- Based on 16 studies, outcomes of telehealth interventions compared with in-person or usual care were generally similar for adolescent and adult women presenting for contraceptive care (screening, counseling, provision, followup care) or receiving services for screening, evaluation, or treatment of interpersonal violence (IPV).
- Two studies demonstrated that telehealth was either better or worse than usual care for contraceptive care or IPV services; the remaining 14 studies showed no differences in effectiveness.
- Compared with usual care alone, telehealth interventions to supplement in-person care resulted in similar rates as comparators for contraceptive use (oral contraception, condoms, or long-acting reversible contraception) at 6 months, sexually transmitted infection (STI), and pregnancy (all low strength of evidence[SOE]); impact on abortion rates was unclear (insufficient SOE).
- Compared with usual care, telehealth interventions for IPV services resulted in similar rates of repeat IPV, depression, fear of partner, coercive control, self-efficacy, post-traumatic stress disorder, and safety behaviors (low SOE), and unclear evidence on harms (insufficient SOE).
- No studies evaluated telehealth services for family planning or STI counseling.
- Three studies indicated the COVID-19 pandemic increased telehealth utilization.
- Studies did not adequately evaluate factors related to access, health equity, or potential harms of telehealth.
Objectives. To evaluate the effectiveness, use, and implementation of telehealth for women’s preventive services for reproductive healthcare 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, 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 2 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, post-traumatic 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 healthcare.
Cantor AG, Nelson HD, Pappas M. et al. Telehealth for Women’s Preventive Services for Reproductive Health and Intimate Partner Violence: a Comparative Effectiveness Review. J Gen Intern Med. 17 Jan 2023. [Epub ahead of print.] https://doi.org/10.1007/s11606-023-08033-6.
Cantor A, Nelson HD, Pappas M, Atchison C, Hatch B, Huguet N, Flynn B, McDonagh M. Effectiveness of Telehealth for Women’s Preventive Services. Comparative Effectiveness Review No. 256. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 75Q80120D00006.) AHRQ Publication No. 22-EHC024. Rockville, MD: Agency for Healthcare Research and Quality; June 2022. DOI: https://doi.org/10.23970/AHRQEPCCER256. Posted final reports are located on the Effective Health Care Program search page.