Trends in Cardiovascular Health Counseling Among Postpartum Individuals.

Importance: Poor prepregnancy cardiovascular health (CVH) and adverse pregnancy outcomes (APOs) are key risk factors for subsequent cardiovascular disease (CVD) in birthing adults. The postpartum visit offers an opportunity to promote CVH among at-risk individuals. Objective: To determine prevalence, predictors, and trends in self-reported CVH counseling during the postpartum visit. Design, Setting, and Participants: Serial, cross-sectional analysis of data from 2016-2020 from the Pregnancy Risk Assessment Monitoring System (PRAMS), a nationally representative, population-based survey. The primary analysis included individuals who attended a postpartum visit 4 to 6 weeks after delivery with available data on receipt of CVH counseling, self-reported prepregnancy CVD risk factors (obesity, diabetes, and hypertension), and APOs (gestational diabetes, hypertensive disorders of pregnancy, and preterm birth) (N = 167 705 [weighted N = 8 714 459]). Exposures: Total number of CVD risk factors (0, 1, or ≥2 prepregnancy risk factors or APOs). Main Outcomes and Measures: Annual, age-adjusted prevalence of self-reported postpartum CVH counseling per 100 individuals, defined as receipt of counseling for healthy eating, exercise, and losing weight gained during pregnancy, was calculated overall and by number of CVD risk factors. Average annual percent change (APC) assessed trends in CVH counseling from 2016 through 2020. Data were pooled to calculate rate ratios (RRs) for counseling that compared individuals with and without CVD risk factors after adjustment for age, education, postpartum insurance, and delivery year. Results: From 2016 through 2020, prevalence of self-reported postpartum CVH counseling declined from 56.2 to 52.8 per 100 individuals among those with no CVD risk factors (APC, -1.4% [95% CI, -1.8% to -1.0%/y]), from 58.5 to 57.3 per 100 individuals among those with 1 risk factor (APC, -0.7% [95% CI, -1.3% to -0.1%/y]), and from 61.9 to 59.8 per 100 individuals among those with 2 or more risk factors (APC, -0.8% [95% CI, -1.3% to -0.3%/y]). Reporting receipt of counseling was modestly higher among individuals with 1 risk factor (RR, 1.05 [95% CI, 1.04 to 1.07]) and with 2 or more risk factors (RR, 1.11 [95% CI, 1.09 to 1.13]) compared with those who had no risk factors. Conclusions and Relevance: Approximately 60% of individuals with CVD risk factors or APOs reported receiving CVH counseling at their postpartum visit. Prevalence of reporting CVH counseling decreased modestly over 5 years.

Trends in Diet Counseling Among Stroke Versus Non-Stroke Patients: Evidence from the NAMCS, 2011-2016.

INTRODUCTION: Dietary modifications in post-stroke patients facilitated by diet counseling improves post-stroke recovery and stroke recurrence. The extent to which clinicians provide dietary counseling for these patients is unknown. METHODS: 2011 to 2016 National Ambulatory Medical Care Surveys (NAMCS) data were used to assess trends in post-stroke diet consultations by age. Multivariate logistic regression models assessed the likelihood of dietary counseling provision among patients with and without stroke. RESULTS: The proportion of patients with stroke aged 60-79 who received diet counseling decreased from 18.2% in 2011 to 5.3%, 11.9%, 8.7%, 13.4%, and 15.2% in 2012-2016, respectively. Among patients without stroke aged 60-79, diet counseling rate decreased from 12.9% in 2011 to 7%, 9.5%, 10.5%, 13.5%, and 12% in 2012-2016, respectively. Similar trends were observed among patients with and without stroke aged over 80. CONCLUSIONS: The proportion of patients with and without stroke receiving dietary counseling has remained low over the past half-decade. It is likely multifactorial- related to clinician knowledge, patients' receptiveness, and system-level factors of time and reimbursement. Future interventions should explore methods to address barriers to nutrition recommendations for post-stroke patients and patient activation to adopt dietary changes.

Development of a Scale Measuring Nurses' Physical Activity Counseling in a Primary Care Facility: Implications for Healthcare Quality.

This study constructed a scale for measuring nurses' physical activity (PA) counseling in healthcare from the points of view of regular patients. Confirmatory factor analysis produced a two-factor solution with 7 items. The first factor extracted was "follow-up", which accounted for a variance of 44.5% out of a total variance of 64.8% and comprises 4 items. The second factor, "PA recommendation", accounted for a variance of 20.3% and comprises 3 items. The final scale had a good internal consistency (Cronbach's α = 0.75; factor loading ≥0.50) as well as satisfactory validity indicators.

