REVIEW SUMMARIES

Summaries of systematic reviews on public health nursing-related issues from the Cochrane Library, CochraneNursing Care Field, and other evidence review organizations

THE COCHRANECOLLABORATION®

A FIELD OF

Strategies for CommunicatingContraceptive EffectivenessZhu Jianzhong, B.Med.,1† Yan Ma, B.N.,2 and Liu Weihua, M.Med., R.N.21Department of Medical Imaging, Affiliated Hospital of Taishan Medical University, TaiAn City, Shandong, China; and 2School of Nursing,Taishan Medical University, TaiAn City, Shandong, China

Correspondence to:

Liu Weihua, RN School of Nursing, Taishan Medical University, 2 YingSheng East Rd, TaiAn City, Shandong 271000, China.

E-mail: weihualiu1966@gmail.com

This is a summary of a Cochrane Review: The full citation and the names of the researchers who conducted the Review are listed in the Reference

section below.

Review QuestionWhat is the most useful strategy for communicatingto consumers the effectiveness of contraceptives inpreventing pregnancy?

Keywords: communicate, contraceptive effective-ness, strategy.

Type of ReviewThis is a Cochrane systematic review containingseven randomized controlled trials with a total of4526 women participants.

Relevance for Public Health NursingInformed choice for family planning requiresknowledge of contraceptive effectiveness as well asthe pros and cons of different contraceptive meth-ods. Choices may be influenced by knowledge ofthe likelihood of pregnancy and the factors that

influence effectiveness of each method. Nurses playa significant role in helping patients choose appro-priate contraceptive methods, so it is important fornurses to know evidence-based strategies for com-municating to their patients the effectiveness ofcontraceptives in preventing pregnancy.

Characteristics of the EvidenceFour studies were conducted in clinical settings,and three were conducted in the community. Thepopulation of interest was consumers or potentialusers of the contraceptive methods; however, onlywomen were examined in the included trials. Inter-ventions were methods for communicating contra-ceptive effectiveness to consumers, includingeducational programs or materials and counselingsessions focused on individuals or groups, the con-tent of which had to include the effectiveness ofmore than one type of contraception. Interventionswere compared with usual practice or an alternativeto the experimental intervention. The outcomemeasures were knowledge of contraceptive effec-tiveness, attitude about contraception or toward†All are members of the Cochrane Nursing Care Field (CNCF).

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any particular contraceptive, and choice or use ofcontraceptive method.

The overall methodological quality of evidencewas considered low. Evidence provided by theremaining two trials was considered high and mod-erate, respectively. Meta-analysis was undertakenwhere possible. For the initial review, one authorabstracted the data and entered the informationinto RevMan; another author conducted a seconddata abstraction and verified correct data entry. Forthe evidence quality assessment, the authors firstsummarized the characteristics of the interventionsand the outcome assessments, and then summa-rized the evidence quality results based on the riskof bias in the included studies and the characteris-tics summary.

The results are as follows:Two trials provided multiple educational ses-

sions for participants. In one study that examinedcontraceptive choice, women received informationand education 4 times (on admission to study [gesta-tion week 29–35], prenatal visit after week 36 ofpregnancy, hospitalization for delivery, and 6 weekspostpartum) in the treatment group and standardfamily planning counseling at the clinic in the con-trol group. The result indicated that women in thetreatment group were more likely to choose steriliza-tion (odds ratio [OR]: 4.26; 95% confidence intervals[CI]: 2.46–7.37), or use a modern contraceptivemethod by 6 weeks postpartum (i.e., sterilization,pills, injectable, intrauterine device [IUD] or barriermethod) (OR: 2.35; 95% CI: 1.82–3.03) comparedwith the standard information group. The secondstudy was a couple-based intervention for preventingHIV and STDs with a three-session interventiongroup compared with a one-session informationgroup. It showed that there was no significant differ-ence in consistent use of an effective contraceptive(i.e., sterilization, IUD, injectable, implant, and con-sistent use of oral contraceptives, diaphragm, or malecondoms) by 6 months between the two groups.

