Effectiveness of interventions to support person-centered contraceptive care for adolescents and young adults: a systematic review.

OBJECTIVE

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.

DATA SOURCES

PubMed, Cumulative Index to Nursing and Allied Health Literature via EBSCO, Embase.com, PsycInfo via EBSCO, and Scopus searched on March 31, 2024.

STUDY ELIGIBILITY CRITERIA

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.

STUDY APPRAISAL AND SYNTHESIS METHODS

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.

RESULTS

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.

CONCLUSION

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.