Mindfulness-Based Intervention For Nurses In AIDS Care In China: A Pilot Study.

Background/purpose:Workplace stress among nurses providing care for people living with human immunodeficiency virus is a serious problem in China that may increase rates of job burnout and affect quality of care. Mindfulness-based intervention has been shown to be effective in relieving stress and burnout in nurses. Therefore, we designed a mixed-method pilot study to evaluate a mindfulness-based intervention for nurses providing care for people living with human immunodeficiency virus. Methods:Twenty nurses caring for people living with human immunodeficiency virus in the First Hospital of Changsha, China participated in a mindfulness-based intervention for 2 hr sessions weekly for 6 weeks. The Perceived Stress Scale, Maslach Burnout Inventory, Five Facets Mindfulness Questionnaire, State-Trait Anxiety Inventory, and the Beck Depression Inventory were used to collect data before and after the mindfulness-based intervention. Participants were invited to attend an in-depth interview 1 week after the end of the mindfulness-based intervention to give feedback. Results:The quantitative analyses revealed a significant change in Five Facets Mindfulness Questionnaire scores. There were no significant differences between pre- and post-intervention measures of any other variables. Qualitative results showed nurses experienced a decrease in work and daily life pressures; improvements in communications with patients, colleagues and families, with better regulation of negative emotions, and acceptance of other people and attention. Conclusion:This study supports the acceptability and potential benefits of the mindfulness-based intervention in helping nurses caring for people living with human immunodeficiency virus to manage stress and emotions, and improve their acceptance of others and attention. A larger study with a randomized controlled trial design is warranted to confirm the effectiveness of this mindfulness-based intervention

Associations of Partner Support and Acculturation With Physical Activity in Mexican American Women.

IntroductionInsufficient physical activity (PA) and obesity-related health conditions have reached epidemic proportions worldwide. Mexican American women (MAW) report low leisure time physical activity. Few studies examine activities beyond leisure time. Qualitative research suggests that partner support influence provides a cultural approach relevant to PA among MAW.MethodThis cross-sectional study used an ecological model to investigate community (the physical environment), interpersonal (partner support, attitudinal familism), and intrapersonal (age, health conditions, acculturation, employment, and body mass index) factors associated with PA among 112 MAW. Community-based participatory research recommendations guided the preparatory phase of the study and the face-to-face interviews. Frequencies and descriptive statistics were computed. Multivariable linear regression analyses were used to examine associations between study variables.ResultsModerate to high PA levels were found based on combined activities performed during leisure time, transportation, household tasks, and occupational duties. Women with greater partner support reported higher PA levels. Although acculturation levels were low among women, those with higher acculturation were found to be more physically active.ConclusionsFuture studies should examine strategies to increase partner support and address acculturation within intervention programs to enhance overall PA among MAW

Nursing Care for Pregnant Adolescents

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73476/1/0884217503252191.pd

Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes

Background: While maternal, infant and under-five child mortality rates in developing countries have declined significantly in the past two to three decades, newborn mortality rates have reduced much more slowly. While it is recognised that almost half of the newborn deaths can be prevented by scaling up evidence-based available interventions such as tetanus toxoid immunisation to mothers, clean and skilled care at delivery, newborn resuscitation, exclusive breastfeeding, clean umbilical cord care, management of infections in newborns, many require facility based and outreach services. It has also been stated that a significant proportion of these mortalities and morbidities could also be potentially addressed by developing community-based packages interventions which should also be supplemented by developing and strengthening linkages with the local health systems. Some of the recent community-based studies of interventions targeting women of reproductive age have shown variable impacts on maternal outcomes and hence it is uncertain if these strategies have consistent benefit across the continuum of maternal and newborn care.Objectives: To assess the effectiveness of community-based intervention packages in reducing maternal and neonatal morbidity and mortality, and improving neonatal outcomes.Search strategy: We searched The Cochrane Pregnancy and Childbirth Group\u27s Trials Register (January 2010), World Bank\u27s JOLIS (12 January 2010), BLDS at IDS and IDEAS database of unpublished working papers (12 January 2010), Google and Google Scholar (12 January 2010). Selection criteria: All prospective randomised and quasi-experimental trials evaluating the effectiveness of community-based intervention packages in reducing maternal and neonatal mortality and morbidities, and improving neonatal outcomes.Data collection and analysis: Two review authors independently assessed trial quality and extracted the data.Main results:The review included 18 cluster-randomised/quasi-randomised trials, covering a wide range of interventional packages, including two subsets from one trial. We incorporated data from these trials using generic inverse variance method in which logarithms of risk ratio estimates were used along with the standard error of the logarithms of risk ratio estimates. Our review did not show any reduction in maternal mortality (risk ratio (RR) 0.77, 95% confidence interval (CI) 0.59 to 1.02, random-effects (10 studies, n = 144,956), I(2) 39%, P value 0.10. However, significant reduction was observed in maternal morbidity (RR 0.75, 95% CI 0.61 to 0.92, random-effects (four studies, n = 138,290), I(2) 28%, neonatal mortality (RR 0.76, 95% CI 0.68 to 0.84, random-effects (12 studies, n = 136,425), I(2) 69%, P value \u3c 0.001), stillbirths (RR 0.84, 95% CI 0.74 to 0.97, random-effects (11studies, n = 113,821), I(2) 66%, P value 0.001) and perinatal mortality (RR 0.80, 95% CI 0.71 to 0.91, random-effects (10 studies, n = 110,291), I(2) 82%, P value \u3c 0.001) as a consequence of implementation of community-based interventional care packages. It also increased the referrals to health facility for pregnancy related complication by 40% (RR 1.40, 95% CI 1.19 to 1.65, fixed-effect (two studies, n = 22,800), I(2) 0%, P value 0.76), and improved the rates of early breastfeeding by 94% (RR 1.94, 95% CI 1.56 to 2.42, random-effects (six studies, n = 20,627), I(2) 97%, P value \u3c 0.001). We assessed our primary outcomes for publication bias, but observed no such asymmetry on the funnel plot.Authors\u27Conclusion:Our review offers encouraging evidence of the value of integrating maternal and newborn care in community settings through a range of interventions which can be packaged effectively for delivery through a range of community health workers and health promotion groups. While the importance of skilled delivery and facility-based services for maternal and newborn care cannot be denied, there is sufficient evidence to scale up community-based care through packages which can be delivered by a range of community-based workers