Brief Report: Preliminary Outcomes of a Peer Counselling Program for Parents of Children with Autism in the South Asian Community.

Peer volunteers have been found to be effective in delivering psychosocial interventions when they come from the same culture and share similar experiences as participants. We examined the clinical utility (feasibility and preliminary effectiveness) of a community-based, manualized, peer-delivered group counselling program to address the need for culturally responsive counselling for parents of children with autism in the South Asian community. Sixty-three parents (Mage = 43.7 years, 68% mothers) participated in the program, and reported high stable program satisfaction across sessions. Further, parents reported improved mental health and quality of life following involvement in the program, with changes noted even after the first session. Further research is warranted to assess the efficacy of this kind of parent support intervention.

Dynamic changes in generalized anxiety and depression during counseling.

Comorbidity of generalized anxiety and depression is common in clinical populations. Understanding how change in generalized anxiety and depression are related during counseling may help improve treatment. College student data (N = 51,922) from university and college counseling centers across the United States were used to examine relationships between change in generalized anxiety and depression across 12 counseling sessions using bivariate dual change score models. Results suggested greater improvement in depression was related to greater improvement in generalized anxiety across sessions, but greater improvement in generalized anxiety was related to less improvement in depression across sessions. This same pattern of results generalized to individuals who attended counseling with concerns in anxiety only, depression only, and both anxiety and depression. Although there were general improvements in generalized anxiety and depression across counseling sessions, greater improvement in depression at earlier sessions appeared to be a leading indicator of greater improvement in generalized anxiety at later sessions. Implications and future directions are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

What's Known and What's Next: Contraceptive Counseling and Support for Adolescents and Young Adult Women.

The low rates of actual contraceptive failure and high rates of contraceptive use among young women highlight that choice of contraceptive method and patterns of contraceptive use greatly influence unintended pregnancy risk. Promoting contraceptive use among adolescent and young adult women requires supportive health systems and health providers who understand this population's evolving developmental needs. It also requires an awareness of effective tools for counseling patients, while being mindful of the power dynamics operational during clinical encounters to avoid inadvertently coercive interpersonal dynamics. Missed opportunities to provide such patient-centered care can lead to unplanned pregnancies and suboptimal health and social consequences for young women. Unfortunately, health providers often lack the tools and resources to appropriately identify and meet individual young women's contraceptive needs. This article summarizes the evidence supporting contraceptive counseling strategies linked with contraceptive initiation among young women, and evidence-based approaches for supporting contraceptive adherence and continuation after method initiation. It also orients readers to the unique neurodevelopmental factors that influence the shared decision-making process during contraception counseling sessions with young women. New and emerging approaches for supporting contraceptive initiation, adherence, and continuation are reviewed.

"Guarding the Gatekeepers": Suicides among Mental Health Professionals and Scope of Prevention, A Review.

Suicide is a social evil that is considered to be a global epidemic. Mental healthcare professionals (MHP) (psychiatrists, clinical psychologists, psychiatric social work, etc.) are often involved as 'gatekeepers' in the management of suicidality and suicide prevention. Even though the risk of suicide in medical profession has received attention in research, there has been scarcity of literature related to the same in MHPs. They are not immune to the perils of psychological distress and its cascading consequences including suicide, contrary to the popular societal myths. The intrinsic and extrinsic pressures of the profession, persistent discourse in managing the psychological distress of others, professional burnout, self-stigma, societal apathy and easy access to psychotropics are certain factors making the MHPs more vulnerable. This disengagement and stress can contribute to depression, anxiety and complex trauma in the MHPs. The situation is furthermore compounded in developing countries with resource constraints, low MHP: patient ratio and inflexibility of work schedules. This makes tailored interventions, peer counselling, periodic mental health screenings and administrative understanding and accountability necessary at all levels. Keeping this in background, the review glances at the risk factors of suicide related to MHPs, highlights the problem statement and discusses the possible interventions.

The Use of New Digital Information and Communication Technologies in Psychological Counseling during the COVID-19 Pandemic.

