Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 4 appraisals
JMIR formative research
Development of a User-Informed Decision Aid for Contraceptive Decision-Making Among Adolescents and Young Adults: Qualitative Study
BACKGROUND: Adolescents and young adults seeking contraceptive care face many considerations related to differences in contraceptive indications and knowledge, which are often overlooked and can lead to contraceptive nonadherence or nonuse as well as adverse health outcomes. OBJECTIVE: This study aimed to develop a digital decision aid that meets the contraceptive decisional needs of adolescents and young adults from diverse backgrounds. METHODS: We developed a web-based decision aid using a user-centered design framework and the International Patient Decision Aid Standards. The design and development process was informed by a literature review and consultations with scientific experts, health informatics specialists, clinicians experienced in adolescent reproductive health, and a diverse group of adolescent and young adult advisors. We gathered feedback on the decision aid's content and functionality from clinicians, adolescents, and young adult stakeholders during focus group interviews conducted across 2 user testing cycles. Each focus group was recorded and transcribed, and the data were analyzed using a focus group guide to identify key attributes, patterns, and perspectives among users. Two qualitative researchers used rapid qualitative analysis to explore and summarize findings across 4 key domains, which contributed to the refinement of the decision aid content and the improvement of its functionality. RESULTS: Twenty-four clinicians, adolescents, and young adult participants from diverse backgrounds shared their perspectives on the decision aid's content, relevance, design, and usability across 2 user testing cycles conducted from February 2023 to June 2024. The decision aid includes a survey, a decision algorithm that generates a summary of contraceptive method recommendations, infographics, and a health care provider summary view. The decision algorithm applies a weighted scoring system ranging from +1 or -1 to +10 or -10 for each method, reflecting the user's primary indication for seeking contraception, contraceptive use preferences, and relevant health history. CONCLUSIONS: This approach allowed us to capture rich perspectives from a diverse group of stakeholders that accounted for the unique contraceptive decision-making needs of adolescents and young adults, resulting in a functional, youth-informed decision aid prototype, MyPlanMyChoice, ready for pilot and feasibility evaluation in a clinical setting.
22 July 2026
Read appraisal →Advanced drug delivery reviews
Artificial intelligence and machine learning in smart vaginal formulation development
Vaginal drug delivery in women's health remains underutilized and insufficiently studied, largely due to the complexity and dynamic nature of the vaginal microenvironment. Variations in vaginal pH, hormonal levels, and microbiota composition introduce significant biological variability, complicating formulation design and contributing to inconsistent therapeutic outcomes and poor patient adherence. Conventional vaginal formulations often fail to account for these individual differences, highlighting the need for more adaptive and predictive approaches. Emerging advances in artificial intelligence (AI) and machine learning (ML) offer promising strategies to address these challenges by enabling multi-parameter, data-driven formulation development that explicitly considers biological variability. Despite their transformative potential, the application of AI and ML in vaginal drug delivery remains limited. This review addresses this gap by examining the emerging role of AI/ML in the design, optimization, and development of next-generation vaginal formulations, including mucoadhesive, mucus-penetrating, bio-responsive, and controlled-release systems. Key factors influencing formulation performance, such as vaginal microbiota composition, are discussed, and ethical, regulatory, and technical challenges relevant to integrating AI/ML into vaginal drug delivery are also considered. Although research is in its early stages, existing studies indicate that AI and ML integration can enhance predictability, efficiency, and reproducibility in vaginal formulation development. Finally, we highlight the potential of developing personalized medicines through the integration of AI/ML and digital health monitoring devices to create patient-centered vaginal drug delivery systems, thereby advancing therapeutic outcomes and transforming women's health.
