***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE The objective of the study was to compare 3 different approaches for increasing clients ' underst and ing of contraceptive effectiveness . STUDY DESIGN We r and omized 900 reproductive-age women in India and Jamaica to 1 of 3 charts presenting pregnancy risk . RESULTS The most important reason for choosing a contraceptive was how well it prevents pregnancy ( 54 % ) followed by few side effects ( 17 % ) . At baseline , knowledge about contraceptive effectiveness was poor . About half knew  oral contraceptive pills  are more effective than condoms ( 46 % ) and intrauterine devices are more effective than injectables ( 50 % ) . All 3 charts improved knowledge significantly ( P < .01 ) for these 2 questions . No chart improved knowledge better than any other ( P > .05 ) . The chart ranking contraceptive methods on a continuum was judged slightly easier to underst and than the other 2 charts . CONCLUSION Only with accurate underst and ing of pregnancy risk can clients make informed choices . Our results have already informed a global h and book for family planning providers to use the chart ranking contraceptive methods on a continuum Objectives To compare two post-abortion family planning ( FP ) service packages on contraceptive use and repeat abortion rate  among young women in three cities in China . Methods In this cluster-r and omized trial , one FP service package included provision of limited information and referral to existing FP services , and the other , more comprehensive , package consisted – in addition to the above simple package – of individual counselling , free provision of contraceptive material s , and involvement of the male partner . Eight matched pairs of hospitals were certified by central ized r and omization . Women undergoing abortion were followed up for six months , and data were collected in two rounds , before and after the intervention . Results We followed a total of 2336 women younger than 25 years ( 555 before and 555 after the simple intervention package ; 634 before and 592 after the comprehensive intervention package ) . Both packages increased use of any contraceptive method , but the comprehensive approach also increased use of more effective methods . Odds ratios for consistent and correct use of condoms were 2.32 ( 95 % confidence interval 1.55–3.46 ) and 2.78 ( 1.81–4.26 ) , respectively , compared with the simple package . The rates of unwanted pregnancies and repeat abortions were somewhat reduced for both packages , with no significant statistical difference between them . Conclusion Couples who received the comprehensive post-abortion FP service appear to use more effective contraceptive methods and show better compliance Abstract Objective : To determine whether a theoretically based sex education programme for adolescents ( SHARE ) delivered by teachers reduced unsafe sexual intercourse compared with current practice . Design : Cluster r and omised trial with follow up two years after baseline ( six months after intervention ) . A process evaluation investigated the delivery of sex education and broader features of each school . Setting : Twenty five secondary schools in east Scotl and . Participants : 8430 pupils aged 13 - 15 years ; 7616 completed the baseline question naire and 5854 completed the two year follow up question naire . Intervention : SHARE programme ( intervention group ) versus existing sex education ( control programme ) . Main outcome measures : Self reported exposure to sexually transmitted disease , use of condoms and contraceptives at first and most recent sexual intercourse , and unwanted pregnancies . Results : When the intervention group was compared with the conventional sex education group in an intention to treat analysis there were no differences in sexual activity or sexual risk taking by the age of 16 years . However , those in the intervention group reported less regret of first sexual intercourse with most recent partner ( young men 9.9 % difference , 95 % confidence interval −18.7 to −1.0 ; young women 7.7 % difference , −16.6 to 1.2 ) . Pupils evaluated the intervention programme more positively , and their knowledge of sexual health improved . Lack of behavioural effect could not be linked to differential quality of delivery of intervention . Conclusions : Compared with conventional sex education this specially design ed intervention did not reduce sexual risk taking in adolescents OBJECTIVE The objective of the study was to determine whether a transtheoretical model-tailored expert system intervention increases dual- method contraceptive use , compared with a nontailored educational intervention . STUDY DESIGN We performed a r and omized clinical trial of 542 women at high risk for sexually transmitted infections ( STIs ) and unintended pregnancy . The intervention group received computer-based tailored feedback using a multimedia program . The control group received general contraceptive