Summary of findings 2. Reminders (+/‐ educational information) compared to usual family planning care for improving adherence and continuation of shorter‐term hormonal methods of contraception.
| Reminders (+/‐ educational information) 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: Reminders (+/‐ educational information) 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 reminders (+/‐ educational information) | |||||
| Continuation of hormonal contraceptive method | 516 per 1000 | 587 per 1000 (524 to 649) |
OR 1.33 (1.03 to 1.73) |
933 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 2 3 | High unexplained heterogeneity (I2 = 69%) (unable to determine whether heterogeneity was due to differences in type of contraception, or in type of intervention) |
| Rates of discontinuation due to adverse events | Not reported | ‐ | ‐ | ‐ | ||
| Adherence to method use as indicated by missed pills per cycle | The mean adherence was 5.8 | MD 0.8 higher (1.22 lower to 2.82 higher) | ‐ | 73 (1 RCT) | ⊕⊕⊝⊝ LOW 4 5 | |
| Adherence to method use as indicated by on‐time injections overall | 50 per 100 | 46 per 100 (35 to 56) | OR 0.84 (0.54 to 1.29) | 350 (2 RCTs) | ⊕⊕⊝⊝ LOW 1 5 | |
| Pregnancy | Not reported | ‐ | ‐ | ‐ | ||
| *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 were at high risk of bias due to lack of blinding and/or rates of attrition > 20%
2 Downgraded one level for serious inconsistency due to some heterogeneity (I2 > 50% indicating some variation between point estimates due to between‐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 small sample size
5 Downgraded one level for serious imprecision as 95% confidence interval included the null effect, and included appreciable benefit or harm