Strategies for improving the acceptability and acceptance of the copper intrauterine device

46 Pages·2012·0.55 MB·English

Strategies for improving the acceptability and acceptance of
the copper intrauterine device (Review)
Arrowsmith ME, Aicken CRH, Saxena S, Majeed A
ThisisareprintofaCochranereview,preparedandmaintainedbyTheCochraneCollaborationandpublishedinTheCochraneLibrary
2012,Issue3
http://www.thecochranelibrary.com
Strategiesforimprovingtheacceptabilityandacceptanceofthecopperintrauterinedevice(Review)
Copyright©2012TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
TABLE OF CONTENTS
HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
PLAINLANGUAGESUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
SUMMARYOFFINDINGSFORTHEMAINCOMPARISON . . . . . . . . . . . . . . . . . . . 2
BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Figure1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Figure2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Figure3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Figure4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Figure5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Figure6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
ADDITIONALSUMMARYOFFINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . 14
DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
AUTHORS’CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
CHARACTERISTICSOFSTUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
DATAANDANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Analysis1.1.Comparison1Effectivenessofcommunity-basedfamilyplanningprogramme:communityworkersversus
control,Outcome1UptakeofIUD. . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Analysis1.2.Comparison1Effectivenessofcommunity-basedfamilyplanningprogramme:communityworkersversus
control,Outcome2KnowledgeofIUD. . . . . . . . . . . . . . . . . . . . . . . . . 40
Analysis2.1.Comparison2Effectivenessofcontraceptivecounsellingprovisionamongpostpartumpopulation:postnatal
counsellingversuscontrol,Outcome1UptakeofIUD. . . . . . . . . . . . . . . . . . . . 41
Analysis3.1.Comparison3Effectivenessofcontraceptivecounsellingprovisionamongpostpartumpopulation(short-
term):antenatalcounsellingversuscontrol,Outcome1UptakeofIUD. . . . . . . . . . . . . . . 42
Analysis4.1.Comparison4Effectivenessoffamilyplanningcounsellingamongpostabortionpopulation,Outcome1
UptakeofIUD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
HISTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
CONTRIBUTIONSOFAUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
DECLARATIONSOFINTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
SOURCESOFSUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Strategiesforimprovingtheacceptabilityandacceptanceofthecopperintrauterinedevice(Review) i
Copyright©2012TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
[InterventionReview]
Strategies for improving the acceptability and acceptance of
the copper intrauterine device
MyatEArrowsmith1,CatherineRHAicken2,SoniaSaxena1,AzeemMajeed1
1DepartmentofPrimaryCareandPublicHealth,ImperialCollegeLondon,London, UK.2UniversityCollegeLondon, Centrefor
SexualHealth&HIVResearch,London,UK
Contact address: Myat E Arrowsmith, Department of Primary Care and Public Health, Imperial College London, Charing Cross
Hospital,St.Dunstan’sRoad,London,W68RP,[email protected].
Editorialgroup:CochraneFertilityRegulationGroup.
Publicationstatusanddate:New,publishedinIssue3,2012.
Reviewcontentassessedasup-to-date: 2September2011.
Citation: Arrowsmith ME, Aicken CRH, Saxena S, Majeed A. Strategies for improving the acceptability and acceptance
of the copper intrauterine device. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD008896. DOI:
10.1002/14651858.CD008896.pub2.
Copyright©2012TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
ABSTRACT
Background
Intrauterinedevices(IUDs)arehighlyeffectiveandarethemostwidelyusedreversiblecontraceptivemethodintheworld.However,
indevelopedcountriesIUDsareamongtheleastcommonmethodsofcontraceptionused.Weevaluatedtheeffectofinterventionsto
increaseuptakeofthecopperIUD,along-acting,reversiblecontraceptivemethod.
Objectives
TodetermineeffectivenessofinterventionstoimproveuptakeandcontinuationofthecopperIUD.
Searchmethods
WesearchedtheCochraneCentralRegisterofControlledTrials(CENTRAL),MEDLINE,EMBASE,POPLINE,PsycINFO,PubMed,
ClinicalTrials.gov, International Clinical Trials Registry Platform (ICTRP) and OpenSIGLE. We also handsearched references of
relevantreviewsandincludedstudies.
