The effectiveness of educational interventions about contraception in adolescence: a systematic review of the literature

The aim was to investigate the effectiveness of educational interventions about contraception in adolescence. Searches were conducted in the databases Latin American and Caribbean Center on Health Sciences Information (LILACS), Cumulative Index to Nursing & Allied Health Literature (CINAHL), Web of Science and in the National Library of Medicine (Pubmed/Medline). The inclusion criteria were followed: studies assessing the effectiveness of educational interventions about contraception in adolescence, fully available, in the languages Portuguese, English, and Spanish. Observing the eligibility criteria, eight papers composed the sample. There were different educational interventions about contraception in adolescence used in diverse contexts and scenarios, where the interventions were effective, promoting changes in the knowledge and/or attitudes; thus showing self-efficacy for prevention of pregnancy and sexually transmitted diseases. Therefore, the educational interventions were effective to promote sexual and reproductive health in adolescents. Descriptors: Health Education; Adolescent; Contraception; Pediatric Nursing. 1 Nurse. Student of the Professional Master’s of Child and Adolescence Health at Ceará State University. Fortaleza, CE, Brazil. E-mail: marcelalsilveira@yahoo.com. br. 2 Nurse, Ph.D in Nursing. Adjunct Professor at Ceará State University. Fortaleza, CE, Brazil. E-mail: veracioq@hotmail.com. Received: 01/30/2018. Accepetd: 10/01/2018. Published: 12/31/2018. Suggest citation: Praxedes MLS, Queiroz MVO. The effectiveness of educational interventions about contraception in adolescence: a systematic review of the literature. Rev. Eletr. Enf. [Internet]. 2018 [cited ____________];20:v20a57. Available from: https://doi.org/10.5216/ree.v20. 51274. Praxedes MLS, Queiroz MVO. Rev. Eletr. Enf. 2018;20:v20a57. doi: 10.5216/ree.v20. 51274. INTRODUCTION Adolescence can be defined as a period of physical, psychological and social maturation that marks the passage of the childhood to adulthood, chronologically delimitated by the World Health Organization (WHO) as the age group between 10 and 19 years(1). Adolescents have their peculiarities in their psychoemotional development, as the omnipotence and desire to experience new situations and, therefore, tend to adopt risky behaviors, becoming more vulnerable(2). The sexuality awakening arises as a psychological and social phenomenon strongly influenced by personal and family beliefs and, moral, social norms(3). The sexual initiation, many times, occurs early and it is associated to the lack of or incorrect use of contraceptive methods, with risks for sexually transmitted diseases (STD) and use of alcohol and other drugs; being the unplanned pregnancy one of its most significant consequences, according to the findings of the last National Survey of School Health (PeNSE), conducted in 2015(4). The PeNSE, developed by the Brazilian Institute of Geography and Statistics (IBGE) in partnership with the Health Ministry, investigated the health risk and protection factors of adolescents and found that more than 25% of students of 13and 15 years old and more than 50% of students of 16 and 17 years old had initiated sexual life. Regarding pregnancy occurrence and considering only the percentage of girls that had sexual intercourse, 9% became pregnant at least once, predominantly girls from public schools (9.4%) and the Northeast region of the country (13.3%)(4). The adolescent pregnancy occurrence, therefore, configures a social and public health issue, once it can become a risk for the biopsychosocial development of the adolescent, as well as for the baby development, with social, economic and family repercussions(5). In this context, health educational practices have been needed, as they stimulate the active participation of subjects, encouraging their autonomy and protagonism in the decisions to obtain good actions for the sexual and reproductive health, which can be mediated by a broad diversity of techniques and materials(6). Nevertheless, the follow-up and orientation are fundamental, with broad participation of the family, school, health institutions and community, as ways to shape opinions(7). Many studies have demonstrated the conduction of educational interventions designated to sexual and reproductive health promotion for the adolescent public(2,8-10). Although adolescents recognize the occurrence of sexuality educational practices, 56% of these assessed interventions as unsatisfactory(7). Therefore, there is a need for investments in participative actions and with technological resources that can stimulate the interest and participation of this public. Besides, it is essential to follow Evidence-Based Practices (EBP) that