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Try out PMC Labs and tell us what you think. Learn More. This systematic review evaluated the evidence on the impact of contraceptive counseling provided in clinical settings on reproductive health outcomes to provide information to guide national recommendations on quality family planning services. Multiple databases were searched during — for peer-reviewed articles published in English from January through February describing studies that evaluated contraceptive counseling interventions in clinical settings.

Studies were excluded if they focused primarily on prevention of HIV or sexually transmitted infections, focused solely on men, or were conducted outside the U. The initial search identified 12, articles, of which 22 studies from 23 articles met the inclusion criteria. Six studies examined the impact of contraceptive counseling among adolescents, with four finding a ificant positive impact on at least one outcome of interest. Sixteen studies examined the impact of counseling among adults or mixed populations adults and adolescentswith 11 finding a ificant positive impact on at least one outcome of interest.

Promising components of contraceptive counseling were identified despite the diversity of interventions and inability to compare the relative effectiveness of one approach versus another.

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The evidence base would be strengthened by improved documentation of counseling procedures; assessment of intervention implementation and fidelity to put study findings into context; and development and inclusion of more RCTs, studies conducted among general samples of women, and studies with sample sizes sufficient to detect important behavioral outcomes at least 12 months post-intervention. Unintended pregnancy rates in the U.

Some of the most effective contraceptives, based on rates of pregnancy with typical use, are sterilization, intrauterine devices IUDsand implants Tier 1 methods ; and injectables, oral contraceptives, contraceptive patches, vaginal rings, and diaphragms Tier 2 methods. Contraceptive counseling provided by trained health-care professionals may reduce unintended pregnancy rates by encouraging women, men, and couples to choose a method concordant with their goals and preferences, and use the chosen method correctly.

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The U. Preventive Services Task Force USPSTF defines behavioral counseling interventions in clinical care as those activities delivered by primary care clinicians and related healthcare staff that assist patients in adopting, changing, or maintaining behaviors proven to affect health outcomes and health status. The objective of this systematic review was to summarize the evidence on the impact of contraceptive counseling provided in clinical settings on reproductive health outcomes including contraceptive behaviors to guide national recommendations on quality family planning services.

The information was presented to an expert technical panel in May at a meeting convened by the Office of Population Affairs and CDC. The methods for conducting this systematic review have been described elsewhere. Search terms were identified Appendix Awhich were used to search multiple electronic databases during — to identify potential articles published from January Women seeking oral of Norcross February A targeted search was rerun in March to identify newly published articles since the initial search. Studies were not considered if they focused primarily on prevention of HIV or sexually transmitted infections STIs ; focused solely on men; or were conducted outside the U.

Analytic framework for systematic review on the impact of contraceptive counseling in clinical settings. Note: ed lines map to key questions Q. Dashed lines show logical relationships between outcomes, but these relationships were not assessed in this systematic review. Note: Questions are put into context by the analytic framework presented in Figure 1. Retrieval and inclusion criteria identical across reviews in this series have been described elsewhere. For the purpose of this review, we defined contraceptive counseling as an interactive process between provider and client intended to help the client achieve a reproductive health goal.

This definition was developed after considering other counseling definitions from the USPSTF, 8 the American Counseling Association, 12 and a dictionary of public health terms and concepts. Some inclusion criteria were specific to key questions. For Questions 1—3, which sought to examine the relationships between contraceptive counseling and improved long- medium- and short-term outcomes, studies had to include a comparison group. Articles that described a multicomponent program e. For Questions 4—6, which sought to examine unintended negative consequences and barriers and facilitators, articles had to describe a study that examined the impact of counseling on at least one outcome of interest and met the inclusion criteria for Key Questions 1—3.

The quality of each piece of evidence identified by the initial search was assessed using the grading system developed by the USPSTF. Findings are reported separately for studies conducted among adolescents and those conducted among adults or mixed populations adults and adolescents. Findings are also stratified by long- medium- and short-term outcomes. As a result, studies that examined multiple outcomes may be discussed more than once.

