An exploration of adherence patterns in contraceptive pill users from technical and educational interventions: A meta-analysis

Simran Sandhu, Patrick Ball, Hana Morrissey

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Background: Poor adherence to contraception has long been one cause of unintended pregnancies, emergency contraception and terminations. Oral contraception accounts for a largest group of contraception users and whilst
there is a common understanding of general poor adherence, little is known about the impact of adherence interventions in this population.
Aim: To explore the effectiveness of technical and non-technical interventions currently used or studied to encourage adherence to the oral contraceptive.
Methods: Databases were used to conduct a comprehensive search of current literature including: PubMed©, ScienceDirect©, and
Cochrane© Library. CASP© criteria was used for the quality assessment of individual studies. RevMan® software was then used to analyse the data for a quantitative assessment and the qualitative data was analysed
thematically. Adherence was assessed from the primary or secondary outcomes including number of missed pills, and continuation of oral contraception. Results: Seven studies including 4,226 women met the selected PICO©
framework and had risk of bias moderate to low. Results from the meta-analysis demonstrated an overall increase in adherence with real time interventions OR=2.16, [1.65, 2.83] and continuation with knowledge interventions or
text messages OR=1.50, [1.25,1.80]. A real effect was indicated with technical and educational interventions and outcomes but, the strength of the effect is weak. Individually however, a mean difference of only 0.5 missed pills
resulted from one study (4.0 vs 3.5) (P=0.56) and in another, more participants actually missed pills in the text group (39% vs 27%) (p=0.4). Text messages also displayed positive differences in 6 month pill knowledge vs control (25.5 vs 23.7) (p<0.001) but digital tablet dispenser +/- acoustic alarm set promoted adherence. A greater percentage of participants missed zero pills, 70% vs control 24% (p=0.0001). Furthermore, an educational study revealed that 86% of women adhered to OC with tailored educational leaflets (OR 2.74, 1.21-6.21) yet another suggested summary leaflets were effective for understanding of all pill rules when questioned OR=4.41 (2.17- 8.97).
Conclusions: Adherence to the contraceptive pill remains less than optimal. Although educational and phone text messages interventions indicated only modest improvements in in some contraceptive pill users, it should not be completely disregarded. The long term benefits and cost-effectiveness of reminder tablet dispensers require more attention toovercome unintentional non-adherence.
Original languageEnglish
Pages (from-to)435-452
Number of pages18
JournalEuropean Journal of Biomedical and Pharmaceutical Sciences
Issue number8
Publication statusPublished - 2021


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