Selectioncriteria
Weincludedrandomised controlledtrials(RCTs) andcontrolledbeforeandafterstudiesof interventions whichmeasureduseand
uptakeofcontraceptionincludingcopperIUDasanoutcome.
Datacollectionandanalysis
Twoauthorsindependentlyscreenedthesearchresultsforrelevantstudiesandextracteddatafromincludedstudies.WeusedRevMan
5.1tocalculatePetooddratios(OR)with95%confidenceintervals(CI)fordichotomousoutcomes.Weconductedmeta-analysisby
poolingdataforsimilartypesofinterventionwherepossible.WeusedtheGRADEsystemtoevaluatethequalityofevidence.
Mainresults
Ninestudiesrepresenting7960womenmetour inclusioncriteria,includingsevenrandomised controlledtrialsandtwocontrolled
beforeandafterstudiesthatreportedIUDuptakepostintervention.Weevaluatedthequalityofevidenceasmoderatetolow.Three
studiesoncontraceptivecounsellingandreferralsbycommunityworkersshowedanincreaseinuptakeoftheIUDamongintervention
Strategiesforimprovingtheacceptabilityandacceptanceofthecopperintrauterinedevice(Review) 1
Copyright©2012TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
groups(PetoOR2.00;95%CI1.40to2.85).Twostudiesonantenatalcontraceptivecounsellingalsofavouredtheinterventiongroups
(PetoOR2.33;95%CI1.39to3.91).OnestudyonpostnatalcouplecontraceptivecounsellingalsoshowedanincreaseinIUDuptake
comparedtocontrol(PetoOR5.73;95%CI3.59to9.15).Theresultsofonestudyevaluatingpostnatalhomevisitsandtwostudies
onenhancedpostabortioncontraceptivecounsellingdidnotreachstatisticalsignificance.
Authors’conclusions
Community-based interventions andantenatal contraceptivecounsellingimproveduptake ofcopperIUDcontraception. Sincethe
copperIUDisoneofthemosteffectivereversiblecontraceptivemethods,primarycareandfamilyplanningandpractitionerscould
consideradoptingtheseinterventions.Althoughourreviewsuggeststheseinterventionsareclinicallyeffective,acost-benefitanalysis
mayberequiredtoevaluateapplicability.
PLAIN LANGUAGE SUMMARY
Waystoincreaseuseofnon-hormonallong-actingbirthcontrol
Thecopperintrauterinedevice(copperIUD)isahighly-effectivenon-hormonaltypeofbirthcontrol,andisthemostcommonlyused
methodintheworld.However,useofthecopperIUDislowincountrieswithrelativelyhighratesofunintendedpregnancy,suchas
theUnitedKingdomandUnitedStates.OurreviewlookedatstudiesofdifferentinterventionstoimproveuseofthecopperIUD.
Wedidcomputersearchesforrelevantstudiesandlookedatthereferencelistsofstudyreportstoidentifymorestudies. Wefound
ninestudiesofmoderatetolowquality.Threestudiesoncontraceptivecounsellingandreferralsbycommunityworkersshowedan
increaseinuseofthecopperIUD.Twostudiesonantenatalcontraceptivecounsellingandonestudyonpostnatalcouplecounselling,
withprovisionofaninformationleafletbeforebeingdischargedfromthematernityward,alsoshowedanincreaseinuseofthecopper
IUD.Astudyonpostnatalhomevisitsandtwostudiesonenhancedpostabortioncontraceptivecounsellingdidnotshowanincrease
inuseofthecopperIUD.Morehigh-qualityresearchisneededtolookatthelonger-termeffectivenessofinterventionstoimproveuse
ofthecopperIUD.
