Priority 1 from the Contraception PSP

UNCERTAINTY: Which interventions (decision support aids, ease of access , motivational interviewing) increase uptake and continuation of effective contraception including long acting methods (implants, injections and intrauterine contraceptives)? (JLA PSP Priority 1)
Overall ranking	1
JLA question ID	0049/1
Explanatory note	In 2013 commissioning contraceptive services in England moved to local councils, 1 in 3 councils has closed services since 2015. GPs also provide contraceptive services but young people may be embarrassed to discuss sexual health with their GP, they may not be registered with a GP or may find it difficult to get an appointment. Young women are most likely to use community sexual health services, clinic attendances are falling (about 2% per year), this may indicate that people who need to use the service are not aware of them or how to access care. The NATSAL3 survey DOI: http://dx.doi.org/10.1016/S0140-6736(13)62071-1 suggests that overall 1 in 6 pregnancies is unplanned but this is almost 1 in 2 in women aged 16-19 years old. The systematic reviews provide moderate level evidence that teaching young people about contraceptive methods or using behavioural interventions such as motivational interviewing can improve effective use of contraception and reduce unwanted pregnancy. The cost of providing these interventions such as skilled staff time may limit their use in practice. Simple text message reminders do not seem to be effective. Cost effective methods of supporting use of effective contraception are needed.
Evidence	Theory‐based interventions for contraception Laureen M Lopez, Thomas W Grey, Mario Chen, Elizabeth E. Tolley, Laurie L Stockton. November 2016 (SOF-mod/high quality evidence) Brief educational strategies for improving contraception use in young people. Laureen M Lopez, Thomas W Grey, Elizabeth E. Tolley, Mario Chen. March 2016 Mobile phone‐based interventions for improving contraception use. Chris Smith, Judy Gold, Thoai D Ngo, Colin Sumpter, Caroline Free. June 2015 Interventions for preventing unintended pregnancies among adolescents Chioma Oringanje, Martin M Meremikwu, Hokehe Eko, Ekpereonne Esu, Anne Meremikwu, John E Ehiri. February 2016
Health Research Classification System category	Reproductive Health and Childbirth

Extra information provided by this PSP
Original uncertainty examples	“More info on LARC to show why women should use it Again so many hearsay and forums on fears and side-effects that young women don't want to try. So many haven't even heard of some larc's ie patch.” (both) ~ “What are my options if I don't want to use hormonal contraception? Will sexual health HCPs explain this to me, or will they focus on hormonal methods?” (patient) ~ “There isn't enough information that is discreetly available for patients or partners who maybe embarrassed to ask or who don't visit a family planning clinic or the gp surgery where most leaflets are available.” (both) ~ “There's a lot to know about various contraceptives. " (both) ~ “Are there any tools to help me with choosing the right method other than seeing a doctor/nurse? “ (patient) ~ “What different options are there other than the pill?” (patient)
Submitted by	Healthcare Professionals x 32~Patients x 56~Both 33

Extra information provided by this PSP

Original uncertainty examples

“More info on LARC to show why women should use it Again so many hearsay and forums on fears and side-effects that young women don't want to try. So many haven't even heard of some larc's ie patch.” (both) ~ “What are my options if I don't want to use hormonal contraception? Will sexual health HCPs explain this to me, or will they focus on hormonal methods?” (patient) ~ “There isn't enough information that is discreetly available for patients or partners who maybe embarrassed to ask or who don't visit a family planning clinic or the gp surgery where most leaflets are available.” (both) ~ “There's a lot to know about various contraceptives. " (both) ~ “Are there any tools to help me with choosing the right method other than seeing a doctor/nurse? “ (patient) ~ “What different options are there other than the pill?” (patient)

Submitted by

Healthcare Professionals x 32~Patients x 56~Both 33

PSP information
PSP unique ID	0049
PSP name	Contraception
Total number of uncertainties identified by this PSP.	57 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	21 April 2017