Summary of findings for the main comparison. Intensive counseling compared to usual family planning care for improving adherence and continuation of shorter‐term hormonal methods of contraception.
| Intensive counseling compared to usual family planning care for improving adherence and continuation of shorter‐term hormonal methods of contraception | ||||||
| Patient or population: Women of reproductive age seeking to avoid pregnancy Setting: Family planning clinics in middle‐ to high‐income countries Intervention: Intensive counseling Comparison: Usual family planning care | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with usual family planning care | Risk with intensive counseling | |||||
| Continuation of hormonal contraceptive method | 392 per 1,000 | 452 per 1,000 (408 to 498) | OR 1.28 (1.07 to 1.54) | 2624 (6 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 2 3 | I2 = 79% |
| Rate of discontinuation due to menstrual disturbances | 320 per 1,000 | 86 per 1,000 (49 to 148) | OR 0.20 (0.11 to 0.37) | 350 (1 RCT) | ⊕⊕⊝⊝ LOW 1 3 | |
| Rate of discontinuation due to all other adverse events | 549 per 1000 | 470 per 1000 (304 to 641) | OR 0.73 (0.36 to 1.47) | 350 (1 RCT) | ⊕⊕⊝⊝ LOW 1 3 | |
| Adherence to method use | Not reported | ‐ | ‐ | ‐ | ||
| Pregnancy | 18 per 100 | 21 per 100 (18 to 25) | OR 1.24 (0.98 to 1.57) | 1985 (3 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 3 4 | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the median risk in the comparison group (usual care) and the relative effect of the intervention (and its 95% CI). Calculations were done using GRADEpro. CI: Confidence interval; OR: Odds ratio | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Downgraded one level for serious risk of bias as included trials had high risk of bias due to lack of blinding and/or rates of attrition > 20%
2 Downgraded one level for very serious inconsistency due to considerable heterogeneity (I2 = 79% indicating large variation between point estimates due to among‐study differences)
3 Downgraded one level for serious indirectness as differences in intervention or comparison could be sufficient to make a difference to the outcome
4 Downgraded one level for serious imprecision as 95% Confidence Interval included the null effect, and included appreciable benefit or harm