Strategiesforimprovingtheacceptabilityandacceptanceofthecopperintrauterinedevice(Review) 2
Copyright©2012TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
CopStra SUMMARY OF FINDINGS FOR THE MAIN COMPARISON [Explanation]
yrte
ighgie
ts
©fo
2r
01im Contraceptivecounsellingandreferralbycommunityworkersformarriedwomen15to49yearsold
2p
TheCroving Patientorpopulation:marriedwomenaged15to45/49
octh Settings:home
he
raa Intervention:contraceptivecounsellingandreferralbycommunityworkers
necce
Cp
ollabortability Outcomes Illustrativecomparativerisks*(95%CI) R(9e5la%tivCeI)effect N(sotuodfiepsa)rticipants Q(GuRaAlitDyEo)ftheevidence Comments
atioand
n.Pacc Assumedrisk Correspondingrisk
ue
bp
lishtan Control Contraceptive
edce counselling and referral
bo
yf bythecommunitywork-
Joth
he ers
nc
Wop
ileyper UptakeofIUD 12per1000 24per1000 OR2.00 6224 ⊕⊕⊕(cid:13)
&Sons,Ltdintrauterine utNivsueemIbUeDr aosf awocmonetnracwehpo- (17to34) (1.4to2.85) (3studies) moderate1,2
.d
e
v *Thebasisfor theassumedrisk(e.g.themediancontrol groupriskacross studies) isprovidedinfootnotes. Thecorresponding risk(andits95%confidence interval) isbasedonthe
ic
e assumedriskinthecomparisongroupandtherelativeeffectoftheintervention(andits95%CI).
(R
ev CI:confidenceinterval;IUD:intrauterinedevice;OR:oddsratio
ie
w
)
GRADEWorkingGroupgradesofevidence
Highquality:Furtherresearchisveryunlikelytochangeourconfidenceintheestimateofeffect.
Moderatequality:Furtherresearchislikelytohaveanimportantimpactonourconfidenceintheestimateofeffectandmaychangetheestimate.
Lowquality:Furtherresearchisverylikelytohaveanimportantimpactonourconfidenceintheestimateofeffectandislikelytochangetheestimate.
Verylowquality:Weareveryuncertainabouttheestimate.
1Thesestudieshave’high’riskofbiasfortwocategoriesorhigher.
2UnexplainedheterogeneityofI2=86%;twostudiessuggestedbenefit,howevertheconfidenceintervalsdonotoverlap.
3
BACKGROUND
oralcontraceptivepillsandcondoms.Furthermore,nationalsur-
veysofcontraceptiveuseintheUnitedKingdomshowthattheuse
of long-acting reversiblecontraceptives (LARCs)including cop-
Descriptionofthecondition
perIUDsislowerthaninmanyotherEuropeancountries(Lader
Unintendedorunplannedpregnanciesduetocontraceptivefail- 2009).Alargestudyofcontraceptiveuseamong12,000women
uresareassociatedwithmethodefficacyanduser-adherencefac- (agebetween15to49yearsold)acrossfiveEuropeancountries
tors,suchasincorrectandinconsistent use(Kost2008;Trussell alsoshowsthatoralcontraceptivepillsandcondomsarethemost
2004;Trussell2009).Non-hormonalintrauterinedevices(IUDs) commonly usedmethodsinEurope,with theUnited Kingdom
orcopperIUDsareconsideredtobehighlyeffectiveinpreventing showingthelowestuseofIUDs(Haimovich2009;Skouby2004).
pregnancy,withfailureratesbeinglessthen1%,andlowreliance Interventionsorstrategiestoimproveacceptanceandacceptability
onuseradherence(Mansour2010;Trussell2009).CopperIUDs ofhormonalcontraceptiveswereassessedinapreviousCochrane
arealsoconsideredaneffectivemethodofemergencycontracep- systematicreview(Halpern2006).Thissystematicreviewwillex-
tion(Cheng2008). aminewhetherclient-andprovider-interventionscouldincrease
uptakeorcontinuationofanon-hormonallong-actingreversible
contraceptivemethod,namelycopperIUDs.
Descriptionoftheintervention
IUDsare themostwidelyusedreversiblecontraceptive method
in theworld (at14.2% in2009 and 15.4% in2007), followed
OBJECTIVES
by oral contraceptive pills and male condoms (United Nations
2008;UnitedNations2009).Anestimated175millionwomen Theobjectiveofthisreviewwastodeterminetheeffectivenessof
worldwidewereusingcopperIUDsandintrauterinesystems(IUS) interventionstoimproveuptakeandcontinuationofthecopper
in2007,ofwhomjust5millionusedhormonalIUS(Sivin2010). IUD.