information and nontailored advice . RESULTS Participants in the intervention group were more likely to report use of dual contraceptive methods during follow-up ( adjusted hazard rate ratio 1.70 , 95 % confidence interval 1.09 , 2.66 ) , compared with controls . However , there were no differences in the rates of incident STI or unintended pregnancy between the 2 groups . CONCLUSIONS The computer-based transtheoretical model-tailored intervention result ed in a 70 % increase in reported dual- method contraceptive use in a group of women at high risk for STIs and unintended pregnancy . Inconsistent use of dual methods may explain the lack of effect on unintended pregnancy rates and incident STIs Recent efforts to involve patients more actively in therapeutic decisions have suggested the relevance of computer-based interventions at clinic visits . This paper presents a longitudinal , experimental study evaluating a computer-based contraceptive decision aid in Chicago and Madison family planning clinic visits . Patient interviews at three time points evaluated patient acceptance by  and  program impact on 949 young women . Both Chicago and Madison patients reported high acceptance . The program result ed in improved short-term knowledge and confidence in oral contraceptive ( OC ) efficacy for Chicago and Madison patients . In addition , compared to their control group , Madison experimental group patients had higher OC knowledge 1 year after the initial visit and a trend for fewer pregnancies ( P < 0.074 ) . Compared to their control group , a higher percent of the Chicago experimental group patients adopted OC 's after stating their intention to do so at the initial visit . Exposure to the computer program had no observable impact on the number of months on the oral contraceptive for Chicago or Madison patients . Overall findings suggest the usefulness of informatics tools as a supplement to patient-provider interactions The study examined the effect of pretreatment counseling upon discontinuation of 150 mg depo-medroxyprogesterone acetate ( Depo-Provera ( DMPA ) ) , given for contraception . A total of 421 Chinese women participated , 204 receiving detailed structured pretreatment and ongoing counseling on the hormonal effects and probable side effects of DMPA and 217 receiving only routine counseling .  The primary study endpoint was termination rate ; secondary endpoints were frequency of medical events and reasons for termination . Study termination rates were significantly lower in the intensive structured counseling group than in the routine counseling group . At one year , the total cumulative termination rates were 11 % ( 23/204 ) and 42 % ( 92/217 ) , respectively ( p < 0.0001 ) . The most common reasons for terminating DMPA were menstrual changes . No pregnancy , serious or unexpected medical events were reported , nor were statistically or clinical ly significant changes in vital signs observed . We conclude that pretreatment counseling on expected side effects increases the acceptability of DMPA Abstract Objectives : To evaluate impact of postnatal health education for mothers  on infant care and postnatal family planning practice s in Nepal . Design : R and omised controlled trial with community follow up at 3 and 6 months post partum by interview . Initial household survey of study areas to identify all pregnant women to facilitate follow up . Setting : Main maternity hospital in Kathm and u , Nepal . Follow up in urban Kathm and u and a periurban area southwest of the city . Subjects : 540 mothers r and omly allocated to one of four groups : health education immediately after birth and three months later ( group A ) , at birth only ( group B ) , at three months only ( group C ) , or none ( group D ) . Interventions : Structured baseline household question naire ; 20 minute , one to one health education at birth and three months later . Main outcome measures : Duration of exclusive breast feeding , appropriate immunisation of infant , knowledge of oral rehydration solution and need to continue breast feeding in diarrhoea , knowledge of infant signs suggesting pneumonia , uptake of postnatal family planning . Results : Mothers in groups A and B ( received health education at birth ) were slightly more likely to use contraception at six months after birth compared with mothers in groups C and D ( no health education at birth ) ( odds ratio 1.62 , 95 % confidence interval 1.06 to 2.5 ) . There were no other significant differences between groups with regards to infant feeding , infant care , or immunisation . Conclusions : Our findings suggest that the recommended practice of individual health education for postnatal mothers in poor communities has no impact on infant feeding , care , or immunisation , although uptake of family planning may be slightly enhanced . Key messages Health education is widely promoted in primary care , but there have been few rigorous evaluations of its impact , especially in developing