The use of digital information and communication technologies (ICTs) has enabled many professionals to continue to provide their services during the COVID-19 pandemic. However, little is known about the adoption of ICTs by psychologists and the impact of such technologies on their practice. This study aimed to explore psychologists' practices related with the use of ICTs before and during the COVID-19 lockdown, to identify the main changes that the pandemic has brought and the impact that such changes have had on their practice with clients, and also identify the factors that potentially have affected such changes. The Portuguese Psychologists Association announced the study, and 108 psychologists responded to an online survey during the mandatory lockdown. The results showed that these professionals continued to provide their services due to having adopted ICTs. Comparing with face-to-face interventions, psychologists recognized that additional precautions/knowledge were needed to use such technologies. Despite the challenges identified, they described the experience with the use of ICTs as positive, meeting clients' adherence, and yielding positive results. Psychologists with the most years of professional experience maintained their services the most, but those with average experience showed the most favorable attitudes toward the use of technologies and web-based interventions.

Innovative approaches to exploring processes of change in counseling psychology: Insights and principles for future research.

In recent years, innovative approaches have been implemented in counseling and psychotherapy research, creating new and exciting interdisciplinary subfields. The findings that emerged from the implementation of these approaches demonstrate their potential to deepen our understanding of therapeutic change. This article serves as an introduction to the "Innovative Approaches to Exploring Processes of Change in Counseling Psychology" special issue. The special issue includes articles representing several of the most promising approaches. Each article seeks to serve as a sourcebook for implementing a given approach in counseling research, in such areas as the assessment of coregulation processes, language processing, physiology, motion synchrony, event-related potentials, hormonal measures, and sociometric signals captured by a badge. The studies included in this special issue represent some of the most promising pathways for future studies and provide valuable resources for researchers, as well as clinicians interested in implementing such approaches and/or being educated consumers of empirical findings based on such approaches. This introduction synthesizes the articles in the special issue and proposes a list of guidelines for conducting and consuming research that implements new approaches for studying the process of therapeutic change. We believe that we are not far from the day when these approaches will be instrumental in everyday counseling practice, where they can assist therapists and patients in their collaborative efforts to reduce suffering and increase thriving. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Machine learning and natural language processing in psychotherapy research: Alliance as example use case.

Artificial intelligence generally and machine learning specifically have become deeply woven into the lives and technologies of modern life. Machine learning is dramatically changing scientific research and industry and may also hold promise for addressing limitations encountered in mental health care and psychotherapy. The current paper introduces machine learning and natural language processing as related methodologies that may prove valuable for automating the assessment of meaningful aspects of treatment. Prediction of therapeutic alliance from session recordings is used as a case in point. Recordings from 1,235 sessions of 386 clients seen by 40 therapists at a university counseling center were processed using automatic speech recognition software. Machine learning algorithms learned associations between client ratings of therapeutic alliance exclusively from session linguistic content. Using a portion of the data to train the model, machine learning algorithms modestly predicted alliance ratings from session content in an independent test set (Spearman's ρ = .15, p < .001). These results highlight the potential to harness natural language processing and machine learning to predict a key psychotherapy process variable that is relatively distal from linguistic content. Six practical suggestions for conducting psychotherapy research using machine learning are presented along with several directions for future research. Questions of dissemination and implementation may be particularly important to explore as machine learning improves in its ability to automate assessment of psychotherapy process and outcome. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Health Implications and Counseling Considerations for Individuals With Piercings and Tattoos.

Body art has become common and mainstream. Tattoos and body piercings represent highly individual expressions of identity and personal values. Health care services are enhanced when clinicians understand the anatomy and physiology, common discomforts, and real but rare serious risks of body modification and are prepared to provide compassionate support for individuals' choices. Special consideration must be given to the needs of childbearing women. By opening channels of communication, clinicians can engage with clients in shared decision making to help those who possess or desire body art take steps to reduce the risk of adverse effects and obtain prompt and effective medical care when problems arise. Through respectful discussion of existing body art, the therapeutic relationship is strengthened, and greater insight into an individual's health needs may be achieved.

Contraceptive Counseling in the Postpartum Period: Could Pediatricians Have a Role?