ThishighprevalenceisattributedtothecopperIUDbeing the
mostcommonlyusedmethodindevelopingcountries,particularly
China(UnitedNations2008;UnitedNations2009).
METHODS
Contraceptivechoicesanduseornon-useofparticularmethods
areinfluencedby,andassociatedwith,anumberofcomplexfac-
tors.Theseincludesocio-demographiccharacteristics,knowledge,
Criteriaforconsideringstudiesforthisreview
information,lifestyleneed,perceptionsofwomen,availabilityand
accessibilityofservices,healthcareproviders’attitudeandknowl-
edge;andalsootherexternalfactorssuchaslegalrestrictionsonthe
Typesofstudies
availability ofabortion servicesandreproductiverights(Belfield
2009;Campbell2006;Frost2008;Oddens1997;Wellings2007). Weconsideredstudieswhicharerandomisedcontrolledtrials,con-
trolledclinicaltrialsandcontrolledbeforeandafterstudiescom-
paring an intervention with standard care or comparing multi-
pleinterventions,andinterruptedtimeseriesthatreportedobjec-
Howtheinterventionmightwork
tivelymeasuredoutcomesconcerningtheeffectofinterventions
Thequalityoffamilyplanningcounsellingisanimportantcom- toimproveuptakeandcontinuation ofcontraception including
ponentinincreasingcontraceptiveuptake;interventionssuchas thecopperIUD.
specialistcontraceptive counselling canincrease uptake of long-
termcontraceptivemethods(Davie1996).Interventionscouldbe
Typesofparticipants
client-orprovider-focusedandmayincludeprovisionofeduca-
tionalmaterialsorprogrammes,peerormulti-componentcoun- Eligibleparticipantswerewomenofreproductiveage.Weexcluded
selling, medical interventions to increase acceptability, provider trials with women who have specific health conditions such as
educationprogrammesandchecklisttools. diabetesorHIV.
Typesofinterventions
Whyitisimportanttodothisreview
Eligibleinterventionsweredesignedtoimprovecontraceptiveuse
AlthoughIUDsarethemostcommonlyusedreversiblecontracep- ortoreduceunplannedpregnancy,andincludedcontraceptiveand
tivemethodintheworld,theuseofIUDsismuchlower(at9%)in familyplanningcounselling;informationprovisioninleafletsand
developedcountries,wherethemostcommonlyusedmethodsare otherformats;decisionaids;educationandtrainingprogrammes
Strategiesforimprovingtheacceptabilityandacceptanceofthecopperintrauterinedevice(Review) 4
Copyright©2012TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
fortheproviders.Weconsideredinterventionswhichaimedtoim- • ClinicalTrials.govsearchusedthesearchterms
provecontraceptiveuseortoreduceunplannedpregnancythrough contraceptiveORcontraceptionORbirthcontrolORfamily
improving contraceptive use; and weincluded allstudies which planning;searchlimitedbygender,notseniors66+.
measuredIUDuptakeasanoutcome. • WHOInternationalClinicalTrialsRegistryPlatform
(ICTRP)searchusedthesearchtermscontraceptionOR
contraceptiveORintheConditionsearchfield.
Typesofoutcomemeasures
Thegeneralterm’contraception’or’contraceptive’wastoensure
that the interventions with a primary or secondary outcome of
Primaryoutcomes
contraceptiveuseoruptakeoftheparticipantsincludingcopper
Theprimaryoutcomeofinterestwasachangeinuptakeoruseof
IUDwerenotmissedduringthesearch.Theterms‘birthcontrol’
thecopperIUDpostintervention.
and‘familyplanning’wereusedassomestudieswerelistedunder
thesekeywordsratherthancontraceptionorIUD.