Although short-term outcomes are fully described in the evidence table, they are not discussed in detail in the text. Summary measures of association were not computed across studies because of the diversity of the interventions, study des, and populations. Articles published since the initial search were not incorporated into the evidence table because we wanted to only include information considered during the May expert technical panel to guide national recommendations on quality family planning services. The initial search strategy identified 12, articles Appendix B.

After applying the retrieval criteria, 1, articles were reviewed more closely. Of these, 23 articles 15 — 37 met the inclusion criteria and are summarized in detail in the evidence table Appendix C. Findings from two studies 2930 are described together because they used the same sample of women.

Of the 22 studies included in this review, Women seeking oral of Norcross 171920232436 examined the impact of contraceptive counseling among adolescents, and 16 151618212225 — 3537 from 17 articles examined the impact among adults or mixed populations adults and adolescents.

Although many studies were conducted among the general population of women seeking contraceptive services, five 1625283237 were conducted among postabortion samples, two 2231 were conducted among postpartum samples, and one 33 was conducted among women seeking services at an STI clinic. Of the six studies that examined the impact of contraceptive counseling among adolescents, two 2324 were RCTs rated as having moderate risk for bias, one 36 was a prospective, nonrandomized controlled trial rated as having high risk for bias, and three 171920 were pre—post studies rated as having high risk for bias.

A variety of outcomes were examined, ranging from reducing unintended pregnancy to enhancing psychosocial determinants of contraceptive use e. Four studies 19202436 examined long-term outcomes, six 171920232436 examined medium-term outcomes, and three 232436 examined short-term outcomes. Five 1920232436 of the six studies examined multiple outcomes. None of the studies reported barriers or facilitators for clinics or clients, but two studies 1719 reported on unintended negative consequences.

Sample sizes in the six studies ranged from 39 20 to 1, 19 and all participants were aged 11—18 years. Four studies 19202436 recruited participants from health clinics; the recruitment sites of the other two studies 1723 were not reported.

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A different model or approach to counseling was used in each of the six studies. Examples included use of peer providers, 19 motivational interviewing and narrative therapy, 2024 a model based on a theory of goal achievement, 23 and extensive follow-up telephone calls. Appendix C describes the details of each study; Table 2 summarizes findings by outcome of interest. Note: Intensity of intervention defined as low intervention took place during a single visit ; moderate intervention took place during more than one visit, but less frequently than weekly ; or high intervention took place weekly.

Of the three adolescent studies 192436 that examined the impact of contraceptive counseling on long-term outcomes, one 19 found a statistically ificant positive impact of counseling on decreasing teen pregnancy. In this pre—post study of 1, sexually active youth recruited from one of five reproductive health clinics in California, female adolescents were followed for up to 36 months after receiving counseling Women seeking oral of Norcross a peer provider at intake.

Peer providers were used to enhance the quality of the provider—client relationship. Participants also received quarterly follow-up telephone calls to reinforce messages and answer questions. The six adolescent studies that examined the impact of contraceptive counseling on medium-term outcomes investigated a variety of outcomes. Of the five studies 1719202436 that examined contraceptive use i. In the second study, 17 which used a pre—post de, contraceptive use among unmarried youth was examined before and after receiving a counseling intervention that included discussions on establishing sexual values, ability and right to refuse sexual activity, abstinence and alternative forms of intimacy, contraceptive methods, and consequences of unprotected sex.

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The third study, 19 which also used a pre—post de, found a ificant impact of a peer provider counseling model in which intervention participants received quarterly follow-up telephone calls after receiving counseling from a peer provider at intake. The remaining two studies either found no statistically ificant effect of counseling on contraceptive use 24 or observed some uptake in contraceptive use but did not conduct statistical testing.

Of two studies 1920 that examined use of more effective contraceptives either shifting from using less effective to more effective methods or initiating methods with higher rates of typical use effectivenessone 19 found a statistically ificant impact. Two studies 2324 examined the impact of counseling interventions on correct use of contraceptives e. One study 36 examined continuation of contraceptive use i.

