Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, and qualitative ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2017-08-15

AUTHORS

Rabeea’h W. Aslam, Maggie Hendry, Andrew Booth, Ben Carter, Joanna M. Charles, Noel Craine, Rhiannon Tudor Edwards, Jane Noyes, Lupetu Ives Ntambwe, Diana Pasterfield, Jo Rycroft-Malone, Nefyn Williams, Rhiannon Whitaker

ABSTRACT

BackgroundUnintended repeat conceptions can result in emotional, psychological and educational harm to young women, often with enduring implications for their life chances. This study aimed to identify which young women are at the greatest risk of repeat unintended pregnancies; which interventions are effective and cost-effective; and what are the barriers to and facilitators for the uptake of these interventions.MethodsWe conducted a mixed-methods systematic review which included meta-analysis, framework synthesis and application of realist principles, with stakeholder input and service user feedback to address this. We searched 20 electronic databases, including MEDLINE, Excerpta Medica database, Applied Social Sciences Index and Abstracts and Research Papers in Economics, to cover a broad range of health, social science, health economics and grey literature sources. Searches were conducted between May 2013 and June 2014 and updated in August 2015.ResultsTwelve randomised controlled trials (RCTs), two quasi-RCTs, 10 qualitative studies and 53 other quantitative studies were identified. The RCTs evaluated psychosocial interventions and an emergency contraception programme. The primary outcome was repeat conception rate: the event rate was 132 of 308 (43%) in the intervention group versus 140 of 289 (48%) for the control group, with a non-significant risk ratio (RR) of 0.92 [95% confidence interval (CI) 0.78–1.08]. Four studies reported subsequent birth rates: 29 of 237 (12%) events for the intervention arm versus 46 out of 224 (21%) for the control arm, with an RR of 0.60 (95% CI 0.39–0.93). Many repeat conceptions occurred in the context of poverty, low expectations and aspirations and negligible opportunities. Qualitative and realist evidence highlighted the importance of context, motivation, future planning and giving young women a central and active role in the development of new interventions.ConclusionsLittle or no evidence for the effectiveness or cost-effectiveness of any of the interventions to reduce repeat pregnancy in young women was found. Qualitative and realist evidence helped to explain gaps in intervention design that should be addressed. More theory-based, rigorously evaluated programmes need to be developed to reduce unintended repeat pregnancy in young women.Trial registrationPROSPERO, CRD42012003168. Cochrane registration number: i = fertility/0068 More... »

PAGES

155

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12916-017-0904-7

DOI

http://dx.doi.org/10.1186/s12916-017-0904-7

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1091112188

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28806964


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67 grey literature sources
68 group
69 harm
70 health
71 health economics
72 implementation factors
73 implications
74 importance
75 importance of context
76 index
77 input
78 intervention
79 intervention arm
80 intervention design
81 intervention effectiveness
82 intervention group
83 life chances
84 literature sources
85 low expectations
86 mixed-methods systematic review
87 motivation
88 negligible opportunities
89 new interventions
90 opportunities
91 outcomes
92 paper
93 planning
94 poverty
95 pregnancy
96 primary outcome
97 principles
98 program
99 psychosocial interventions
100 qualitative study
101 quantitative study
102 range
103 rate
104 ratio
105 realist principles
106 realist synthesis
107 repeat pregnancy
108 repeat unintended pregnancies
109 research paper
110 review
111 risk
112 risk ratio
113 role
114 science
115 search
116 service user feedback
117 social sciences
118 source
119 stakeholder input
120 study
121 subsequent birth rates
122 synthesis
123 systematic review
124 teenagers
125 trials
126 unintended pregnancy
127 unintended repeat pregnancy
128 uptake
129 user engagement
130 user feedback
131 women
132 young women
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