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. 2018 Nov;55(5):703-715.
doi: 10.1016/j.amepre.2018.07.012.

Impact of Contraceptive Education on Knowledge and Decision Making: An Updated Systematic Review

Karen Pazol  1 , Lauren B Zapata  2 , Christine Dehlendorf  3 , Nikita M Malcolm  4 , Rachel B Rosmarin  4 , Brittni N Frederiksen  5
Affiliations

Impact of Contraceptive Education on Knowledge and Decision Making: An Updated Systematic Review

Karen Pazol et al. Am J Prev Med. 2018 Nov.

Abstract

Context: Educational interventions can help individuals increase their knowledge of available contraceptive methods, enabling them to make informed decisions and use contraception correctly. This review updates a previous review of contraceptive education.

Evidence acquisition: Multiple databases were searched for articles published March 2011-November 2016. Primary outcomes were knowledge, participation in and satisfaction/comfort with decision making, attitudes toward contraception, and selection of more effective methods. Secondary outcomes included contraceptive behaviors and pregnancy. Excluded articles described interventions that had no comparison group, could not be conducted feasibly in a clinic setting, or were conducted outside the U.S. or similar country.

Evidence synthesis: A total of 24,953 articles were identified. Combined with the original review, 37 articles met inclusion criteria and described 31 studies implementing a range of educational approaches (interactive tools, written materials, audio/videotapes, and text messages), with and without healthcare provider feedback, for a total of 36 independent interventions. Of the 31 interventions for which knowledge was assessed, 28 had a positive effect. Fewer were assessed for their effect on attitudes toward contraception, selection of more effective methods, contraceptive behaviors, or pregnancy-although increased knowledge was found to mediate additional outcomes (positive attitudes toward contraception and contraceptive continuation).

Conclusions: This systematic review is consistent with evidence from the broader healthcare field in suggesting that a range of interventions can increase knowledge. Future studies should assess what aspects are most effective, the benefits of including provider feedback, and the extent to which educational interventions can facilitate behavior change and attainment of reproductive health goals.

Theme information: This article is part of a theme issue entitled Updating the Systematic Reviews Used to Develop the U.S. Recommendations for Providing Quality Family Planning Services, which is sponsored by the Office of Population Affairs, U.S. Department of Health and Human Services.

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Conflict of interest statement

No conflicts of interest or financial disclosures were reported by the authors of this paper.

Figures

Figure 1.
Figure 1.. Analytic framework for systematic review of impact of contraceptive education.
KQ, key question.
Figure 2.
Figure 2.
Flow diagram—process of identifying studies included.
Figure 3.
Figure 3.. Summary of evidence from systematic review on contraceptive education.
aIncludes decision aids, computer games, Facebook page, and smart phone apps. bMaterials provided or read as a script. cInterventions described in Kirby et al. 1989; Paperny and Starn 1989; Reis and Tymchyshyn 1992; O’Donnell et al. 1995,; Smith and Whitfield 1995; Deijen and Kornaat 1997; Little 1998, 2001; DeLamater et al. 2000; Lindenberg et al. 2002; Johnson et al. 2003; Mason et al. 2003; Steiner et al. 2003; Roberto et al. 2007; Schwarz et al. 2008; Castano et al. 2012; Hall et al. 2013, 2014; Garbers et al. 2012,; Vogt and Schaefer 2012; Schwarz et al. 2013; Gilliam et al. 2014; Kofinas et al. 2014; Davidson et al. 2015; Garbers et al. 2015; and Sridhar et al. 2015. dInterventions described in: O’Donnell et al. 1995,; Little et al. 1998, 2001; Chewning et al. 1999; DeLamater et al. 2000; Pedrazzini et al. 2000; Whitaker et al. 2010; Ragland et al. 2011; Garbers et al. 2012,; Schwarz et al. 2014; Lee et al. 2015; Ragland et al. 2015; de Reilhac et al. 2016; and Michie et al. 2016. eInterventions described in: Kirby et al. 1989; Paperny and Starn 1989; Reis and Tymchyshyn 1992; O’Donnell et al. 1995,; Smith and Whitfield 1995; Deijen and Kornaat 1997; Little 1998, 2001; DeLamater et al. 2000; Lindenberg et al. 2002; Mason et al. 2003; Steiner et al. 2003; Roberto et al. 2007; Schwarz et al. 2008; Castano et al. 2012; Hall et al. 2013, 2014; Vogt and Schaefer 2012; Schwarz et al. 2013; Gilliam et al. 2014; Kofinas et al. 2014; Garbers et al. 2015; and Sridhar et al. 2015. fInterventions described in O’Donnell et al. 1995,; Little et al. 1998, 2001; Chewning et al. 1999; DeLamater et al. 2000; Pedrazzini et al. 2000; Ragland et al. 2011; Schwarz et al. 2014; Lee et al. 2015; Ragland et al. 2015; de Reilhac et al. 2016; and Michie et al. 2016. gInterventions described in Johnson et al. 2003; Mason et al. 2003; Steiner et al. 2003; Kofinas et al. 2014; Davidson et al. 2015; and Sridhar et al. 2015. hIntervention described in: Schwarz et al. 2014; Lee et al. 2015. iIndicates intervention had a marginally significant effect on this outcome (0.05<p<0.1). jInterventions described in Deijen and Kornaat 1997; Schwarz et al. 2008; Vogt and Schaefer 2012; and Kofinas et al. 2014. kIntervention described in Whitaker et al. 2010. lInterventions described in Garbers et al. 2012; Gilliam et al. 2014; and Sridhar et al. 2015. mIntervention described in Garbers et al. 2012. nInteraction with educational level described in Little et al. 2001 and Hall et al. 2013. oInteraction with educational level described in Little et al. 2001 and Regland et al. 2011. pInterventions described in Kirby et al. 1989; O’Donnell et al. 1995,; Vogt and Schaefer 2012; and Garbers et al. 2015. qInterventions described in O’Donnell et al. 1995, and Michie et al. 2016. rSignificant increase over baseline, but significance of increase relative to controls not reported. sInterventions described in Kirby et al. 1989; DeLamater et al. 2000; and Schwarz et al. 2008. tIntervention described in DeLamater et al. 2000. uInterventions described in Deijen and Kornaat 1997; Garbers et al. 2012; and Castano et al. 2012; Hall et al. 2013, 2014. vInterventions described in Chewning et al. 1999; Garbers et al. 2012; and Michie et al. 2016. wIntervention described in Schwarz et al. 2008. xIntervention described in Chewning et al. 1999. KQ, key question.
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