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Two studies 1924 examined use of repeat or follow-up services, with one 19 finding a statistically ificant impact. Of the three adolescent studies 232436 that examined the impact of contraceptive counseling on short-term outcomes, two 2436 examined quality and satisfaction with services, one 36 examined changes in participant knowledge, and two 2336 examined psychosocial determinants of contraceptive use.

No other statistically ificant effects of counseling on short-term outcomes were found. Two studies 1719 examined unintended negative consequences associated with contraceptive counseling in family planning settings. Of the 16 studies 151618212225 — 3537 from 17 articles that examined the impact of contraceptive counseling among adults or mixed populations adults and adolescentsnine 16212225282931 — 33 were RCTs. Of these nine studies, eight were rated as having moderate risk Women seeking oral of Norcross bias and one 31 was rated as having high risk for bias.

One 27 was a prospective, nonrandomized controlled trial, one 15 was a prospective cohort study, two 1834 were pre—post studies, and three 263537 were cross-sectional surveys. All of the non-RCT studies were rated as having high risk for bias. Six studies 212227293233 examined long-term outcomes, 15 151618212225 — 2931 — 333537 examined medium-term outcomes, and five 2228313435 examined short-term outcomes.

Thirteen 161821222527 — 2931 — 333537 of the 16 studies examined multiple outcomes. None of the studies reported barriers or facilitators for clinics or clients or reported on unintended negative consequences. Sample sizes in the 16 studies ranged from 33 22 to 35 ; all participants were aged 14—50 years and were recruited from some type of clinical setting. A different counseling model or approach was used in each of the 16 studies.

Examples included motivational interviewing, 151829 use of specific provider tools e. Of the six studies 212227293233 among adults or mixed populations that examined the impact of contraceptive counseling on long-term outcomes, none found a statistically ificant impact of counseling on decreasing teen or unintended pregnancy.

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Of the 15 studies among adults or mixed populations that examined the impact of contraceptive counseling on medium-term outcomes, a variety of outcomes were investigated. Seven studies 15161826323537 examined contraceptive use, with three 152635 finding a statistically ificant impact of counseling. Counseling sessions for both groups were audiotaped and coded to measure three components of interest: promotion of dual protection, relapse prevention counseling, and quality of nurse—client interaction.

Promotion of dual protection and relapse prevention techniques were not ificantly associated with condom use at 6-month follow-up. The second study, 35 cross-sectional in de, examined patient-reported contraceptive counseling received in the past 2 years from managed care providers in a county commercial provider network on three components: exposure, content, and personalization.

Among women considered at risk of unintended pregnancy i. The third study 26 that found a ificant impact of counseling on contraceptive use was a cross-sectional survey conducted among women recruited from four primary care clinics. This study asked women about the contraceptive counseling they received from their primary care physician 7—30 days after their visit.

Of the remaining four studies that examined contraceptive use, two 1632 found no statistically ificant effect of counseling on contraceptive use, and two 1837 reported an improvement but did not conduct tests of statistical ificance. Eight studies 1621252831 — 3337 examined use of more-effective contraceptives, with four 21283233 finding Women seeking oral of Norcross statistically ificant impact of counseling. One RCT 21 examined female participants who received standard counseling and a counseling intervention that used a standardized provider tool intended to help women select the most appropriate behavioral or barrier contraceptive method and increase satisfaction with their chosen method.

This group was compared with female participants who received only standard counseling to examine changes in method selection from baseline to 12—month follow-up. The authors did not compare the change from baseline to follow-up between the intervention and control groups. In the fourth study, 33 also an RCT, women seeking services at an STI clinic were randomized into two groups, both of which received condoms with spermicide and a referral list of primary care providers for ongoing reproductive health care. Differences were not ificant at month follow-up. Of the remaining four studies, three 162531 found no statistically ificant effect of counseling on effective contraceptive use, and one 37 observed an improvement but did not conduct tests of statistical ificance.

Three studies 182729 examined the impact of counseling on correct use of contraceptives e. Of the remaining two studies, one 29 did not find a statistically ificant impact of counseling on increasing correct use, and the other 18 observed an improvement in correct use but did not conduct tests of statistical ificance. Three studies 222532 examined continuation of contraceptive use, and two studies 2733 examined use of repeat or follow-up services, with none finding a statistically ificant positive impact of counseling.

