Reported evidence on the effectiveness of mass media interventions in increasing knowledge and use of family planning in low and middle-income countries: a systematic mixed methods review

BACKGROUND: An estimated 200 million women and girls in low and middle-income countries (LMICs) wish to delay, space or avoid becoming pregnant, yet are not using contraceptives. This study seeks to investigate the effectiveness of mass media interventions for increasing knowledge and use of contraceptives, and to identify barriers to program implementation. METHODS: Using a mixed-methods systematic approach, we searched five electronic databases using pre-determined search strategies and hand-searching of articles of any study design published from 1994 to 2017 of mass media interventions for family planning education. Two reviewers independently applied clearly defined eligibility criteria to the search results, quality appraisal, data extraction from published reports, and data analysis (using meta-analysis and thematic analysis) following PRISMA guidelines. RESULTS: We identified 59 eligible studies. Although the majority of studies suggest a positive association between media interventions and family planning outcomes, the pooled results are still consistent with possibly null intervention effects. The reported prevalence ratios (PR) for media interventions association with increased contraceptive knowledge range from 0.97 to 1.41, while the PRs for contraceptive use range from 0.54 to 3.23. The qualitative analysis indicates that there are barriers to contraceptive uptake at the level of individual knowledge (including demographic factors and preconceived notions), access (including issues relating to mobility and financing), and programming (including lack of participatory approaches). CONCLUSIONS: There is a need for rigorous impact evaluation, including randomised controlled trials, of mass media interventions on knowledge and uptake of family planning in LMIC settings. Interventions should be better tailored to cultural and socio-demographic characteristics of the target populations, while access to resources should continue to remain a priority and be improved, where possible.