Tailored and Interactive Mobile Telehealth Contraceptive Counseling Compared With In-Person Care: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

backgroundUse of effective contraceptive methods (ECMs) reduces maternal mortality. Person-centered counseling increases uptake, but barriers to high-quality counseling persist. Telehealth may improve access to comprehensive contraceptive care, but its effectiveness remains unclear.

objectiveThis study assesses the effectiveness and acceptability of tailored, interactive telehealth contraceptive counseling (TECC) compared with in-person counseling.

methodsWe conducted a systematic review and meta-analysis of English-language randomized controlled trials (RCTs) comparing TECC with in-person counseling for women and girls of any age and setting. We searched MEDLINE, Embase, Web of Science, and the Cochrane Library from inception through October 15, 2025. Outcomes were use of ECM less than 6 months from intervention (primary outcome); use of ECM at 6-12 months; use of long-acting reversible contraception (LARC); choice of ECM; choice of LARC; satisfaction with counseling; and method switching. Two researchers assessed risk of bias (RoB) using Cochrane RoB 2, certainty of evidence using GRADE (Grading of Recommendations Assessment, Development, and Evaluation), and performed meta-analysis using a random-effects model. The protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews) a priori (CRD42023404402). No specific funding was received.

resultsEight RCTs (RoB: low, n=4; moderate, n=2; and high, n=2) and 1 cluster RCT (moderate-to-high RoB) were included in the review, with 5353 participants across all included studies. Eight studies evaluated TECC as an adjunct to in-person care (hybrid model) and 1 as a standalone model, of which 7 and 1, respectively, contributed outcome data for the meta-analyses. Certainty of evidence was low to very low. The pooled effect of 4 studies of TECC on ECM use less than 6 months showed no clear evidence of an effect (relative risk [RR] 1.10; 95% CI 0.95-1.29). The pooled effect of 4 studies of TECC on choice of ECM (RR 1.07; 95% CI 0.96-1.18) likewise showed no clear effect. The pooled effect of 4 studies of TECC on ECM use at 6-12 months showed a small but statistically significant (P=.04) effect in favor of TECC, narrowly excluding the null (RR 1.07; 95% CI 1.002-1.130). Because of high statistical and clinical heterogeneity (I2=87%-96%), results for LARC choice (2 studies) and LARC use at 0-6 months (2 studies) and 6-12 months (2 studies) were narratively described. The evidence for these outcomes was very uncertain. Narrative analysis of satisfaction across 2 studies showed no difference in effect. There were no data on method switching to support the analysis.

conclusionsCurrent evidence suggests, with low certainty, that adjunct TECC, when delivered alongside in-person care, shows little to no effect on contraceptive use compared with in-person care. For use at 12 months, method choice, LARC use, and satisfaction compared with in-person care, the evidence is very uncertain. Future research should prioritize adequately powered evaluations of standalone models and assess how tailoring, timing, and delivery influence effectiveness, including long-term use and method switching.