INTRODUCTION: Unplanned pregnancies lead to adverse health outcomes and contribute to economic burdens. A lack of continuity and consistency in immediate postpartum care may be a contributor. The most frequent postpartum medical encounters occur with the child's pediatric health care provider, which represents an opportunity to discuss postpartum contraception. Therefore, our objective was to evaluate postpartum family planning knowledge and behavior in women, and to assess the potential acceptability of a pediatrician-delivered intervention to improve knowledge of and convenient access to contraception among postpartum women. METHODS: This was a non-interventional pilot study that employed survey and interview methodology. RESULTS: Women attending pediatric visits for their newborn or infant (N = 346) were surveyed; 35 were interviewed. On average, respondents were 27 years old (SD = 6), 6 months postpartum (SD = 5), and resumed sex 8 weeks after delivery (SD = 6). Of those who had resumed sex, 68% were not using contraception at the time. However, only 18% of survey respondents wanted to have another child. Few exhibited accurate knowledge of birth spacing or long acting reversible contraception. Most interviewees (86%) supported the idea of pediatricians providing contraceptive counseling. Concerns identified included whether it was "allowable" and pediatrician's lack of knowledge of complex maternal health histories. DISCUSSION: This study highlights a gap between contraceptive need and provision in postpartum women. However, the findings suggest women's willingness to engage in conversations with their child's pediatrician about family planning. Future research should assess the feasibility and impact of integrating postpartum counseling into pediatric visits.

Emerging Issues in Male Adolescent Sexual and Reproductive Health Care.

Pediatricians are encouraged to address male adolescent sexual and reproductive health on a regular basis, including taking a sexual history, discussing healthy sexuality, performing an appropriate physical examination, providing patient-centered and age-appropriate anticipatory guidance, and administering appropriate vaccinations. These services can be provided to male adolescent patients in a confidential and culturally appropriate manner, can promote healthy sexual relationships and responsibility, can and involve parents in age-appropriate discussions about sexual health.

Does Health Professional Counseling Impact the Quality-of-Life Levels of Older Adults Enrolled in Physical Activity Programs?

Background and objectives: There are studies showing that exercise counseled by health professionals can improve physical fitness. However, less is known about the effects of exercise counseling on quality of life. The aim of this study was to investigate health-related quality of life of older adults who received or did not receive physical exercise counseling by sport and exercise professionals or physicians. Materials and Methods: This was a cross-sectional study that investigated quality of life of older adults who did or did not receive exercise counseling from health professionals. Older adults who were physically active took part in this study: 45 participants performed exercise advised by sport and exercise professionals (SEPCG), 19 participants performed exercise advised by physicians (PCG), and 26 participants performed exercise without counseling (NCG). Participants answered the SF-36 to estimate quality of life. Results: Analysis revealed that responses on all SF-36 subscales were higher in those participants who received counseling by sport and exercise professionals (Functioning capacity, ß = -26.283, p < 0.001 and ß = -26.482, p < 0.001, Role limitations due to physical problems, ß = -43.372, p < 0.001 and ß = -45.177, p < 0.001, Pain, ß = -17.634, p < 0.001 and ß = -16.015, p < 0.001, General health perceptions, ß = -38.008, p < 0.001 and ß = -32.529, p < 0.001, Vitality, ß = -18.573, p < 0.001 and ß = -16.406, p = 0.001, Social functioning, ß = -37.963, p < 0.001 and ß = -29.224, p < 0.001, Role limitations due to emotional problems, ß = -52.246, p < 0.001 and ß = -40.173, p < 0.001, Mental health, ß = -17.381, p < 0.001 and ß = -12.121, p < 0.001, PCG and NCG respectively). Conclusions: The results showed that those older adults who were counseled by sport and exercise professionals presented better quality of life, possibly because these professionals counseled exercise based on current guidelines for exercise prescription.

National Trends in Mental Health Care for US Adolescents.