Secondaryoutcomes
Additionaloutcomesintendedtobeincludedwerecontinuation
ofcopperIUD,whichismeasuredbydiscontinuationorremoval Searchingotherresources
rate;knowledgeofcontraception(copperIUD),reasonsforuseor Weexaminedstudieslistedintherelevantreviews,systematicre-
non-useofcontraceptive(copperIUD)andreasonsforremovalif views and references of included studies. We contacted investi-
available. gatorsofcompletedunpublishedstudiestoobtaindata.Wealso
contacted the firstauthors of identified and includedstudies to
requestadditionalinformationaboutstudieswhereabreakdown
Searchmethodsforidentificationofstudies bytypesofcontraceptiveusedwasnotreported.
Wesearchedthefollowingcomputeriseddatabases:theCochrane
Central Register of Controlled Trials (CENTRAL), PubMed,
MEDLINE, EMBASE, POPLINE, PsycINFO, ClinicalTri-
Datacollectionandanalysis
als.gov, the World Health Organization (WHO) International
ClinicalTrialsRegistryPlatform(ICTRP)andOpenSIGLE(Sys-
temforInformationonGreyLiteratureinEurope)usingthefol-
lowingkeywords:contracepti*,birthcontrol,uptake,use,accep- Selectionofstudies
tance.
The primary and secondary authors screened the titles and ab-
stractsfromtheliteraturesearchtoidentifyrelevantstudies.The
Electronicsearches twoauthorsretrievedandscreenedthefulltextofalltherelevant
studiesindependentlyusingourinclusionandexclusioncriteria.
We used the following search strategies for each computerised
WeincludedallstudiespublishedbetweenJanuary1990andJune
databases.
2011asspecifiedintheprotocol.Weexcludedstudieswhichdid
• CENTRALsearchusedthesearchtermscontracepti*OR
notpresentanyoftheoutcomemeasures.Wealsoexcludedstudies
birth?controlAND(complianceORaccept*ORadherenceOR
whichfocusedonwomenwithchronichealthconditionssuchas
continu*ORdiscontinu*ORuseORuptake));searchrestricted
diabetesorHIV.
toCochraneReviews,OtherReviews,ClinicalTrials,anddate
rangelimitedto1990-2010.
• PubMedsearchusedthesearchterms(contracepti*OR
Dataextractionandmanagement
“birthcontrol”)AND(interventionAND(complianceOR
acceptanceORadherenceORcontinu*ORdiscontinu*ORuse Twoauthorsindependentlyextracteddatafromthestudies.We
ORuptake)). resolveddiscrepanciesbetweenthetwoindependentreviewingau-
• POPLINEusedthesearchterms(contracepti*/birth thorsthroughdiscussion and theinvolvementof athirdauthor
control)&(intervention&(accept*/adherence/continu*/ whenneeded.WeusedReviewManager5.1toanalysethedata
discontinu*/use/uptake). (RevMan2011).Wefoundafewstudieswhichmadenodistinc-
• EMBASE,PsycINFOandMEDLINE(viaOVID)searches tionbetweenlevonorgestrel-releasingintrauterine device (LNG-
usedthesearchterms(contracepti*ORbirthcontrol)AND IUD)andcopperintrauterinedevice.Wecontactedtheprimary
(interventionAND(complianceORaccept*ORadherenceOR authors of these studies toclarify ambiguities and toseekaddi-
continu*));searchlimitedtohumans,publicationyear1990- tionaldataasrequired.Weexcludedstudiesinwhichtheprimary
2010. authorswerenotabletoprovideseparatecopperIUDuptakedata.
Strategiesforimprovingtheacceptabilityandacceptanceofthecopperintrauterinedevice(Review) 5
Copyright©2012TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
Assessmentofriskofbiasinincludedstudies Assessmentofreportingbiases
We assessed the biases and risk of biases using a domain-based Weusedfunnelplotstoidentify possiblebiases. Weassessedall
evaluationasrecommendedbytheCochraneHandbookforSystem- reporting biases atthe study levelas recommendedin Cochrane
aticReviewsofInterventions(Higgins 2009).Weconsideredfac- Handbook for Systematic Reviews of Interventions (Chan 2005;
torssuchasstudydesign,randomisationmethod(whereapplica- Kirkham 2010). The assessment results of reporting biases are
ble),allocationconcealment,blindingandlossestofollow-up.We includedwithinthe’Riskofbias’tables.
