The impact of psychosocial interventions on condom and contraceptive use in LMICs: Meta-analysis of randomised controlled trials

Inconsistent contraceptive use and risky sexual behaviour perpetuate the burden of sexually transmitted diseases, especially in low- and middle-income countries (LMIC). Psychosocial interventions (PSI) can contribute to change sexual behaviour, however, their overall effectiveness is unclear. We thu...

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Vydáno v:	Global public health Ročník 15; číslo 8; s. 1182 - 1199
Hlavní autoři:	Riedel, Elena M. C., Turner, David T., Kobeissi, Loulou Hassan, Karyotaki, Eirini, Say, Lale, Cuijpers, Pim
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	England Taylor & Francis 02.08.2020 Taylor & Francis Ltd
Témata:	Behavior change Behavior modification Bias Birth control Condom use Condoms contraception Contraceptives Heterogeneity Intervention Low income groups low-and middle-income countries Meta-analysis Psychosocial factors Psychosocial intervention Random effects Randomization Reliability Risk Risk assessment Risk behavior Risk management Safe sexual practices Sex Sexual behavior Sexually transmitted diseases STD Condom use meta-analysis psychosocial intervention contraception low-and middle-income countries
ISSN:	1744-1692, 1744-1706, 1744-1706
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Abstract	Inconsistent contraceptive use and risky sexual behaviour perpetuate the burden of sexually transmitted diseases, especially in low- and middle-income countries (LMIC). Psychosocial interventions (PSI) can contribute to change sexual behaviour, however, their overall effectiveness is unclear. We thus conducted a meta-analysis of the effectiveness of PSIs to increase condom and contraceptive use in LMICs. Seven databases were searched systematically for randomised trials comparing a PSI with a control condition. Risk ratios of 31 eligible studies were pooled in random-effects analyses for condom and contraceptive use and unprotected sex, using sensitivity analyses to further investigate the results. Risk of bias was assessed using the Cochrane tool, and heterogeneity and publication bias were assessed. PSIs increased condom use by about 6% at post-test and 8% at follow-up as compared to control conditions. Contraceptive use was increased by about 14% at post-test. There were no effects on unprotected sex. Results suggest that PSIs have the potential to increase contraceptive and, to a smaller degree, condom use in LMICs. The reliability of these results is partly limited by heterogeneity and the risk of publication bias. PSIs were further found to provide substantial benefits to the exposed populations beyond the targeted outcomes.
AbstractList	Inconsistent contraceptive use and risky sexual behaviour perpetuate the burden of sexually transmitted diseases, especially in low- and middle-income countries (LMIC). Psychosocial interventions (PSI) can contribute to change sexual behaviour, however, their overall effectiveness is unclear. We thus conducted a meta-analysis of the effectiveness of PSIs to increase condom and contraceptive use in LMICs. Seven databases were searched systematically for randomised trials comparing a PSI with a control condition. Risk ratios of 31 eligible studies were pooled in random-effects analyses for condom and contraceptive use and unprotected sex, using sensitivity analyses to further investigate the results. Risk of bias was assessed using the Cochrane tool, and heterogeneity and publication bias were assessed. PSIs increased condom use by about 6% at post-test and 8% at follow-up as compared to control conditions. Contraceptive use was increased by about 14% at post-test. There were no effects on unprotected sex. Results suggest that PSIs have the potential to increase contraceptive and, to a smaller degree, condom use in LMICs. The reliability of these results is partly limited by heterogeneity and the risk of publication bias. PSIs were further found to provide substantial benefits to the exposed populations beyond the targeted outcomes. Inconsistent contraceptive use and risky sexual behaviour perpetuate the burden of sexually transmitted diseases, especially in low- and middle-income countries (LMIC). Psychosocial interventions (PSI) can contribute to change sexual behaviour, however, their overall effectiveness is unclear. We thus conducted a meta-analysis of the effectiveness of PSIs to increase condom and contraceptive use in LMICs. Seven databases were searched systematically for randomised trials comparing a PSI with a control condition. Risk ratios of 31 eligible studies were pooled in random-effects analyses for condom and contraceptive use and unprotected sex, using sensitivity analyses to further investigate the results. Risk of bias was assessed using the Cochrane tool, and heterogeneity and publication bias were assessed. PSIs increased condom use by about 6% at post-test and 8% at follow-up as compared to control conditions. Contraceptive use was increased by about 14% at post-test. There were no effects on unprotected sex. Results suggest that PSIs have the potential to increase contraceptive and, to a smaller degree, condom use in LMICs. The reliability of these results is partly limited by heterogeneity and the risk of publication bias. PSIs were further found to provide substantial benefits to the exposed populations beyond the targeted outcomes.Inconsistent contraceptive use and risky sexual behaviour perpetuate the burden of sexually transmitted diseases, especially in low- and middle-income countries (LMIC). Psychosocial interventions (PSI) can contribute to change sexual behaviour, however, their overall effectiveness is unclear. We thus conducted a meta-analysis of the effectiveness of PSIs to increase condom and contraceptive use in LMICs. Seven databases were searched systematically for randomised trials comparing a PSI with a control condition. Risk ratios of 31 eligible studies were pooled in random-effects analyses for condom and contraceptive use and unprotected sex, using sensitivity analyses to further investigate the results. Risk of bias was assessed using the Cochrane tool, and heterogeneity and publication bias were assessed. PSIs increased condom use by about 6% at post-test and 8% at follow-up as compared to control conditions. Contraceptive use was increased by about 14% at post-test. There were no effects on unprotected sex. Results suggest that PSIs have the potential to increase contraceptive and, to a smaller degree, condom use in LMICs. The reliability of these results is partly limited by heterogeneity and the risk of publication bias. PSIs were further found to provide substantial benefits to the exposed populations beyond the targeted outcomes.
Author	Turner, David T. Karyotaki, Eirini Riedel, Elena M. C. Say, Lale Kobeissi, Loulou Hassan Cuijpers, Pim
Author_xml	– sequence: 1 givenname: Elena M. C. surname: Riedel fullname: Riedel, Elena M. C. organization: Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit – sequence: 2 givenname: David T. surname: Turner fullname: Turner, David T. organization: Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit – sequence: 3 givenname: Loulou Hassan surname: Kobeissi fullname: Kobeissi, Loulou Hassan email: kobeissil@who.int organization: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organisation – sequence: 4 givenname: Eirini surname: Karyotaki fullname: Karyotaki, Eirini organization: Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit – sequence: 5 givenname: Lale surname: Say fullname: Say, Lale organization: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organisation – sequence: 6 givenname: Pim orcidid: 0000-0001-5497-2743 surname: Cuijpers fullname: Cuijpers, Pim organization: Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit
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SubjectTerms	Behavior change Behavior modification Bias Birth control Condom use Condoms contraception Contraceptives Heterogeneity Intervention Low income groups low-and middle-income countries Meta-analysis Psychosocial factors Psychosocial intervention Random effects Randomization Reliability Risk Risk assessment Risk behavior Risk management Safe sexual practices Sex Sexual behavior Sexually transmitted diseases STD
Title	The impact of psychosocial interventions on condom and contraceptive use in LMICs: Meta-analysis of randomised controlled trials
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