Allison Bianca A, Glodowski Cherise R, Smith Cambray, Mizelle Celia, Leiva Hailey, Wright Sarah Towner, Golin Carol, Arora Kavita Shah, Schilling Samantha
Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC.
University of North Carolina School of Medicine, Chapel Hill, NC.
Am J Obstet Gynecol. 2025 Aug;233(2):82-100.e4. doi: 10.1016/j.ajog.2025.03.016. Epub 2025 Mar 20.
To investigate the association between interventions to support adolescent and young adult person-centered contraceptive counseling and the delivery of person-centered contraceptive counseling, and their impact on clinician and patient outcomes.
PubMed, Cumulative Index to Nursing and Allied Health Literature via EBSCO, Embase.com, PsycInfo via EBSCO, and Scopus searched on March 31, 2024.
Published from March 2011 to present, included patients assigned female at birth and <25 years, studied interventions that operationalized aspects of person-centered contraceptive counseling, and had patient or clinician outcomes related to person-centered contraceptive counseling (eg, direct measurement of person-centered contraceptive counseling, knowledge, confidence, and contraceptive decision-making). All study designs with primary data collection were included except case studies/series.
Search results were downloaded to EndNote, and duplicates were removed. References were uploaded to Covidence Systematic Review software. Two authors independently screened the studies using the eligibility criteria by title and abstract then full-text review. Relevant information was extracted independently by 2 authors. Discrepancies were resolved through consensus discussion. Data included study sample demographic characteristics, methodological characteristics, intervention and comparator descriptions, and outcome measures. We then determined risk of bias for individual studies and strength of evidence by included outcomes.
Of 5611 unique titles and abstracts, 12 studies met eligibility criteria. Four were pre/post studies, 2 were randomized controlled trials, and 6 were observational. These studies evaluated interventions including contraceptive coaching, decision aids, and clinician counseling prompts. No studies directly assessed person-centered contraceptive counseling using validated measures. All studies reported improvements in contraception-related secondary patient and clinician outcomes in the short and medium term. Patient outcomes included the following: continuation, choice, knowledge, perceived benefits, quality of care, and self-efficacy. Clinician outcomes included the following: comfort, knowledge, quality of care, and perceived benefits. Most studies had a high risk of bias.
While interventions to support person-centered contraceptive counseling may improve patient and clinician outcomes, none of the studies directly measured person-centered contraceptive counseling or assessed preferred method use or reproductive autonomy as outcomes. The results were integrated into a Socioecological Model of Person-Centered Contraceptive Counseling and Care to diagram relationships between interventions, delivery of person-centered contraceptive counseling, and secondary outcomes.
探讨支持以青少年和青年人为中心的避孕咨询干预措施与以青少年和青年人为中心的避孕咨询服务提供之间的关联，以及它们对临床医生和患者结局的影响。
2024年3月31日检索了PubMed、通过EBSCO的护理及相关健康文献累积索引、Embase.com、通过EBSCO的PsycInfo以及Scopus。
发表于2011年3月至目前，纳入出生时被指定为女性且年龄<25岁的患者，研究对以青少年和青年人为中心的避孕咨询各方面进行操作化的干预措施，且有与以青少年和青年人为中心的避孕咨询相关的患者或临床医生结局（如直接测量以青少年和青年人为中心的避孕咨询、知识、信心和避孕决策）。除病例研究/系列外，所有具有原始数据收集的研究设计均纳入。
检索结果下载至EndNote，去除重复项。参考文献上传至Covidence系统评价软件。两位作者独立使用纳入标准通过标题和摘要筛选研究，然后进行全文审查。两位作者独立提取相关信息。通过共识讨论解决分歧。数据包括研究样本的人口统计学特征、方法学特征、干预和对照描述以及结局指标。然后我们确定了各个研究的偏倚风险以及纳入结局的证据强度。
在5611个独特的标题和摘要中，12项研究符合纳入标准。4项为前后对照研究，2项为随机对照试验，6项为观察性研究。这些研究评估了包括避孕指导、决策辅助工具和临床医生咨询提示等干预措施。没有研究使用经过验证的测量方法直接评估以青少年和青年人为中心的避孕咨询。所有研究均报告在短期和中期，与避孕相关的次要患者和临床医生结局有所改善。患者结局包括：持续使用、选择、知识、感知益处、护理质量和自我效能感。临床医生结局包括：舒适度、知识、护理质量和感知益处。大多数研究存在较高的偏倚风险。
虽然支持以青少年和青年人为中心的避孕咨询的干预措施可能会改善患者和临床医生结局，但没有研究直接测量以青少年和青年人为中心的避孕咨询，也没有将首选方法的使用或生殖自主权作为结局进行评估。研究结果被整合到一个以青少年和青年人为中心的避孕咨询与护理的社会生态模型中，以描绘干预措施、以青少年和青年人为中心的避孕咨询服务提供与次要结局之间的关系。