assessedrandomisedandnon-randomisedstudiesusingthesame
dimensionswhichincludedselectionbias(concerningcompara-
bilityofgroups,confoundingandadjustment),performancebias Datasynthesis
(concerning the fidelity of the interventions, and quality of the
WeanalyseddatawithReviewManager5.1(RevMan2011).All
informationregardingwhoreceivedwhatinterventions,including
outcomesweredichotomous.Forthenumberofwomenwhoused
blindingofparticipantsandhealthcareproviders),detectionbias
theIUDpostinterventionweusedthePetooddsratio(OR)due
(concerningunbiasedandcorrectassessmentofoutcome,includ-
IUDuptake being arareoutcome. WeusedaMantel-Haenszel
ingblindingofassessors),attritionbias(concerningcompleteness
odds ratio for the secondary outcome, knowledge. We grouped
of sample, follow-up and data) and reporting bias (concerning
studiesonthebasisofinterventiontype,participantcharacteristics
publicationbiasesandselectivereportingofresults).
andstudysetting.
Measuresoftreatmenteffect
The primary outcome, uptake, is measured by the number of Subgroupanalysisandinvestigationofheterogeneity
womenusing, orthatused, copperIUDsduring andpostinter- Weconductedsubgroupanalysesbyinterventiontype,participant
vention.WecalculatedtheeffectofinterventionusingPetoodds characteristicsandstudysetting.
ratios(OR)with95%confidenceinterval(CI).Weintendedto
measure continuation of use of copper IUDs bythenumber of
womenwhodiscontinueduseorremovedthemethod.
Sensitivityanalysis
Weplannedtoinvestigatewhetherthetreatmenteffectsizewould
Unitofanalysisissues varybystudiesexcludedduetodesignormethods.Wecompared
Wefollowedthemethodofcombininggroupsasrecommended theresultsoffixedandrandom-effectsmodels.
intheCochraneHandbookforSystematicReviewsofInterventions
incasesofcluster-randomisedtrialsandcross-overtrials.Fortrials
comparing more than two intervention groups, we assessed the
relevantinterventiongroup.
RESULTS
Dealingwithmissingdata
Whereapplicable,wecontactedtheoriginal investigators of the
studytorequestmissingdataandresults,orresultsshownindi- Descriptionofstudies
agramswithoutspecificnumbersforanalysis.Wecarriedoutthe
See:Characteristicsofincludedstudies;Characteristicsofexcluded
analysis according to intention-to-treat (ITT) for studies where
studies;Characteristicsofongoingstudies.
wewerenotabletoreceiveinformationonmissingdatafromthe
See:Characteristicsofincludedstudies;Characteristicsofexcluded
authors.Whereanyassumptionsweremadeonthemissingdata,
studies;Characteristicsofongoingstudies.
suchasmissingatrandomorassumedtohaveaparticularvalue,
weincludedthepotentialimpactofmissingdataintheDiscussion
sectionofthereview(Higgins2009).
Resultsofthesearch
Oursearchlocated1347trialsregisteredwithClinicalTrials.gov;
Assessmentofheterogeneity
221trialsregisteredwithWHOInternationalClinicalTrialsReg-
WeassessedtheoutcomedataforheterogeneityusingtheI2statis- istryPlatform;12,353articlesviaPOPLINEandOVIDforEM-
tic.Wedidnotpooltheresultsiftherewassignificantheterogene- BASE,MEDLINE andPsycINFO; and1573 studiesviaCEN-
itypresent.Weperformedsubgroupanalysestoexplorepossible TRAL. We also located 40 potentially relevant studies through
causesofheterogeneityinthefirstinstance. previousreviewsfoundviathesearch.