Importance: The prevalence of adolescent depression and other internalizing mental health problems has increased in recent years, whereas the prevalence of externalizing behaviors has decreased. The association of these changes with the use of mental health services has not been previously examined. Objective: To examine national trends in the care of different mental health problems and in different treatment settings among adolescents. Design, Setting, and Participants: Data for this survey study were drawn from the National Survey on Drug Use and Health, an annual cross-sectional survey of the US general population. This study focused on adolescent participants aged 12 to 17 years interviewed from January 1, 2005, to December 31, 2018. Data were reported as weighted percentages and adjusted odds ratios (aORs) and analyzed from July 20 to December 1, 2019. Main Outcomes and Measures: Time trends in 12-month prevalence of any mental health treatment or counseling in a wide range of settings were examined overall and for different sociodemographic groups, types of mental health problems (internalizing, externalizing, relationship, and school related), and treatment settings (inpatient mental health, outpatient mental health, general medical, and school counseling). Trends in the number of visits and nights in inpatient settings were also examined. Results: A total of 47 090 of the 230 070 adolescents across survey years (19.7%) received mental health care. Of these, 57.5% were female; 31.3%, aged 12 to 13 years; 35.8%, aged 14 to 15 years; and 32.9%, aged 16 to 17 years. The overall prevalence of mental health care did not change appreciably over time. However, mental health care increased among girls (from 22.8% in 2005-2006 to 25.4% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.19; P = .001), non-Hispanic white adolescents (from 20.4% in 2005-2006 to 22.7% in 2017-2018; aOR, 1.08; 95% CI, 1.03-1.14; P = .004), and those with private insurance (from 19.4% in 2005-2006 to 21.2% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.18; P = .002). Internalizing problems, including suicidal ideation and depressive symptoms, accounted for an increasing proportion of care (from 48.3% in 2005-2006 to 57.8% in 2017-2018; aOR, 1.52; 95% CI, 1.39-1.66; P < .001), whereas externalizing problems (from 31.9% in 2005-2006 to 23.7% in 2017-2018; aOR, 0.67; 95% CI, 0.62-0.73; P < .001) and relationship problems (from 30.4% in 2005-2006 to 26.9% in 2017-2018; aOR, 0.75; 95% CI, 0.69-0.82; P < .001) accounted for decreasing proportions. During this period, use of outpatient mental health services increased from 58.1% in 2005-2006 to 67.3% in 2017-2018 (aOR, 1.47; 95% CI, 1.35-1.59; P < .001), although use of school counseling decreased from 49.1% in 2005-2006 to 45.4% in 2017-2018 (aOR, 0.86; 95% CI, 0.79-0.93; P < .001). Outpatient mental health visits (eg, private mental health clinicians, from 7.2 in 2005-2006 to 9.0 in 2017-2018; incidence rate ratio, 1.30; 95% CI, 1.23-1.37; P < .001) and overnight stays in inpatient mental health settings (from 4.0 nights in 2005-2006 to 5.4 nights in 2017-2018; incidence rate ratio, 1.18; 95% CI, 1.02-1.37; P = .03) increased. Conclusions and Relevance: This study's findings suggest that the growing number of adolescents who receive care for internalizing mental health problems and the increasing share who receive care in specialty outpatient settings are placing new demands on specialty adolescent mental health treatment resources.

Community reintegration following holistic milieu-oriented neurorehabilitation up to 30 years post-discharge.

BACKGROUND: The primary goal of neurorehabilitation for individuals with acquired brain injury (ABI) is successful community reintegration, which commonly focuses on home independence, productivity, and social engagement. Previous research has demonstrated that holistic treatment approaches have better long-term outcomes than other treatment approaches. Holistic approaches go beyond the fundamental components of neurorehabilitation and address metacognition and self-awareness, as well as interpersonal and functional skills. OBJECTIVES: The present study aimed to examine community reintegration of individuals with ABI who completed holistic milieu-oriented neurorehabilitation at the Center for Transitional Neuro-Rehabilitation (CTN), Barrow Neurological Institute (BNI) at up to 30-years post-discharge. We evaluated (a) functional independence, (b) productivity and driving status, and (c) psychosocial profiles of the brain injury survivors. METHOD: Participants included 107 individuals with ABI with heterogeneous etiologies who attended holistic milieu-oriented neurorehabilitation between 1986 and 2016. These participants completed the Mayo-Portland Adaptability Inventory-4 (MPAI-4) and a long-term outcome questionnaire (LOQ) specifically developed for this study. RESULTS: The results demonstrate that 89% of participants were productive at up to 30 years post-discharge (73% engaged in competitive work and/or school) after excluding the retired participants. Almost all of the participants who were engaged in work and/or school reported using compensatory strategies on a long-term basis. Furthermore, only 14% out of 102 study participants were driving at the time of program admission; whereas 58% out of 96 were driving at the time of discharge; and impressively, 70% out of 107 participants were driving at the time of follow-up. Regression analyses revealed that older age at the time of injury, shorter duration between injury and treatment, and better functionality indicated by lower MPAI-4 Ability Index scores significantly predicted a return to driving status at the time of study participation. Psychosocial data from the LOQ revealed positive findings with respect to patients' marital status, living situation, income, and quality of social life. CONCLUSION: The findings from this study suggest that functional gains made during holistic neurorehabilitation have enduring effects and that patients can benefit highly from holistic milieu therapy beyond the early post-acute phases of their recovery. Additionally, they provide evidence that there is potential to return to driving, years after treatment completion.Our holistic milieu treatment approach addressing metacognition, self-awareness, social and coping skills training, and actively transitioning to community settings, is thought to have contributed to the exceptional and long-lasting outcomes in this study.

