Online decision aids for contraceptive choices in women with chronic conditions: A systematic review.

Abstract

Background: Women with chronic conditions face increased risks of unintended pregnancy and adverse maternal and perinatal outcomes. Tailored, online contraceptive decision aids might improve informed decision-making and support reproductive health by promoting patient-centered care in this population.

Objectives: This study systematically reviews the characteristics and effectiveness of online decision aids designed to support contraceptive and reproductive health choices in women with chronic conditions.

Search strategy: We searched Medline, Embase, CINAHL, Maternity and Infant Care Database, and Emcare up until November 30, 2024, using terms related to contraception, decision aids, chronic conditions, and women's health. We also searched thesis repositories and reference lists of relevant reviews.

Selection criteria: Included studies evaluated web-based decision aids with a contraceptive choice component, targeted women of reproductive age (15-50 years) with chronic conditions, and assessed outcomes related to feasibility, user experience, knowledge, communication, or contraceptive uptake and behavior change.

Data collection and analysis: Two reviewers independently extracted data on study characteristics, intervention features, and outcomes and assessed methodological quality using the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was conducted due to heterogeneity in study designs and outcomes. The GRADE approach was not applied to assess the quality of the included studies due to variability in study designs and outcomes. The protocol was registered with PROSPERO (CRD42023473313).

Main results: Ten studies evaluating nine distinct decision aids met the inclusion criteria. Eight focused primarily on contraceptive choices, while two addressed broader reproductive health planning. Most studies were conducted in the USA (n = 8) and employed various designs: randomized controlled trials (n = 4), mixed-methods studies (n = 2), and descriptive studies (n = 3). The decision aids targeted various chronic conditions, including hypertension, diabetes, cancer, rheumatic diseases, cystic fibrosis, and sickle cell disease. The aids incorporated interactive features, personalized recommendations, and multimedia formats, with high user satisfaction and usability ratings reported. Some decision aids demonstrated improvements in contraceptive use, reproductive health knowledge, and communication. However, the effect on long-term contraceptive behaviors was mixed, with three studies showing positive but not statistically significant changes and one study reporting a negative correlation.

Conclusions: Online decision aids tailored for women with chronic conditions showed promise in improving user satisfaction, reproductive health knowledge, and patient-provider communication. However, their impact on long-term contraceptive behaviors remains inconclusive. Future studies should employ rigorous designs, validated outcome measures, and larger, more diverse populations to further evaluate the effectiveness of these aids and optimize their impact on contraceptive decision-making in this population.