Strategiesforimprovingtheacceptabilityandacceptanceofthecopperintrauterinedevice(Review) 6
Copyright©2012TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
Includedstudies alswerealsoprovidedfordistribution.Thecontrolgroupreceived
standardcareoftwovisitsbyamidwife,oneatthebeginningof
A total of nine studies, representing 7960 women (4960 in the
thetrialandoneatmonthsix,bothwithoutcontraceptivecoun-
intervention groups and 3009 in the control groups), met our
sellingorprovision.Inadditiontocontraceptivecounselling,the
inclusion criteria. Although we retrieved a substantial number
CBD group also receivedoral contraceptive pills,condoms and
of studieswhich aimedtoimprovecontraceptive use, wefound
injectablecontraceptivesifrequired,aswellasareferralletterto
veryfewstudieswithIUDuseresults.Thestudiesincludedwere
thenearestfamilyplanningclinicforthosewhochoseintrauterine
publishedinpeer-reviewedjournals(Bashour2008;Douthwaite
device,tubectomyorvasectomy.Stratifiedrandomsamplingwas
2005;Ferreira2010;Jahanfar2005;Kambo1994;Saeed2008;
usedinthiscontrolledfieldtrial;100participantswereenrolled
Schunmann2006;Smith2002;Soliman1999).
fortheCBDand200wereinthecontrolgroup(withthreelost
Bashour 2008conductedarandomisedcontrolledtrialtoassess
tofollow-up).
theeffectivenessofacommunity-basedintervention,homevisits
Kambo1994conductedacontrolledbeforeandafterpilotstudy
topostpartumpatientswhorecentlygavebirthattheMaternity
toexplorethefeasibilityofusingtraditionalpractitionerstopro-
TeachingHospitalinDamascus,Syria.Atotalof876womenwere
motefamilyplanning inUttar Pradesh,India. Two blockswere
recruitedandrandomlyallocatedtothreegroups,GroupA(n=
matchedforkeyvariables;22traditionalpractitionersintheinter-
285)with fourhomevisits, GroupB(n=294)with onehome
ventionblockweretrainedtoprovide contraceptive counselling
visit, and Group Cthe control group (n = 297) with no home
andreceivedamonthlyhonorariumfortheprovision.Cross-sec-
visit. Registered midwives who received special training carried
tionalsurveyswerecarriedoutbeforeandaftertheintervention
outhomevisitstotheinterventiongroupstoprovideemotional
inbothcontrolandinterventionvillages.Atotalof1000women
support,examinemotherandchild,educatethemotheranddis-
weresurveyedintheinterventiongrouppriortotheintervention
cusschoicesandplansforfamilyplanning.
and800 aftertheintervention; 850 women eachinthecontrol
Douthwaite2005evaluatedtheimpactoftheLadyHealthWorker
groupbeforeandaftertheintervention.
Programme (LHWP) on the uptake of modern contraceptive
Saeed 2008 carried out a postpartum contraceptive counselling
methods.TheLadyHealthWorkers(LHW)aretrainedcommu-
and leaflet provision trial at the Department of Obstetrics and
nity-basedfemaleworkersattachedtoagovernmenthealthfacility;
Gynaecology, ShifaInternational Hospital, Islamabad, Pakistan.
thedoorstepfamilyplanningservicesinterventionincludesmoti-
Sixhundredandforty-eightwomenwereenrolledinthestudy,of
vatingwomentopractisefamilyplanning,providingoralcontra-
which48werelosttofollow-up.Afterdelivery,thewomenwere
ceptivepillsandcondoms,andreferringforinjections,IUDand
randomised into control and intervention groups by the use of
sterilisation.Datafromarandomsamplesurveyof4277,ofwhich
fourrandomisationcharts.Eachwomanintheinterventiongroup
3346 married women were fromthe intervention areaand 931
received20minutesofinformalcontraceptivecounsellingalong
fromthecontrolarea,wereanalysedforcurrentuseofreversible
withherhusbandoracloserelative,andasimpleone-pageleaflet
modernmethodspostintervention.Womenwhohadundergone
oncontraceptivemethodswasgivenatthetimeofdischarge.Con-
sterilisationwereexcludedfromthestudy.
trolgroupwomenweredischargedwithoutacounsellingsession
Ferreira2010performedarandomisedcontroltrialtoassessthe
orleafletsandbothgroupswereaskedreturnforfollow-upat8to
effectivenessofpersonalisedpostabortioncounsellingonaccept-
12weekspostnatal.