One study 33 examined the impact of counseling on dual-method contraceptive use i. In this RCT of women seeking services at an STI clinic, all participants received condoms with spermicide and a referral list of primary care providers for ongoing reproductive health care.

Those in the intervention group also received enhanced contraceptive care that included individual counseling, Women seeking oral of Norcross provision of contraception, and a facilitated referral to a primary care provider. Of the five studies 2228313435 among adults or mixed populations that examined the impact of contraceptive counseling on short-term outcomes, two 3135 examined quality and satisfaction with services, three 222834 examined changes in participant knowledge, and two 2835 examined psychosocial determinants of contraceptive use. Among these studies, two 3135 found positive impacts for satisfaction with services, three 222834 for participant knowledge, and two 2835 for psychosocial determinants.

This systematic review identified 22 studies that examined Women seeking oral of Norcross impact of contraceptive counseling in clinical settings and met the inclusion criteria. Of these, six studies 171920232436 examined the impact of counseling among adolescents, with four finding a statistically ificant positive impact of low-intensity 23 or moderate-intensity 171936 counseling interventions on at least one outcome of interest. Three 192436 of the six adolescent studies examined long-term outcomes, with one 19 finding a statistically ificant positive impact of counseling.

This study found that youth who received clinic-based contraceptive counseling from a peer provider and follow-up telephone calls had lower odds of teen pregnancy than those who received only clinic-based counseling. All six studies examined medium-term outcomes, of which four 17192336 found a statistically ificant positive impact on at least one outcome of interest. Finally, one 36 of three studies 232436 that examined short-term outcomes found a statistically ificant positive impact on at least one outcome of interest.

Of the 16 studies 151618212225 — 2931 — 3537 that focused on adults or mixed populations adolescents and adults11 found a statistically ificant positive impact of counseling interventions with low, 212226 — 2831 — 34 moderate, 15 or unrated 35 intensity on at least one outcome of interest. Six 212227293233 of the 16 adult or mixed population studies examined long-term outcomes.

None found a statistically ificant positive impact of counseling on decreasing teen or unintended pregnancy. Of the 15 studies that examined medium-term outcomes, eight 152126 — 28323335 found a statistically ificant positive impact on at least one outcome of interest. Finally, all five studies 2228313435 that examined short-term outcomes found a statistically ificant positive impact on at least one outcome of interest.

No studies that examined the impact of counseling for adolescents, adults, or mixed populations reported information on barriers or facilitators for clinics offering counseling or clients achieving positive outcomes after receiving counseling in family planning settings. Two studies on adolescents examined unintended negative consequences, with one 17 finding that counseling did not promote sexual debut among non—sexually active participants, and the other 19 finding decreased use of condoms among female participants, possibly because of an increase in use of more-effective methods at preventing pregnancy.

Because each study examined a different counseling intervention—some of which incorporated multiple approaches—this review was unable to assess the impact of a single counseling component separate from the others or to compare the relative effectiveness of one approach versus another. Nevertheless, components of counseling approaches that resulted in some statistically ificant positive change in long- medium- or short-term outcomes can be considered when developing counseling guidelines for family planning clients.

Promising components that emerged from the studies in this systematic review include an emphasis on the quality of interaction between counselor and client e. For example, one study 19 that found positive impacts on both long- and medium-term outcomes including decreased odds of pregnancy used peer providers to enhance the quality of the provider—client relationship and quarterly telephone calls by peer providers to reinforce counseling messages and answer questions.

Evidence from other fields, including chronic disease management and psychotherapy, support the importance of the provider—client relationship. Core components of client-centered care have been developed and described elsewhere. The chronic disease literature has also suggested that goal setting can be used as a behavior change strategy in health education, 4950 and other areas of behavioral counseling related to nutrition, smoking cessation, and physical activity have suggested the need for repeated counseling sessions to support positive behavior change.

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Impact of Contraceptive Counseling in Clinical Settings