Mapping the evidence on digital interventions to improve postpartum contraceptive uptake among adolescent mothers: a scoping review protocol

Abstract

Introduction

Adolescent mothers are at increased risk of rapid repeat pregnancy during the postpartum period, particularly in low-and middle-income countries where unmet need for contraception remains high. Stigma, limited autonomy and inadequate youth-friendly services contribute to low uptake of postpartum contraception. Digital health interventions have been proposed as scalable approaches to improve access to contraceptive information and support. However, evidence specifically focusing on digital interventions to enhance postpartum contraception among adolescent mothers has not yet been comprehensively mapped. This scoping review aims to identify and describe the available evidence in this area.

Methods

This review will follow the Arksey and O’Malley framework, with refinements by Levac et al and guidance from the Joanna Briggs Institute. Reporting will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. MEDLINE, Embase, Scopus and Web of Science along with relevant grey literature sources will be searched. Studies involving adolescent mothers (10–19 years) within 12 months after childbirth and evaluating digital interventions for postpartum contraception will be included. Two reviewers will independently screen and extract data using a standardised charting form. Findings will be synthesised descriptively to map intervention types, outcomes and research gaps. No formal quality appraisal will be undertaken.

Ethics and dissemination

Ethical approval is not required. Findings will be disseminated through peer-reviewed publication, conference presentations and engagement with relevant stakeholders to inform research, policy and programme development.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• This scoping review will be conducted using the Arksey and O’Malley framework, refined by Levac et al, and guided by the Joanna Briggs Institute recommendations.

• A comprehensive search strategy will be applied across multiple electronic databases and grey literature sources.

• Study selection and data extraction will be conducted independently by two reviewers using a standardised charting form.

• The inclusion of diverse study designs will enable a broad mapping of the available evidence; however, no formal quality appraisal will be undertaken.

• Limiting inclusion to English-language publications may introduce language bias.

Introduction

Adolescent pregnancy remains a significant global public health concern, particularly in low- and middle-income countries, where rates of early childbearing and rapid repeat pregnancy are highest.¹ Adolescents who give birth face an elevated risk of adverse health, social and economic outcomes, including maternal morbidity, school discontinuation and intergenerational poverty.²,⁴ The postpartum period represents a critical window for preventing rapid repeat pregnancy through timely and appropriate contraceptive use.⁵

Access to postpartum contraception is crucial in supporting adolescent mothers to recover, continue their education and plan their futures.^{6 7} However, for many young mothers, obtaining family planning services remains challenging. They face stigma, limited decision-making power and services that are often not tailored to adolescents’ needs.⁸,¹⁰ Practical barriers, such as distance to health facilities, transportation costs or inconvenient clinic hours, further restrict access, while missed counselling opportunities during antenatal and postnatal care leave many without adequate information.^{9 11} Consequently, unmet need for postpartum contraception remains high among adolescents, increasing their risk of rapid repeat pregnancies and related health and socioeconomic challenges.¹²,¹⁴ Addressing these barriers is essential to better support adolescent mothers in shaping healthier and more stable life trajectories.

Digital health interventions are increasingly recognised as effective strategies to disseminate information and address barriers in sexual and reproductive health (SRH) service delivery.¹⁵ Mobile health, telehealth services, messaging platforms and digital decision-support tools improve access, strengthen communication and promote continuity of care.¹⁶ These interventions potentially mitigate structural and social barriers experienced by mothers. Previous reviews have shown that digital sexual health interventions delivered via websites and mobile phones are effective in changing cognitive perceptions and behaviours among young adults.¹⁷ Moreover, a systematic review of randomised controlled trials suggests that digital interventions may moderately increase postpartum contraception use among adult women.¹⁸

Furthermore, previous reviews have discussed digital SRH interventions for adult women¹⁹ and adolescents in general.^{20 21} The research on digital treatments targeted at boosting adolescent mothers’ use of postpartum contraception has not been specifically reviewed. Descriptive analysis and cluster randomised trials were the only methods used in earlier studies.¹⁹,²¹ Evidence on the use of digital interventions to support family planning programmes, particularly among adolescents, remains limited. A scoping review is appropriate for accurately mapping current data, explaining key ideas from digital interventions related to family planning and identifying gaps in research and implementation. This protocol describes how to conduct a scoping review of digital interventions to promote postpartum contraceptive use, especially among adolescent mothers.