Supporting Exclusive Breastfeeding Among Factory Workers and Their Unemployed Neighbors: Peer Counseling in Bangladesh.

BACKGROUND: Thirty-six percent of females are employed in Bangladesh, many in the readymade garments manufacturing industry. Inadequate access to health information, care, and long working hours makes exclusive breastfeeding particularly challenging for these employed mothers. RESEARCH AIM: To describe the influence of a breastfeeding education and support program on breastfeeding patterns of mothers working in garment and other factories in Bangladesh. METHODS: A descriptive two-group prospective, mixed methods, longitudinal prospective study was conducted from May 2015 to March 2017. Peer counselors were trained to provide home-based counseling from 6 months of pregnancy until infants completed 6 months for pregnant and lactating factory workers and neighboring unemployed women. The total evaluation sample (N = 304) consisted of participants still employed (n = 190) and unemployed (n = 144). Peer counselors recorded socioeconomic information, weights, and infant feeding patterns. Descriptive statistical analyses examined the peer counselors' influence on breastfeeding practices. RESULTS: Initiation of breastfeeding within 1 hr was high in both groups, 173 (91%) among the employed, and 101 (89%) among the unemployed participants. Exclusive breastfeeding at 6 months was reported by 107 out of 125 (86%) of the employed participants versus 72 out of 76 (95%) of those unemployed. CONCLUSIONS: Community-based peer counselors can help to inform, encourage, and support both factory workers and unemployed women with optimal breastfeeding patterns. Factories who have female workers should consider employing outreach peer counselors as part of their community social responsibility, and as a way to contribute to the sustainability of these programs.

The effect of implementing the partners for change outcome management system in a nationwide student counseling service.

The aims of the present study were to investigate the effect of implementing the Partners for Change Outcome Management System (PCOMS) in the Danish Student Counseling Service and to explore both between-condition moderators and within-condition predictors of outcomes. The study was a nonrandomized controlled study, comparing the outcome of individual and group student counseling for 634 PCOMS clients to that of 740 clients having started treatment as usual (TAU) 2 years before the PCOMS data collection began. The primary outcome measure was the Global Severity Index on the Symptom Checklist 90-Revised. Main analyses were conducted with multilevel models on the intention-to-treat sample. The results demonstrated no effect of the PCOMS compared with the TAU condition, neither for the primary outcome nor for the number of dropouts or clients experiencing deterioration. The PCOMS effect was not predicted by the counselors' adherence to the PCOMS protocol. Because the counselor level explained less than 1% of the variance in outcome, the counselor factors (i.e., attitude to feedback, reactions to negative feedback, and deliberate practice) were not analyzed as predictors. In conclusion, this study does not align with previous studies finding a positive effect of the PCOMS in counseling settings. However, all previous studies relied on the PCOMS Outcome Rating Scale as the only measure of outcome, maybe indicating a measure-specific effect. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A systematic review of the effectiveness of counselling strategies for modern contraceptive methods: what works and what doesn't?

AIM: The aim of this systematic review was to synthesise the evidence on the comparative effectiveness of different counselling strategies for modern contraception on contraceptive behaviour and satisfaction, and to examine their advantages and disadvantages. METHODS: Six electronic databases (Medline, Embase, Global Health, Popline, CINAHL Plus, and Cochrane Library) were searched to identify publications comparing two or more contraceptive counselling strategies and reporting quantitative results on contraceptive use, uptake, continuation or switching, or client satisfaction. Studies of women or couples from any country, published in English since 1990 were considered. RESULTS: A total of 63 publications corresponding to 61 studies met the inclusion criteria. There was substantial heterogeneity in study settings, interventions and outcome measures. Interventions targeting women initiating a method (including structured counselling on side effects) tended to show positive effects on contraceptive continuation. In contrast, the majority of studies of provider training and decision-making tools for method choice did not find evidence of an effect. Additional antenatal or postpartum counselling sessions were associated with increased postpartum contraceptive use, regardless of their timing in pregnancy or postpartum. Dedicated pre-abortion contraceptive counselling was associated with increased use only when accompanied by broader contraceptive method provision. Male partner or couples counselling was effective at increasing contraceptive use in two of five studies targeting non-users, women initiating implants or seeking abortion. High-quality evidence is lacking for the majority of intervention types. CONCLUSIONS: The evidence base and quality of studies are limited, and further research is needed to determine the effectiveness of many counselling interventions in different settings.