A Cochrane review included 9 studies with a total of 3 794 subjects. Three trials showed some benefit of intensified counselling. Women who received repeated, structured information about the injectable contraceptive depo-medroxyprogesterone acetate (DMPA) were less likely to have discontinued the method by 12 months (OR 0.27; 95% CI 0.16 to 0.44; 1 trial, n=350) than were women who had routine counselling. The intervention group was also less likely to discontinue due to menstrual disturbances. In another study, the intervention group was less likely to discontinue due to dissatisfaction with the contraceptive method, but overall continuation was not affected. Another trial showed a group with special counselling plus phone calls was more likely than the special-counselling group to report consistent use of oral contraceptives (OC) at 3 months (OR 1.41; 95% CI 1.06 to 1.87; n=767), though not at 12 months. In third trial, women in the daily text-message group were more likely than the standard-care group to continue OC use by six months (OR 1.54; 95% CI 1.14 to 2.10; n=683). The text-message group was also more likely to avoid an interruption in OC use longer than seven days (OR 1.53; 95% CI 1.13 to 2.07).
Comment: The quality of evidence is downgraded by limitations in study quality (e.g., more than 20% loss to follow up) and by inconsistency (heterogeneity in interventions and outcomes).