Methods and analysis

Registration

This protocol has been registered with the Open Science Framework (OSF registration ID: 8dyrx) to ensure transparency and methodological rigour. The registration is currently under embargo and will be made publicly available upon publication of the review. Any significant amendments to the protocol will be documented and updated in the OSF registry.

Protocol design

This scoping review will systematically map the existing evidence on digital interventions designed to support postpartum family planning among adolescent mothers. The review will follow the methodological framework for scoping reviews originally proposed by Arksey and O’Malley, with subsequent refinements by Levac et al,^{22 23} and will be guided by the recommendations of the Joanna Briggs Institute.²⁴ Reporting of the review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) to ensure transparency and methodological rigour.²⁵ The PRISMA-ScR checklist for this protocol is provided in online supplemental file 2. A fully completed PRISMA-ScR checklist will be included in the final review manuscript. The study is planned to commence in June 2026 and is expected to be completed by December 2026.

The review will be conducted in six sequential stages: (1) Formulation of the review questions, (2) Identification of relevant studies, (3) Selection of eligible studies, (4) Data extraction and charting, (5) Collation, summarising and reporting the results and (6) Consultation with relevant stakeholders.

Stage 1: identifying the research question

The first stage of this scoping review will involve defining clear research questions to guide the scope and direction of evidence mapping. Given the anticipated diversity in intervention types, delivery platforms and outcomes, focused yet sufficiently broad questions will be required to comprehensively capture the existing literature on digital interventions aimed at improving postpartum contraceptive uptake among adolescent mothers. The review will address the following questions:

1. What types of digital interventions have been implemented to support postpartum contraception among adolescent mothers?

2. What contraceptive-related outcomes are reported (eg, uptake, continuation, method choice and counselling attendance)?

3. What implementation characteristics are described (eg, delivery platform, setting, duration and stakeholder involvement)?

4. What contextual, equity, ethical and access-related issues are reported in relation to these interventions?

5. What gaps exist in the current evidence base to inform future research and programme development?

Stage 2: identifying relevant studies

A comprehensive literature search will be conducted across the following electronic databases: MEDLINE (via PubMed), Embase (via Elsevier), Scopus (Elsevier) and Web of Science (Clarivate Analytics). These databases will be selected to ensure broad coverage of public health, reproductive health, digital health and interdisciplinary research. To enhance comprehensiveness, grey literature will also be searched through relevant organisational websites (eg, WHO, UNFPA and UNICEF). The reference lists of all included studies and relevant reviews will be screened to identify additional eligible records. No geographical restrictions will be applied. Where feasible, no restrictions on publication date will be imposed to capture the evolution of digital health interventions over time. Only studies available in English will be included due to resource constraints.

Search strategy

The search strategy will combine controlled vocabulary (eg, Medical Subject Headings terms) and free-text keywords related to adolescents, postpartum contraception and digital health interventions. Boolean operators (“AND”, “OR”) and truncation will be used as appropriate to maximise sensitivity. The search strategy will be initially developed for MEDLINE (via PubMed) and subsequently adapted for Embase, Scopus and Web of Science to account for differences in indexing and search syntax. The draft MEDLINE search strategy is provided in online supplemental file 1 to ensure transparency and reproducibility. Forward and backward citation tracking will be conducted to identify additional relevant studies.

Keyword

The search strategy will be developed using the Population–Concept–Context (PCC) framework to ensure systematic alignment between the review objectives, eligibility criteria and search terms. This structured approach supports comprehensive identification of relevant evidence in scoping reviews. The PCC components and corresponding example keywords are presented in table 1.

Table 1. Population–Concept–Context framework and search keywords.

Component	Example keywords
Population	adolescen*, teen*, youth*, young mother*, teenage mother*, adolescent mother*, young women 10–19, postpartum adolescen*.
Concept	postpartum contraception, postnatal contraception, postpartum family planning, contraceptive uptake, contraceptive use, contraceptive continuation, method choice, birth spacing, rapid repeat pregnancy, postpartum period, postnatal period, post-delivery, after childbirth, puerperium.
Context	digital health, mHealth, digital intervention*, eHealth, mobile application*, mobile health, mobile app*, health messaging, SMS, text messaging, telehealth, telemedicine, interactive voice response, chatbot*, digital counselling, e-intervention*, web-based intervention*, online platform*, social media.

