A Cochrane review [Abstract] 3 included 23 studies with a total of 12 793 subjects. 11 studies were conducted in high-income and 12 were in low-income settings. 13 studies used unidirectional text messaging-based interventions, 6 studies used interactive text messaging, 4 used voice message-based interventions and 2 used mobile-phone apps to improve contraception use. Mobile phone-based interventions increased contraception use compared to the controls, however there was little or no difference in rates of unintended pregnancy (table T2).
The certainty of the evidence is downgraded by heterogeneity.
| Outcome | Relative effect (95% CI) | Risk with usual care | Risk with intensive counseling (95% CI) | №of participants (studies) |
|---|---|---|---|---|
| Contraception use | OR 1.30(1.06 to 1.60) | 515 per 1000 | 580 per 1000(529 to 629) | 8972(16) |
| Pregnancy | OR 0.82(0.48 to 1.38) | 21 per 1000 | 18 per 1000(10 to 29) | 2947(8) |
A Cochrane review [Abstract] 1 included 10 studies with a total of 6 242 subjects. The included trials investigated interventions in women using a variety of different shorter-term hormonal contraceptive methods. Intensified counselling improved continuation of hormonal contraceptive methods compared with usual care (table T1). There were no difference in discontinuation in 12 months. Women in the daily text-message group were more likely than the standard-care group to continue use (OR 1.33, 95% CI 1.03 to 1.73; 2 trials, n=933, I²=69%).
| Outcome | Relative effect (95% CI) | Risk with usual care | Risk with intensive counseling (95% CI) | №of participants (studies) |
|---|---|---|---|---|
| Continuation of hormonal contraceptive method | OR 1.28 (1.07 to 1.54) | 392 per 1 000 | 452 per 1 000 (408 to 498) | 2624 (6) |
| Rate of discontinuation due to menstrual disturbances | OR 0.20 (0.11 to 0.37) | 320 per 1 000 | 86 per 1 000 (49 to 148) | 350 (1) |
| Rate of discontinuation due to all other adverse events | OR 0.73 (0.36 to 1.47) | 549 per 1 000 | 470 per 1 000 (304 to 641) | 350 (1) |
| Pregnancy | OR 1.24 (0.98 to 1.57) | 18 per 100 | 21 per 100 (18 to 25) | 1985 (3) |
A Cochrane review [Abstract] 2 included 53 studies with a total of 105 368 adolescents. 18 studies randomized individuals, 32 randomized clusters (schools 20, classrooms 6, communities/neighbourhoods 6), and 3 studies were mixed. The length of follow up varied from 3 months 7 years. Combination of educational, skill building and contraception promotion lowered significantly the rate of unintended pregnancy among adolescents (RR 0.66, 95% CI 0.50 to 0.87; 4 individual RCTs, n=1905).
Educational interventions increased reported condom use at last sex in adolescents compared to controls (RR 1.18, 95% CI 1.06 to 1.32; 2 studies, n=1431). However, it is not clear if the educational interventions had any effect on unintended pregnancy as this was not reported. For adolescents who received contraceptive-promoting interventions, there was little or no difference in the risk of unintended first pregnancy compared to controls (RR 1.01, 95% CI 0.81 to 1.26; 2 studies, n=3 440 participants).The use of hormonal contraceptives was significantly higher in adolescents in the intervention group (RR 2.22, 95% CI 1.07 to 4.62; 2 studies, n=3 091).
Primary/Secondary Keywords