will answer a question elucidated in the clinical practice, providing aids for a safe-conduct, with quality and low-cost(11). In this perspective, a systematic review was conducted with the following aim: to investigate the effectiveness of educational interventions developed about contraception during adolescence. METHODS A study oriented by the systematic review of the literature that identifies selects and critically assesses relevant studies about a theme in question, through systematic and explicit methods, that can use or not statistical methods (meta-analysis) to summarize their results(12). The operationalization followed the seven steps Praxedes MLS, Queiroz MVO. Rev. Eletr. Enf. 2018;20:v20a57. doi: 10.5216/ree.v20. 51274. established by the Cochrane Collaboration, described as follows: 1) formulation of the question, 2) identification and selection of studies, 3) critical assessment of the studies, 4) data collection, 5) data analysis and presentation, 6) data interpretation and 7) improvement and update of the review(13). The PICO strategy was followed to formulate the question, where: Participants = adolescents, Intervention = educational practice about contraception, Comparison = standard intervention or no intervention and Outcomes = increase of knowledge about contraception during adolescence. Therefore, the following question guided the study: What is the effectiveness of educational interventions about contraception in adolescence? The PICO acronym helps the correct definition of the necessary evidence for the research and avoids unnecessary searches(14). To elucidate the guiding question, a search was conducted during September to October 2017 in the databases Latin American and Caribbean Center on Health Sciences Information (LILACS), Cumulative Index to Nursing & Allied Health Literature (CINAHL), Web of Science and in the National Library of Medicine (Pubmed/Medline). The following controlled descriptors were used and crossed with the boolean operator AND: Health/Saúde Education/Educação, Contraception/Contracepção, and Adolescent/Adolescente, according to the classification of Health Sciences Descriptors (DeCS) and the Medical Subject Headings (MeSH/PubMed). The selection of studies obeyed the inclusion criteria: studies that assessed the effectiveness/efficacy of educational interventions about contraception in adolescence, available in full-text, in the languages Portuguese, English, and Spanish. The adopted exclusion criteria were: editorial publications, letters to editors, books and/or book chapters, monographs, dissertations, theses, experience reports, case studies and review studies. The search for studies was not limited by a time period or year of publication, intended to broaden the largest number of articles possible. The articles identified in more than one database were accounted only once. The initial search resulted in 1,417 publications. After the exclusion of unavailable publications (1,163), the selection through the reading of titles and abstracts was conducted and, when necessary, the full-text reading, to observe if they met the guiding question and met the established criteria. After this rigorous assessment, the final sample was composed of eight studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to explain the search and selection of publications, according to Figure 1(15). An adapted instrument was used to secure the relevance of the extracted data, as well as to minimize the risk of transcription errors and to guarantee the precision when checking the information(16). The selected publications were classified in accordance with the levels of scientific evidence from the Collaborator Center of the Joanna Briggs Institute (JBI), as Level I: systematic review containing only randomized controlled trials; Level II: at least one randomized controlled trial; Level III 1: well-designed non-randomized controlled clinical trials; Level III 2: well-designed cohort studies, or case-control, analytical studies, preferably from more than one research center; Level III 3: multiple temporal series, with or without intervention and results of non-controlled experiments; and Level IV: statements of respected authorities, based on clinical criteria or experience, descriptive studies or reports from committees composed by specialists(17). Additionally, to assess the methodological quality of studies, the Jadad’s quality scale(18) was applied, constituted of the three related items, with two response options: yes (1 point) or no (zero). The items 1 and 2 received an additional point in case the randomization method and masking were adequate (Chart 1). The scale Praxedes MLS, Queiroz MVO. Rev. Eletr. Enf. 2018;20:v20a57. doi: 10.5216/ree.v20. 51274. scoring varies from zero to five, and studies with a score lower than two were considered with bad methodological