Five trials provided one-session for each studygroup. One study providing structured counselingusing a flipchart on family planning methodsshowed no significant difference in choice of contra-ceptive method or continuation of the chosenmethod at 3 months between the intervention andusual-care group. One study focused on HIV sero-discordant or concordant couples. Videos wereshown to four groups (control, motivational, contra-

ceptive methods, and both motivational and meth-ods videos) to provide couples with contraceptiveinformation; this resulted in no significant differ-ence in the types of contraceptives chosen betweenthe four study groups. Within groups, choicesshifted from nearly 80% using condoms to more useof oral contraceptives (35–40%) and injectables (37–41%), as well as implants (10–13%). Another studycompared different media for communicating con-traception information; knowledge gain was less foran oral presentation by the physician–provider com-pared with a slide-and-sound presentation with anunfamiliar voice (mean difference [MD]: �19.00;95% CI: �27.52 to �10.48); there was no significantdifference in satisfaction with the educationalmethod between the study groups. The fourth trialcompared three tables of contraceptive effectivenessinformation: (1) numeric risk of pregnancy; (2) cate-gories of method effectiveness (more effective, effec-tive for most users, and less effective for mostusers); and (3) both categories and numbers. Use ofthe table with contraceptive effectiveness categoriesled to a greater change in women who understoodthat hormone injections were more effective thanpills compared with the table based on pregnancynumbers (OR: 2.42; 95% CI: 1.43–4.12) and thetable with effectiveness categories and pregnancynumbers (OR: 2.58; 95% CI: 1.50–4.42). There wasalso a greater increase in those who understood thatcombined pills were more effective than condoms inthe categories table compared with the numerictable (OR: 2.19; 95% CI: 1.21–3.97) and comparedwith the table with categories and numbers (OR:2.03; 95% CI: 1.13–3.64). In addition, a table withcategories showed that fewer women thought thetool was hard to understand compared with thetable with numbers (OR: 0.29; 95% CI: 0.13–0.63)or the table with categories and numbers (OR: 0.38;95% CI: 0.17–0.85). The last study tested threecharts with contraceptive effectiveness information:(1) control group: three categories of effectivenessstratified by typical or consistent users; (2) catego-ries-chart group: four categories of effectivenesswith numbers of pregnancies; and (3) continuum-chart group: a continuum of effectiveness bynumbers of pregnancies. The three groups with eachchart did not differ significantly in change in com-prehension of relative contraceptive effectiveness.However, women in the categories-chart group weremore likely than the control group to report that the

Jianzhong et al.: Communicating Contraceptive Effectiveness 439

chart provided enough information to choose amethod (OR: 1.97; 95% CI: 1.13–3.44) and that thechart was easier to understand (OR: 1.47; 95% CI:1.03–2.10). The categories-chart group did not differsignificantly from the continuum-chart group forthese perception items.

None of the studies reported whether theinstruments used to assess knowledge or attitudeshad been tested for validity or reliability.

Implications for Population-Based PracticeNo conclusions could be reached about whatwould best help consumers choose an appropriatecontraceptive method because the trials includedin this review varied greatly in the types of partici-pants and interventions. The overall quality ofevidence was considered low, given that five of theseven studies provided low or very low qualityevidence.

Implications for Public Health NursingResearchTo determine the most useful approach for commu-nicating contraceptive effectiveness, more detailedreporting of intervention content and strategiestested in clinical settings should be carried out. Fol-low-up in future studies should be incorporated toassess retention of knowledge over time, and thevalidity or reliability of instruments used to assessknowledge or attitudes should be also described.

Reference

Lopez, L. M., Steiner, M., Grimes, D. A., Hilgen-berg, D., & Schulz, K. F. (2013). Strategiesfor communicating contraceptive effective-ness. Cochrane Database of SystematicReviews, 4. Art. No.: CD006964. doi:10.1002/14651858.CD006964.pub3.

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