A systematic review and meta-analysis 2 assessed technology-based decision aids on contraceptive use, continuation, and patient-reported and decision-making outcomes. 18 studies evaluating 21 decision aids were included. Overall, there were higher odds of contraceptive use and/or continuation among decision aid users compared with controls (odds rati, 1.27, 95% CI 1.05 to 1.55). Use of computer and web-based decision aids was associated with higher odds of contraceptive use and/or continuation (OR 1.36, 95% CI 1.08 to 1.72) than mobile and tablet decision aids (OR 1.27, 95% CI 0.83 to 1.94). Overall, the review provided moderate-level evidence for contraceptive use and continuation, knowledge, and self-efficacy.
Another systematic review and meta-analysis 3 included 35 RCTs with a total of 9 790 women. Patient decision aids were evaluated within a wide range of clinical scenarios in obstetrics and gynecology, including contraception. A standardized mean difference (SMD) of 0.2 is considered small, 0.5 moderate, and 0.8 large. When compared with usual clinical practice, the use of patient decision aids reduced decisional conflict (SMD -0.23, 95% CI -0.36, to -0.11; 19 trials; n=4 624) and improved patient knowledge (SMD 0.58, 95% CI 0.44 to 0.71; 17 trials; n=4 375).
A Cochrane review [Abstract] 1 included 7 studies with a total of 4 526 subjects. Two trials provided multiple sessions for participants. Five trials provided one session and focused on testing educational material or media. In one study, knowledge gain favored a slide-and-sound presentation compared with a physician's oral presentation (WMD -19.00; 95% CI -27.52 to -10.48, n=100). In another study (n=461), a table with effectiveness categories led to more correct answers than one based on numbers [ORs were 2.42 (95% CI 1.43 to 4.12) and 2.19 (95% CI 1.21 to 3.97)] or a table with categories and numbers [ORs were 2.58 (95% CI 1.5 to 4.42) and 2.03 (95% CI 1.13 to 3.64)]. One trial examined contraceptive choice: women in the expanded program were more likely to choose sterilization (OR 4.26; 95% CI 2.46 to 7.37) or use a modern contraceptive method (OR 2.35; 95% CI 1.82 to 3.03). No trial had an explicit theoretical base, but each used concepts from common theories or models.
Comment: The quality of evidence is downgraded by study quality (several limitations), by indirectness (differences in studied interventions and outcomes), by imprecise results (limited study size for each comparison).
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