Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Dec 8, 2025
Date Accepted: Jun 4, 2026
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Tailored and interactive mobile telehealth contraceptive counselling compared with in-person care: a systematic review and meta-analysis of randomised controlled trials
ABSTRACT
Background:
Use of effective contraceptive methods (ECM) reduces maternal mortality. Person-centered counselling increases uptake, but barriers to high quality counselling persist. Telehealth may improve access to comprehensive contraceptive care, but its effectiveness remains unclear.
Objective:
To assess the effectiveness and acceptability of tailored, interactive telehealth contraceptive counselling (TECC) compared with in-person counselling.
Methods:
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing TECC with in-person counselling for women and girls of any age and setting. We searched Medline, Embase, Web of Science, and the Cochrane Library until 15 October 2025. Outcomes were ECM use <6 months (primary outcome); ECM use at 6–12 months; long-acting reversible contraception (LARC) use; method choice; satisfaction with counselling and method switching. We assessed risk of bias (RoB) using Cochrane RoB2, certainty of evidence using GRADE, and performed meta-analysis using a random effects model. The protocol was registered with PROSPERO a priori (CRD42023404402). No specific funding was received.
Results:
Eight RCTs (RoB: low n=4, moderate n=2, high n=2), and one cluster-RCT (moderate to high RoB) were included, eight evaluating TECC adjunct to in-person care and one standalone model (n=5353). Certainty of evidence was low to very low. TECC showed no effects on ECM use <6 months (RR 1.10; 95% CI 0.95–1.29), LARC use or method choice. ECM use at 6–12 months showed a significant effect (RR 1.07; 95% CI 1.00–1.13) in favour of TECC. Narrative analysis of satisfaction showed no difference. There was insufficient data on method switching. Effect estimates had varying heterogeneity, I2 = 0-95%.
Conclusions:
TECC, when delivered alongside standard care, appears to have little or no effect on contraceptive use, method choice, or satisfaction. The effect of standalone TECC remains unknown. Future research should prioritize standalone models and assess how tailoring, timing, and delivery influence effectiveness, including long-term use and method switching. Clinical Trial: The protocol was registered with PROSPERO (CRD42023404402)
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