Stage 3: selection of eligible studies

Eligibility criteria for this review will be defined a priori using the PCC framework to ensure alignment with the review objectives and research questions. Clear inclusion and exclusion criteria are established to support consistent and transparent study selection. The criteria encompass the target population (adolescent mothers in the postpartum period), the central concept (digital interventions to support postpartum contraception) and the contextual scope, including study design and source type. The detailed eligibility criteria are presented in table 2.

Table 2. Eligibility criteria based on the Population–Concept–Context framework.

Component	Description	Inclusion	Exclusion
Population	Adolescent mothers aged 10–19 years in the postpartum period (up to 12 months after childbirth).	Studies involving adolescent mothers aged 10–19 years during the postpartum period (≤12 months after childbirth). Studies including broader age ranges will be included if data for adolescents can be disaggregated.	Studies focusing exclusively on women aged ≥20 years; studies where adolescent-specific data cannot be separated; studies not involving postpartum populations.
Concept	Digital interventions aimed at supporting postpartum contraception or family planning, including but not limited to mobile applications, SMS or messaging services, interactive voice response, telehealth or telecounselling, chatbots, web-based platforms and social media–based interventions.	Studies evaluating digital health interventions designed to improve postpartum contraception, contraceptive uptake, continuation, counselling or related family planning outcomes.	Studies not involving digital components; interventions unrelated to contraception or postpartum family planning; purely face-to-face or non-digital interventions.
Context	All geographical settings and income contexts. Interventions delivered in health facilities, communities or remotely will be included.	Studies conducted in any country or income setting; interventions delivered in facility-based, community-based or remote settings.	None based on geographical location; studies conducted outside the postpartum context.
Type of source	Quantitative, qualitative and mixed-methods studies; implementation studies; pilot studies; programme evaluations and relevant grey literature. Systematic reviews will be excluded, but their reference lists will be screened.	Primary research studies (randomised trials, quasi-experimental studies, observational studies, qualitative studies, mixed-methods studies), implementation reports and programme evaluations; relevant grey literature.	Systematic reviews, meta-analyses (reference lists will be screened); editorials, commentaries, opinion pieces; conference abstracts without full text; protocols without results.

Study selection

All identified records will be imported into reference management software, and duplicates will be removed. The de-duplicated records will then be uploaded to Rayyan, a web-based systematic review management platform, to facilitate the study selection process.

Two reviewers will independently screen titles and abstracts using Rayyan’s blinded screening mode, based on the predefined eligibility criteria. During this stage, each reviewer will label records as include, exclude or maybe. Rayyan’s conflict detection feature will be used to identify discrepancies between reviewers.

Full-text articles will be retrieved for all records classified as include or maybe by at least one reviewer. Full-text screening will also be conducted independently by the two reviewers using Rayyan, with reasons for exclusion recorded for each excluded study. Any disagreements at either the title/abstract or full-text screening stage will be resolved through discussion. If consensus cannot be reached, a third reviewer will be consulted to make the final decision.

The overall study selection process will be presented using a PRISMA 2020 flow diagram (figure 1),²⁶ in accordance with the PRISMA-ScR guidelines detailing the number of records identified, screened, excluded (with reasons) and included in the final review.

Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.

Stage 4: data extraction and charting

A standardised data charting form table 3 will be developed to systematically extract relevant information from all included studies. The form will be pilot-tested on a small sample of studies to ensure consistency, clarity and alignment with the review objectives. Refinements will be made as necessary prior to full data extraction. Two reviewers will independently extract data from the included studies using the finalised charting form. Any discrepancies will be resolved through discussion, with involvement of a third reviewer if required.

Table 3. Data charting form.

No	Data item	Description/details to be extracted
1	Author	First author and co-authors.
2	Year of publication	Year study was published.
3	Country/setting	The country and specific setting (eg, health facility, community and remote) where the study was conducted.
4	Study design	The methodological approach used (eg, randomised controlled trial, quasi-experimental, cohort, cross-sectional, qualitative, mixed-methods and programme evaluation).
5	Study aim/objective	The primary objectives or research questions addressed in the study.
6	Population characteristics	Age range of participants, definition of adolescence used, postpartum period covered (eg, ≤6 weeks, ≤6 months and ≤12 months) and relevant sociodemographic characteristics.
7	Sample size	Total number of participants and any subgroup information relevant to adolescent mothers.
8	Type of digital intervention	The form of digital intervention (eg, SMS, mobile application, telehealth, interactive voice response, chatbot, social media, web-based platform, etc).
9	Delivery platform and modality	Platform used (smartphone, basic phone and web-based), level of interactivity (one-way vs two-way) and integration with health services (if applicable).
10	Duration and intensity	Frequency of contact/messages and overall duration of the intervention.
11	Theoretical framework (if reported)	Behaviour change theory or conceptual framework underpinning the intervention.
12	Contraceptive-related outcomes	Outcomes measured (eg, contraceptive uptake, continuation, method choice, counselling attendance, rapid repeat pregnancy and knowledge or attitudes).
13	Implementation characteristics	Feasibility, acceptability, stakeholder involvement, scalability and reported barriers or facilitators.
14	Equity, ethical and privacy considerations	Main findings relevant to postpartum contraceptive uptake among adolescent mothers.
15	Reported gaps or recommendations	Research or implementation gaps identified by the authors.

