Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, and qualitative and realist synthesis of implementation factors and user engagement

BMC Medicine

Research Article

Joanna M. Charles¹  Rhiannon Tudor Edwards¹  Jo Rycroft-Malone²  Rabeea’h W. Aslam³  Ben Carter⁴  Maggie Hendry⁵  Nefyn Williams⁵  Diana Pasterfield⁵  Noel Craine⁶  Andrew Booth⁷  Jane Noyes⁸  Lupetu Ives Ntambwe⁹  Rhiannon Whitaker^1,10 

[1] Centre for Health Economics and Medicines Evaluations, School of Healthcare Sciences, Bangor University, Bangor, UK;Centre for Health-Related Research School of Healthcare Sciences, Bangor University, Bangor, UK;Department of Biostaistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK;Department of Biostatistics and Health Informatics, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, UK;North Wales Centre for Primary Care Research School of Healthcare Sciences, Bangor University, Bangor, UK;Public Health Wales, Bangor, UK;School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK;School of Social Sciences, Bangor University, Bangor, UK;Veristat, Montreal, Canada;Whitaker Research Ltd., Bangor, UK;

关键词: Pregnancy;    Adolescent;    Complex interventions;    Contraceptives;    Prevention;    Childbearing;   

DOI  :  10.1186/s12916-017-0904-7

 received in 2017-02-05, accepted in 2017-06-27,  发布年份 2017

来源: Springer

【 摘 要 】

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

【 授权许可】

CC BY   
© The Author(s). 2017