1 July 2026
Read appraisal →African journal of reproductive health
A systematic review of unintended pregnancy among adolescents living with HIV in Africa
Adolescent pregnancy remains a significant public health concern across Africa, with Eastern and Southern regions experiencing the highest burden. Among adolescents living with HIV(ALHIV), the challenge is intensified by socio-economic, cultural, and healthcare factors that increase vulnerability to unintended pregnancy. This systematic review examined the prevalence of unplanned pregnancy and associated factors among adolescents living with HIV in Africa. Following PRISMA guidelines and registered in PROSPERO (CRD42024564479), a search of Medline, EMBASE, and CINAHL identified relevant studies published between 2011 and 2023. Of the 550 retrieved articles, only three met the inclusion criteria. Reported prevalence rates varied widely, ranging from 18.8% in South Africa to 60.0% and 73.9% in Kenya, indicating a substantial and uneven burden across settings. Factors associated with unintended pregnancy included involvement with boyfriends or acquaintances rather than spouses, reflecting limited agency and structural vulnerabilities. Documented adverse outcomes included miscarriage, stillbirth, and abortion, although one study did not specify outcomes. Overall, the review highlights persistently high rates of unplanned pregnancy among adolescents living with HIV and underscores the need to integrate sexual and reproductive health services into HIV care, address stigma, and strengthen context-specific interventions. Les grossesses adolescentes demeurent un problème majeur de santé publique en Afrique, les régions de l'Est et du Sud étant les plus touchées. Chez les adolescentes vivant avec le VIH (AVVIH), ce défi est exacerbé par des facteurs socio-économiques, culturels et liés aux soins de santé qui accroissent leur vulnérabilité aux grossesses non désirées. Cette revue systématique a examiné la prévalence des grossesses non planifiées et les facteurs associés chez les adolescentes vivant avec le VIH en Afrique. Conformément aux directives PRISMA et enregistrée dans PROSPERO (CRD42024564479), une recherche dans Medline, EMBASE et CINAHL a permis d'identifier les études pertinentes publiées entre 2011 et 2023. Sur les 550 articles recensés, seuls trois répondaient aux critères d'inclusion. Les taux de prévalence rapportés variaient considérablement, allant de 18,8 % en Afrique du Sud à 60,0 % et 73,9 % au Kenya, ce qui témoigne d'une prévalence importante et inégale selon les contextes. Parmi les facteurs associés aux grossesses non désirées figurait le fait d'avoir des relations avec des petits amis ou des connaissances plutôt qu'avec des conjoints, reflétant un manque d'autonomie et des vulnérabilités structurelles. Les issues défavorables documentées incluaient les fausses couches, les mortinaissances et les avortements, bien qu'une étude n'ait pas précisé ces issues. Globalement, cette analyse met en évidence des taux toujours élevés de grossesses non désirées chez les adolescentes vivant avec le VIH et souligne la nécessité d'intégrer les services de santé sexuelle et reproductive aux soins du VIH, de lutter contre la stigmatisation et de renforcer les interventions adaptées au contexte.
28 June 2026
Read appraisal →BMJ global health
Transforming reproductive healthcare delivery through telemedicine services expansion: evidence from a mixed-methods pilot evaluation in rural Ghana
BACKGROUND: In 2021, Ghana's National Comprehensive Abortion Care Standards and Protocols recognised telemedicine as an approved delivery model for early medical abortion (EMA). Following a successful pilot in Accra, MSI Reproductive Choices Ghana expanded their telemedicine model to more rural areas and broadened their package of sexual and reproductive health (SRH) services to include fertility evaluation. This study evaluates the expanded model. METHODS: A mixed-methods evaluation (January 2024 to March 2025) drew on routine clinical data, courier and call centre tracking, client feedback surveys, and qualitative, individual in-depth interviews with telemedicine clients to assess clinical safety, service utilisation and user experience. Quantitative analysis included descriptive statistics and unadjusted logistic and ordinal regression. Qualitative interviews with clients explored feasibility, acceptability and implementation challenges. A deductive, thematic analysis was conducted with the support of Delve qualitative research software and guided by the Consolidated Framework for Implementation Research. RESULTS: A total of 2721 clients accessed telemedicine services, with 70.0% receiving EMA and 29.5% short-term contraceptive methods. Among EMA clients reached for follow-up, 96.9% reported complete abortion with no further intervention. Satisfaction was high: 89.4% would recommend the service, and 78.2% would use it again. Qualitative findings highlighted that clients valued privacy, convenience and autonomy, particularly in stigmatised or crowded spaces. Barriers to accessing services included unclear eligibility criteria, limited digital access and misperceptions that the service was for abortion only. Most clients contacted the service between 4 and 6 weeks' gestation. Post-abortion contraception uptake was 24.8%, with no significant variation by age or location. Nearly half of clients reported having no other way to access care. CONCLUSIONS: Telemedicine is a feasible, safe and acceptable model for SRH delivery in Ghana. Findings will inform national scale-up and strategies to strengthen equity, communication and service integration.
11 May 2026
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