countries A r and omised controlled trial of postnatal individual health education for mothers given by trained female health workers showed no significant impact on maternal knowledge and practice s of child care or on infant health outcomes , but there was a small improvement in uptake of family planning at six months after birth The efficacy of health education interventions that rely solely on giving people information to bring about a change in health behaviour is unproved ; interventions should be evaluated before being implemented on a large scale Alternative strategies for health promotion in developing countries such as interactions within families , peer groups , or communities may be more effective but are costly and difficult to implement on a large OBJECTIVES This study measured the effect of information about family planning methods and STD risk factors and prevention , together with personal choice on the selection of  intrauterine devices ( IUDs ) by clients with cervical infection . METHODS We conducted a r and omised , controlled trial in which family planning clients were assigned to one of two groups , the st and ard practice ( control ) group in which the provider selected the woman 's contraceptive and the information and choice ( intervention ) group . The study enrolled 2107 clients in a family planning clinic in Mexico City . RESULTS Only 2.1 % of the clients had gonorrhoea or chlamydial infections . Significantly fewer women in the intervention group selected the IUD than the proportion for whom the IUD was recommended in the st and ard care group by clinicians ( 58.2 % v 88.2 % , p = 0.0000 ) . The difference was even more pronounced among infected women : 47.8 % v 93.2 % ( intervention v control group , p = 0.0006 ) . CONCLUSIONS The intervention increased the selection of condoms and reduced the selection of IUDs , especially among women with cervical infections , for whom IUD insertion is contraindicated CONTEXT Given levels of unintended pregnancy and STDs , an effective counseling intervention is needed to improve women 's consistent use of effective prevention methods . METHODS A sample of 764 women aged 16 - 44 who were at risk of unintended pregnancy were enrolled in a r and omized controlled trial in North Carolina in 2003 - 2004 . Intervention participants received pregnancy and STD prevention counseling , adapted from motivational interviewing , both at enrollment and two months later ; controls received only a session of general health counseling . Levels of contraceptive use ( categorized as high , low or none on the basis of the effectiveness of the method and the consistency of use ) and barriers to use were measured at two , eight and 12 months ; chi-square tests were used to compare selected outcomes between the groups . Rates of unintended pregnancy and chlamydia infection were assessed over the study period . RESULTS At baseline , 59 % of all participants reported a high level of contraceptive use , 19 % a low level and 22 % nonuse . At two months , the proportions of intervention and control participants who had improved their level of use or maintained a high level ( 72 % and 66 % , respectively ) were significantly larger than the proportions who had reported a high level of use at baseline ( 59 % and 58 % , respectively ) . No significant differences were found between the groups at 12 months , or between baseline and 12 months for either group . During the study , 10 - 11 % of intervention and control participants became pregnant , 1 - 2 % received a chlamydia diagnosis and 7 - 9 % had another STD diagnosed . CONCLUSIONS Repeated counseling sessions may be needed to improve contraceptive decision-making and to reduce the risk of unintended pregnancy and STDs BACKGROUND One in four abortions in the UK is undertaken for women who have had one before . Women undergoing abortion in Edinburgh were targeted for improved contraceptive advice and provision in this r and omized trial . METHODS Between November 2001 and May 2002 , women recruited at assessment for abortion were r and omized at admission to receive specialist contraceptive advice and enhanced provision ( 316 women ) or st and ard care ( 297 women ) . R and omization was based on the week of admission . Contraceptive use 16 weeks after abortion was assessed by question naire and subsequent abortions by review of the hospital records 2 years later . RESULTS Women receiving specialist advice and enhanced provision were more likely to leave the hospital with contraception ( 271 versus 115 , P < 0.001 ) , which was more likely to be a long-acting method ( 141 versus 78 , P < 0.001 ) than women receiving st and ard care . Four months later , there was no significant difference in contraceptive prevalence or continuation , but women in the intervention group were more likely to be using contraceptive implants (  
    Output:
    
We have limited evidence about what works to help consumers choose an appropriate contraceptive method .