Stage 5: collation, summarising and reporting the results

In this stage, the extracted data will be collated, synthesised and presented to provide a comprehensive overview of the existing evidence. Consistent with scoping review methodology, the aim is not to assess the effectiveness of interventions or to produce pooled effect estimates, but to map the range, characteristics and distribution of available studies. The findings will be summarised using both descriptive numerical analysis and narrative synthesis. Descriptive analysis will outline the distribution of studies by year of publication, geographical location, study design and type of digital intervention. Results will be presented in tables and figures to illustrate patterns in intervention characteristics, contraceptive-related outcomes and implementation contexts. A narrative synthesis will be conducted to summarise key themes, including types of digital strategies employed, reported outcomes, implementation facilitators and barriers and equity or ethical considerations. Particular attention will be given to identifying evidence gaps, methodological limitations in the literature and areas requiring further research. The reporting of the review will follow the PRISMA-ScR checklist to ensure transparency and completeness. The study selection process will be presented using a PRISMA 2020 flow diagram, in accordance with PRISMA-ScR guidelines, and summary tables will present the key characteristics and findings of included studies.

Result presentation

The findings of this scoping review will be presented using a combination of descriptive numerical summaries, tabular presentation and thematic analysis. In addition to mapping the distribution of studies by year, country, study design and type of digital intervention, thematic categories will be developed to synthesise the qualitative and contextual dimensions of the evidence.

An inductive approach will be used to identify and group recurring patterns across included studies. Thematic categories will be developed to reflect key domains aligned with the review objectives, including:

1. Types of digital interventions (eg, SMS-based messaging, mobile applications, telehealth and social media platforms).

2. Contraceptive-related outcomes (eg, uptake, continuation, method choice and prevention of rapid repeat pregnancy).

3. Intervention characteristics and delivery models (eg, duration, intensity, level of interactivity and theoretical underpinning).

4. Implementation facilitators and barriers (eg, feasibility, acceptability, provider involvement and technological constraints).

5. Equity, ethical and privacy considerations (eg, digital access, confidentiality for minors, data protection and gender norms).

6. Reported research and programme gaps.

These thematic categories will enable structured synthesis of heterogeneous evidence while remaining consistent with scoping review methodology, which prioritises mapping the breadth and nature of available research rather than evaluating intervention effectiveness. Where appropriate, visual representations (eg, summary tables, conceptual diagrams or evidence maps) will be used to enhance clarity and facilitate interpretation.

Stage 6: consultation

In line with the optional consultation stage proposed in scoping review methodology, stakeholder consultation will be undertaken to enhance the relevance, interpretation and applicability of the findings. This stage is intended to provide additional insights beyond the published literature and to support knowledge translation.

Consultation will involve key stakeholders with expertise in adolescent reproductive health, digital health implementation and postpartum family planning. These may include:

• Public health researchers with experience in adolescent and maternal health.

• Digital health specialists involved in the design or evaluation of mHealth interventions.

• Healthcare providers (eg, midwives, family planning counsellors) working with adolescent mothers.

• Representatives from the Ministry of Health and the Ministry of Population and Family Development (BKKBN), particularly those involved in postpartum family planning and digital health initiatives.

Stakeholders will be invited to provide feedback on the preliminary synthesis, identified evidence gaps and implications for programme design and scale-up. Their input will be used to contextualise the findings and inform recommendations for future research and implementation. The consultation will not involve the collection of primary data from patients and will therefore not require additional ethical approval.

Ethics and dissemination

Ethical approval is not required as this study will use publicly available data. Findings will be disseminated through publication in a peer-reviewed journal and presentations at relevant scientific conferences. The results will inform future research, policy and digital health programme design to support postpartum contraception among adolescent mothers.