Comparison of life quality of pregnant adolescents with that of pregnant adults in Turkey

Objectives. This study aimed to determine the quality of life of pregnant adolescents aged < 20 years and pregnant adults aged between 20-29 years, to evaluate the effects of gestational periods on the quality of life, and to compare the quality of life scores of pregnant adolescents and adults

Postpartum Bonding Difficulties And Adult Attachment Styles: The Mediating Role Of Postpartum Depression And Childbirth‐Related Ptsd

Despite decades of research demonstrating the role of adult attachment styles and early motherâ infant bonding in parenting behaviors and maternal mental health, these constructs have seldom been studied together. The present study aimed to investigate the relationship between attachment styles and specific bonding difficulties of mothers. In addition, as postpartum depression and childbirthâ related posttraumatic stress symptoms have been associated with both constructs, we explored their possible mediation effect. One hundred fourteen mothers, 4 to 12 weeksâ postpartum, completed a demographic questionnaire, the Adult Attachment Style Questionnaire (M. Mikulincer, V. Florian, & A. Tolmacz, 1990), the Postpartum Bonding Questionnaire (L.F. Brockington, C. Fraser, & D. Wilson, 2006), the Modified Perinatal Posttraumatic Stress Disorder Questionnaire (J.L. Callahan, S.E. Borja, & M.T. Hynan, 2006), and the Edinburgh Postnatal Depression Scale (J.L. Cox, G. Chapman, D. Murray, & P. Jones, 1996), using an online survey system. As predicted, insecure attachment styles were associated with bonding difficulties wherein anxious/ambivalent attachment was associated with greater infantâ focused anxiety, mediated by postpartum depression but not childbirthâ related PTSD symptoms. In contrast, greater avoidant attachment style was associated with greater rejection and anger, mediated by childbirthâ related posttraumatic stress disorder (PTSD), but not depression symptoms. The current study confirmed the association of different attachment styles with bonding as well as the mediating roles of childbirthâ related PTSD and postpartum depression symptoms. Future psychological interventions may utilize such evidence to target interventions for bonding disorders in accordance with individual differences.RESUMENA pesar de las décadas de investigación demostrando el papel de los estilos de afectividad adulta y la temprana unión afectiva madreâ infante en los comportamientos de crianza y la salud mental materna, estos conceptos han sido poco estudiados en conjunto. El presente estudio se propuso investigar la relación entre los estilos de afectividad y las específicas dificultades de unión afectiva de las madres. Adicionalmente, ya que la depresión posterior al parto y los síntomas de estrés postraumático relacionados con dar a luz han sido asociados con ambos conceptos, exploramos su posible efecto de mediación. 113 madres completaron, entre 4 y 12 semanas después del parto, un cuestionario demográfico, el Cuestionario del Estilo de Afectividad Adulta (AAQ), el Cuestionario de Unión Posterior al Parto (PBQ), el Cuestionario Modificado del Trastorno de Estrés Postraumático Perinatal (mPPQ), y la Escala de Edimburgo de Depresión Postnatal, usando un sistema de encuesta electrónico. Tal como se predijo, los estilos de afectividad inseguros fueron asociados con las dificultades de unión afectiva, donde la afectividad ansiosa/ambivalente se asoció con una mayor ansiedad enfocada en el infante, mediada por la depresión posterior al parto pero no así por los síntomas PTSD relacionados con dar a luz. En contraste, un mayor estilo de ocultar o evitar la afectividad se asoció con mayor rechazo e ira, mediado por PTSD relacionado con dar a luz pero no así por los síntomas de depresión. El presente estudio confirmó la asociación de diferentes estilos de afectividad con