harms of mobile phone-based interventions for improving contraception use.
We used standard, extensive Cochrane search methods. The latest search date was August 2022.
We included randomised controlled trials (RCTs) of mobile phone-based interventions to improve forms of contraception use amongst users or potential users of contraception.
We used standard Cochrane methods. Our primary outcomes were 1. uptake of contraception, 2. uptake of a specific method of contraception, 3. adherence to contraception method, 4. safe method switching, 5. discontinuation of contraception and 6. pregnancy or abortion. Our secondary outcomes were 7. road traffic accidents, 8. any physical or psychological effect reported and 9. violence or domestic abuse.
Twenty-three RCTs (12,793 participants) from 11 countries met our inclusion criteria. Eleven studies were conducted in high-income resource settings and 12 were in low-income settings. Thirteen studies used unidirectional text messaging-based interventions, six studies used interactive text messaging, four used voice message-based interventions and two used mobile-phone apps to improve contraception use. All studies received funding from non-commercial bodies. Mobile phone-based interventions probably increase contraception use compared to the control (odds ratio (OR) 1.30, 95% confidence interval (CI) 1.06 to 1.60; 16 studies, 8972 participants; moderate-certainty evidence). There may be little or no difference in rates of unintended pregnancy with the use of mobile phone-based interventions compared to control (OR 0.82, 95% CI 0.48 to 1.38; 8 trials, 2947 participants; moderate-certainty evidence). Subgroup analysis assessing unidirectional mobile phone interventions versus interactive mobile phone interventions found evidence of a difference between the subgroups favouring interactive interventions (P = 0.003, I = 88.5%). Interactive interventions had an OR of 1.71 (95% CI 1.28 to 2.29; P = 0.0003, I = 63%; 8 trials, 3089 participants) whilst unidirectional interventions had an OR of 1.03 (95% CI 0.87 to 1.22; P = 0.72, I = 17%; 9 trials, 5883 participants). Subgroup analysis assessing high-income versus low-income trial settings found no difference between groups (subgroup difference test: P = 0.70, I = 0%). Only six trials reported on safety and unintended outcomes; one trial reported increased partner violence whilst another four trials reported no difference in physical violence rates between control and intervention groups. One trial reported no road traffic accidents with mobile phone intervention use.
AUTHORS' CONCLUSIONS: This review demonstrates there is evidence to support the use of mobile phone-based interventions in improving the use of contraception, with moderate-certainty evidence. Interactive mobile phone interventions appear more effective than unidirectional methods. The cost-effectiveness, cost benefits, safety and long-term effects of these interventions remain unknown, as does the evidence of this approach to support contraception use among specific populations. Future research should investigate the effectiveness and safety of mobile phone-based interventions with better quality trials to help establish the effects of interventions delivered by mobile phone on contraception use. This review is limited by the quality of the studies due to flaws in methodology, bias or imprecision of results.
避孕措施对妇女和儿童的健康有显著的益处，但许多女性对避孕的需求未得到满足。近年来，手机的快速普及对人际沟通产生了巨大的影响。在健康领域，短信和智能手机应用程序为客户和医疗服务提供者之间提供了沟通的手段。本综述重点关注通过手机提供的干预措施及其对避孕措施使用的影响。
评估基于手机的干预措施对改善避孕措施使用的益处和危害。
我们使用了标准的、广泛的 Cochrane 检索方法。最新的检索日期是 2022 年 8 月。
我们纳入了随机对照试验（RCT），这些试验评估了基于手机的干预措施对提高避孕措施使用的效果。
我们使用了标准的 Cochrane 方法。我们的主要结局是 1. 避孕措施的使用率，2. 特定避孕方法的使用率，3. 避孕方法的坚持率，4. 安全的方法转换率，5. 避孕措施的停用率，6. 妊娠或流产率。我们的次要结局是 7. 道路交通事故，8. 报告的任何身体或心理影响，9. 暴力或家庭虐待。
23 项 RCT（12793 名参与者）来自 11 个国家，符合我们的纳入标准。11 项研究在高收入资源充足的环境中进行，12 项研究在低收入环境中进行。13 项研究使用了单向短信干预，6 项研究使用了互动短信，4 项研究使用了语音消息干预，2 项研究使用了移动电话应用程序来提高避孕措施的使用。所有研究都得到了非商业机构的资助。与对照组相比，基于手机的干预措施可能会增加避孕措施的使用（比值比（OR）1.30，95%置信区间（CI）1.06 至 1.60；16 项研究，8972 名参与者；中等确定性证据）。与对照组相比，使用基于手机的干预措施可能不会降低意外怀孕的风险（OR 0.82，95%CI 0.48 至 1.38；8 项研究，2947 名参与者；中等确定性证据）。对单向手机干预与互动手机干预进行的亚组分析发现，两组之间存在差异，支持互动干预（P = 0.003，I = 88.5%）。互动干预的 OR 为 1.71（95%CI 1.28 至 2.29；P = 0.0003，I = 63%；8 项研究，3089 名参与者），而单向干预的 OR 为 1.03（95%CI 0.87 至 1.22；P = 0.72，I = 17%；9 项研究，5883 名参与者）。对高收入与低收入试验环境进行的亚组分析发现，两组之间没有差异（亚组差异检验：P = 0.70，I = 0%）。只有 6 项试验报告了安全性和意外结果；一项试验报告了增加的伴侣暴力，而另外四项试验报告了对照组和干预组之间的身体暴力率没有差异。一项试验报告使用手机干预没有发生道路交通事故。
本综述表明，有证据支持使用基于手机的干预措施来改善避孕措施的使用，具有中等确定性证据。互动手机干预似乎比单向方法更有效。这些干预措施的成本效益、成本效益、安全性和长期效果仍然未知，包括这些方法在支持特定人群避孕措施使用方面的证据。未来的研究应调查基于手机的干预措施的有效性和安全性，以更好质量的试验来帮助确定手机干预对避孕措施使用的影响。本综述受到研究方法缺陷、偏倚或结果不精确的限制，因此质量较低。
