Title: Intervention Now to Eliminate Repeat Unintended Pregnancies in Teenagers
Funder: Division for Social Care and Health Research (Wales)

Abstract: Design:Systematic review using mixed methods: To cater for the complexities in the question we propose a pragmatichighly structured innovative and iterative approach combining methodological techniques tailored to each element of thereview.Search strategy:Searches of the international literature since 1995 (two years previous to the last substantive systematicreviews in the field) using multiple search strategies including thesaurus terms and keywords relating to teenage pregnancyand second or subsequent pregnancies. We will not restrict search terms to “unwanted” or “unplanned” as not all relevantpapers include these terms terms We will refine and test these strategies iteratively to enhance sensitivity and specificity.A separate search excluding the terms for second or subsequent pregnancies but including a filter for systematic reviews willaugment the initial searches. Searches will include the bibliographies of included papers and hand-searches of key journals.For published studies we will include : MEDLINE & MEDLINE IN PROCESS PsycInfo The Cochrane Library ERIC(Educational Resource Index and Abstracts) SocAbs (Sociological Abstracts) ASSIA (Applied Social Sciences Abstract &Indexes) and BiblioMap (The EPPI-Centre register of health promotion and public health research) CINAHL (CumulativeIndex to Nursing & Allied Health Literature) including the Cochrane Database of Systematic Reviews DARE (Database ofAbstracts of Reviews of Effects) the HTA Database NHS EED (NHS Economic Evaluation Database) and EMBASE (TheExcerpta Medica database).In contrast to the searches of published literature the search of grey literature will focus primarily but not exclusively onsources within the UK. We will search the electronic databases: Scopus Sirius OpenGrey Social Care Online the NationalResearch Register Archive the NIHR portfolio database and the Index to Theses. We will utilise Google Google Scholarand search the websites of or make personal contacts with professional networks e.g. Family Planning Associationreproductive health nursing networks General Practitioners’ fora to identify DoH and third sector policy documents andevaluations. Since the issues surrounding implementation of interventions are a primary focus of this review qualitativeevidence associated with trials is highly relevant. Therefore we will contact the Principal Investigators of effectivenessstudies to obtain any associated qualitative/views study outcomes.Review strategy:The overall mixed method review framework is based on a structured phased EPPI-Centre approach.After evidence searching and retrieval it will be screened against inclusion and exclusion criteria and quality appraised. Amapping exercise will organise and describe the evidence and the scope of the review refined focusing on key areas of thetopics identified. This process will draw heavily on the advice of the expert advisory group.RCT data will by synthesisedwith reference to Cochrane guidelines for public health interventions. Qualitative and effectiveness evidence assessed froma narrative synthesis viewpoint will address facilitators of and barriers to interventions (feasibility) experience(appropriateness) and acceptability (meaningfulness) of interventions. Realist synthesis will identify the mechanismsthrough which the intervention works or fails. Economic evidence from a behavioural economics stance will stratifystudies by the public health lever mechanism used paying attention to the perspective of analysis and type of economicevaluation. Outcomes will be fed back to service users to incorporate their perspective in the final reportAll search results will be imported and managed in bibliographic reference management software (Endnote).Expected outcome of research: A report and further publications (1. Protocol paper 2. Methodology paper and 3. Outcomespaper) designed to inform policy makers providers researchers and service users by identifying and describing: population ofyoung girls at risk of repeat pregnancy interventions available to prevent repeat pregnancies effectiveness of the interventionsand barriers and facilitators of these interventions. Stratifying by groups at greatest risk we will report interventions designed toreduce repeat unintended teenage pregnancies; assess the utility feasibility and costs of those interventions (or elements ofcomplex interventions) and identify barriers and facilitators to implementation and uptake. We will describe the impact ofdifferent interventions on access to and uptake of relevant health and social services subsequent use of contraceptive methodspregnancy and abortion rates. Where there is little or no evidence of effectiveness we will identify promising interventionsthat are worthy of further evaluation. The focus of the review will be on the implementation of interventions: barriers an


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH