Effectiveness of Telehealth for Women’s Preventive Services

Project Summary Title and Description

Title
Effectiveness of Telehealth for Women’s Preventive Services
Description
Structured Abstract Objectives. To evaluate the effectiveness, use, and implementation of telehealth for women’s preventive services for reproductive health care and interpersonal violence (IPV), and to evaluate patient preferences and engagement for telehealth, particularly in the context of the coronavirus (COVID-19) pandemic. Data sources. Ovid MEDLINE®, CINAHL®, EMBASE, and Cochrane CENTRAL databases (July 1, 2016 to March 4, 2022); manual review of reference lists; suggestions from stakeholders and responses to a Federal Register Notice. Review methods. Eligible abstracts and full-text articles of telehealth interventions were independently dual reviewed for inclusion using predefined criteria. Dual review was used for data abstraction, study-level risk of bias assessment, and strength of evidence (SOE) rating using established methods. Meta-analysis was not conducted due to heterogeneity of studies and limited available data. Results. Searches identified 5,704 unique records. Eight randomized controlled trials (RCTs), one nonrandomized trial, and seven observational studies, involving 10,731 participants, met inclusion criteria. Of these, nine evaluated IPV services and seven evaluated contraceptive care, the only reproductive health service studied. Risk of bias was low in one study, moderate in nine trials and five observational studies, and high in one study. Telehealth interventions were intended to replace usual care in 14 studies and supplement care in two studies. Delivery modes included telephone (5 studies), online modules (5 studies), and mobile applications (1 study), and was unclear or undefined in five studies. There were no differences between telehealth interventions to supplement contraceptive care and comparators for rates of contraceptive use, sexually transmitted infection, and pregnancy (low SOE); evidence was insufficient for abortion rates. There were no differences between telehealth IPV services versus comparators for outcomes measuring repeat IPV, depression, posttraumatic stress disorder, fear of partner, coercive control, self-efficacy, and safety behaviors (low SOE). The COVID-19 pandemic increased telehealth utilization. Barriers to telehealth interventions included limited internet access and digital literacy among English-speaking IPV survivors, and technical challenges and confidentiality concerns for contraceptive care. Telehealth use was facilitated by strategies to ensure safety of individuals who receive IPV services. Evidence was insufficient to evaluate access, health equity, or harms outcomes. Conclusions. Limited evidence suggests that telehealth interventions for contraceptive care and IPV services result in equivalent clinical and patient-reported outcomes as in-person care. Uncertainty remains regarding the most effective approaches for delivering these services, and how to best mobilize telehealth, particularly for women facing barriers to health care.
Attribution
N/A
Authors of Report
Amy Cantor, MD, MPH Heidi D. Nelson, MD, MPH Miranda Pappas, MA Chandler Atchison, MPH Brigit Hatch, MD, MPH Nathalie Huguet, PhD Brittny Flynn, BS Marian McDonagh, PharmD
Methodology description
Systematic Review
PROSPERO
CRD42021282298
DOI
10.23970/AHRQEPCCER256
Notes
The data was entered prospectively using SRDR+'s data abstraction function and templates. Final report posted here: https://effectivehealthcare.ahrq.gov/products/telehealth-women/research
Funding Source
Agency for Healthcare Research and Quality

Key Questions

1. KQ 1a. What is the evidence of effectiveness of telehealth as a strategy for delivery of health care services for reproductive health (including family planning, contraception, and STI counseling)?
2. KQ 1b. What are patient preferences and patient choice in the context of telehealth utilization for reproductive health (including family planning, contraception, and STI counseling)?
3. KQ 1c. What is the effectiveness of patient engagement strategies for telehealth for reproductive health (including family planning, contraception, and STI counseling)?
4. KQ 1d. What is the impact of COVID-19 on the effectiveness of telehealth and patient engagement for reproductive health (including family planning, contraception, and STI counseling)?
5. KQ 1e. What are the barriers to and facilitators of telehealth for women’s reproductive health (including family planning, contraception, and STI counseling) in low-resources settings and populations?
6. KQ 1f. What are the harms of telehealth for women’s reproductive health (including family planning, contraception, and STI counseling)?
7. KQ 2a. What is the evidence of effectiveness of telehealth as a strategy for screening and interventions for interpersonal violence?
8. KQ 2b. What are patient preferences and patient choice in the context of telehealth utilization for screening and interventions for interpersonal violence?
9. KQ 2c. What is the effectiveness of patient engagement strategies for telehealth for screening and interventions for interpersonal violence?
10. KQ 2d. What is the impact of COVID-19 on the effectiveness of telehealth and patient engagement for screening and interventions for interpersonal violence?
11. KQ 2e. What are the barriers to and facilitators of telehealth for screening and interventions for interpersonal violence in low-resources settings and populations?
12. KQ 2f. What are the harms of telehealth for screening and interventions for interpersonal violence?

Associated Extraction Forms

Type
Standard

Associated Studies (each link opens a new tab)

Title Authors Year
A randomized controlled study of two educational interventions on adherence with oral contraceptives and condoms. Berenson Abbey B; Rahman Mahbubur 2012
Longitudinal impacts of an online safety and health intervention for women experiencing intimate partner violence: randomized controlled trial. Ford-Gilboe Marilyn; Varcoe Colleen; Scott-Storey Kelly; Perrin Nancy; Wuest Judith; Wathen C Nadine; Case James; Glass Nancy 2020
Project WINGS (Women Initiating New Goals of Safety): A randomised controlled trial of a screening, brief intervention and referral to treatment (SBIRT) service to identify and address intimate partner violence victimisation among substance-using women receiving community supervision. Gilbert Louisa; Shaw Stacey A; Goddard-Eckrich Dawn; Chang Mingway; Rowe Jessica; McCrimmon Tara; Almonte Maria; Goodwin Sharun; Epperson Matthew 2015
The Longitudinal Impact of an Internet Safety Decision Aid for Abused Women. Glass Nancy E; Perrin Nancy A; Hanson Ginger C; Bloom Tina L; Messing Jill T; Clough Amber S; Campbell Jacquelyn C; Gielen Andrea C; Case James; Eden Karen B 2017
An online healthy relationship tool and safety decision aid for women experiencing intimate partner violence (I-DECIDE): a randomised controlled trial. Hegarty Kelsey; Tarzia Laura; Valpied Jodie; Murray Elizabeth; Humphreys Cathy; Taft Angela; Novy Kitty; Gold Lisa; Glass Nancy 2019
Racial and ethnic differences in family planning telehealth use during the onset of the COVID-19 response in Arkansas, Kansas, Missouri, and Oklahoma. Hill Brandon J; Lock Li; Anderson Brie 2021
Efficacy of a Web-Based Safety Decision Aid for Women Experiencing Intimate Partner Violence: Randomized Controlled Trial. Koziol-McLain Jane; Vandal Alain C; Wilson Denise; Nada-Raja Shyamala; Dobbs Terry; McLean Christine; Sisk Rose; Eden Karen B; Glass Nancy E 2018
Mobile Remote Monitoring of Intimate Partner Violence Among Pregnant Patients During the COVID-19 Shelter-In-Place Order: Quality Improvement Pilot Study. Krishnamurti Tamar; Davis Alexander L; Quinn Beth; Castillo Anabel F; Martin Kelly L; Simhan Hyagriv N 2021
Specialist follow-up contraceptive support after abortion-Impact on effective contraceptive use at six months and subsequent abortions: A randomised controlled trial. Kumar Usha; Pollard Louise; Campbell Lucy; Yurdakul Selin; Calvete Clara Cantalapiedra; Coker Bola; Chen Tao; Douiri Abdel 2019
Increasing the safety-promoting behaviors of abused women. McFarlane Judith; Malecha Ann; Gist Julia; Watson Kathy; Batten Elizabeth; Hall Iva; Smith Sheila 2004
Effect of COVID-19 pandemic on women's health and safety: A study of immigrant survivors of intimate partner violence. Sabri Bushra; Hartley Maria; Saha Jyoti; Murray Sarah; Glass Nancy; Campbell Jacquelyn C 2020 Nov-Dec
Motivational interviewing and intimate partner violence: a randomized trial. Saftlas Audrey F; Harland Karisa K; Wallis Anne B; Cavanaugh Joseph; Dickey Penny; Peek-Asa Corinne 2014
COVID-19 and Sexual and Reproductive Health Care: Findings From Primary Care Providers Who Serve Adolescents. Steiner Riley J; Zapata Lauren B; Curtis Kathryn M; Whiteman Maura K; Brittain Anna W; Tromble Erin; Keys Katherine R; Fasula Amy M 2021
Telemedicine for contraceptive counseling: An exploratory survey of US family planning providers following rapid adoption of services during the COVID-19 pandemic. Stifani Bianca M; Avila Karina; Levi Erika E 2021
Telemedicine for contraceptive counseling: Patient experiences during the early phase of the COVID-19 pandemic in New York City. Stifani Bianca M; Smith Abigail; Avila Karina; Boos Elise W; Ng June; Levi Erika E; Benfield Nerys C 2021
COVID-19 and family planning service delivery: Findings from a survey of U.S. physicians. Zapata Lauren B; Curtis Kathryn M; Steiner Riley J; Reeves Jennifer A; Nguyen Antoinette T; Miele Kathryn; Whiteman Maura K 2021

Downloadable Data Content

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