abilityanduseofcontraceptivemethodsbylow-incomewomen
Schunmann2006conductedarandomisedcontrolledtrialofspe-
fromthenortheastregionofBrazil.Womenwererecruitedwithin
cialistcontraceptivecounsellingandenhancedcontraceptivepro-
onetotwoweeksaftertheabortionandfollowedforaperiodof
visionafterterminationofpregnancy(TOP)inahospitalinEd-
sixmonths.Atotalof246womenwereenrolledandrandomlyal-
inburgh.Theinterventiongroup(n=316)receivedanin-depth
locatedtotheinterventionandcontrolgroupequally(n=123for
interviewondemographicdetailsandafullreproductivehistory
eacharm).Theinterventiongroupreceived30minutesofperson-
beforetermination,inadditiontocontraceptivediscussionsatthe
alisedandcomprehensiveface-to-facecontraceptivecounselling,
initial consultation with standard care provided (n= 297). The
andthecontrolgroupreceivedstandardcare,whichis30to40
interventiongroupalsoreceivedthreemonths’supplyoforalcon-
minutesofeducationalgroupcounselling.
traceptivepillsorfirmarrangementsforinsertionofIUD/IUSat
Jahanfar2005studiedtheimpactofcommunity-baseddistribu-
alocalfamilyplanningclinicformedicalTOPpatients,whereas
tion (CBD) on contraceptive knowledge, use and continuation
thestandardcareisonemonth’ssupplyofpillsandreferraltoa
among non-pregnant married women in suburbs of Hamedan
local family planning clinic. Insertion of IUD/IUS was offered
City,Iran.Theintervention(CBD)groupreceivedfivevisits,the
tobothcontrolandinterventiongroups,butonlywomeninthe
first two and thelast visit were by a midwife and interval visits
interventiongroupwereofferedimplants.
byatraineddistributionagent(DA)athome.DAsweretrained
Smith2002examinedtheeffectsofcontraceptivecounsellingat
by the midwife on the Johns Hopkins University checklists for
anantenatalclinicappointmentthattookplacebetween24and36
familyplanningprogrammesandtheGATHER(Greet,Ask,Tell,
weeksofpregnancy.Therandomisedcontrolledstudywascarried
Help,Explain,Return)guidelines.Pamphletsandwrittenmateri-
Strategiesforimprovingtheacceptabilityandacceptanceofthecopperintrauterinedevice(Review) 7
Copyright©2012TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
outinthreedifferentlocationsacrossthreecontinents:People’sRe- Oftherelevantstudiesweretrieved,weexcluded31studieswith
publicofChina(Shanghai),SouthAfrica(CapeTown)andScot- reasons.Someofthereasonsforexclusionwere:
land(Edinburgh).Antenatalclinicsessionswererandomisedona • noIUDoutcomereportedandnospecificdataonIUD
weeklybasisinEdinburghandCapeTown,andonadailybasisin availablefromthestudy’sprimaryauthorwhetheruseor
Shanghai.Atotalof771participantsreceivedexpertcontraceptive continuation;
adviceand886controlsreceivedstandardcare.Althoughitwas • participantsfelloutsideoftheinclusioncriteria,e.g.males;
cross-nationalstudy,dataandanalysiswerereportedbyindividual • nocomparisongroupwiththeinterventiongroup,orcross-
site. sectionalstudywithnobaseline;
Soliman 1999 investigated the impact of antenatal counselling • participantswererecruitedonthebasisofrequestforIUD
on knowledge and practice of contraception among a postnatal insertion.
cohortatthematernity hospital attheUniversity of Mansoura.
Excludedstudiesmay havemore thanone reasonfor exclusion.
Therandomisedcontrolledtrialconsists of200 womenpartici-
Weexcludedthemajorityoftheexcludedstudiesduetolackof
pantswhowererandomlyassigned tothecontrol andinterven-
dataonIUD.
tiongroup.Antenatalcounsellingsessionswereprovidedforthe
womenandtheirhusbandsusingtheGATHER(Greet,Ask,Tell,
Help,Explain,Return)technique.
Riskofbiasinincludedstudies
Excludedstudies
The’Riskofbias’summaryhasbeenillustratedinFigure1.
Strategiesforimprovingtheacceptabilityandacceptanceofthecopperintrauterinedevice(Review) 8
Copyright©2012TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.