la unión afectiva así como también los papeles de mediación de síntomas PTSD relacionados con dar a luz y los de depresión posterior al parto. Futuras intervenciones sicológicas pudieran utilizar tal evidencia para dirigir intervenciones para trastornos de unión afectiva de acuerdo con diferencias individuales.Rà SUMà En dépit de dizaines d’années de recherches démontrant le rôle des styles de l’attachement adulte et du lien précoce mèreâ bébé dans les comportements de parentage et la santé mentale maternelle, ceuxâ ci ont rarement été étudiés ensemble. Cette étude s’est donné pour but dâ étudier la relation entre les styles d’attachement et les difficultés spécifier à se lier des mères. De plus puisque la dépression postpartum et les symptômes de stress postâ traumatique liés à l’accouchement ont été aussi liés à ces éléments, nous avons exploré leur effet de médiation possible. 113 mères à 4â 12 semaines postpartum ont rempli un questionnaire démographique, le Questionnaire de Style de l’Attachement Adulte, le Questionnaire de Lien Postpartum, le Questionnaire Modifié de Trouble de Stress Périnatal Postâ traumatique, et l’Echelle de Dépression Postnatale d’Edinbourg, en utilisant un système d’enquête en ligne. Comme on l’avait prédit, les styles d’attachement insécures étaient liés à des difficultés à se lier, alors que l’attachement anxieux/ambivalent était lié à une anxiété plus importante, centrée sur le bébé, médiées par la dépression postpartum mais pas par les symptômes liés au TSPT de l’accouchement. En revanche les styles d’attachement le plus évitant étaient liés à un plus grand rejet et à une colère plus importante, médiés par le TSPT lié à l’accouchement mais pas aux symptômes de dépression. Cette étude a confirmé le lien entre différents styles d’attachement et le lien affectif ainsi que les rôles de médiation du TSPT lié à l’accouchement et des symptômes de dépression postpartum. Les interventions psychologiques à venir pourraient utiliser ces résultats afin de cibler des intervention pour les troubles du lien affectif en fonctions des différences individuelles.ZUSAMMENFASSUNGAuch wenn in jahrzehntelanger Forschungsarbeit die Zusammenhänge von erwachsenen Bindungsstilen und frühem Mutterâ Kindâ Bonding mit dem Elternverhalten und der psychischen Gesundheit von Müttern demonstriert werden konnten, wurden diese Konstrukte selten gemeinsam untersucht. Ziel der vorliegenden Studie war es, den Zusammenhang zwischen Bindungsstilen und spezifischen Bindungsschwierigkeiten von Müttern zu untersuchen. Darüber hinaus wurden postpartale Depression und geburtsbedingte posttraumatische Stresssymptome bereits mit beiden Konstrukten in Verbindung gebracht, so dass wir zusätzlich diese potentiellen Mediationseffekte erforschten. 113 Mütter füllten 4â 12 Wochen nach der Geburt mithilfe eines Onlineâ Umfragesystems einen demografischen Fragebogen, den â Adult Attachment Style Questionnaireâ (AAQ), den â Postpartum Bonding Questionnaireâ (PBQ), den â Modified Perinatal Posttraumatic Stress Disorder Questionnaireâ (mPPQ) und die â Edinburgh Postnatal Depression Scaleâ (EPDS) aus. Wie vorhergesagt, wurden unsichere Bindungsstile mit Bindungsschwierigkeiten in Verbindung gebracht, wobei die ängstliche/ambivalente Bindung mit einer gröà eren, auf den Säugling bezogenen Angst assoziiert wurde, die durch postpartale Depression, aber nicht durch geburtsbedingte PTBSâ Symptome mediiert wurde. Im Gegensatz dazu wurde ein stärker vermeidender Bindungsstil mit gröà erer Ablehnung und Wut assoziiert und durch geburtsbedingte PTBS, aber nicht durch Depressionssymptome mediiert. Die aktuelle Studie bestätigte die Assoziation verschiedener Bindungsstile mit Bonding sowie die mediierenden Rollen von geburtsbedingter PTBS und postpartalen Depressionssymptomen. 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Ø¨Ø§Ù Ø§Ø¶Ø§Ù Ù Ø¥Ù Ù Ø°Ù Ù Ø Ø¨Ù Ø§ ا٠ا٠ا٠تئاب بعد ا٠٠٠ادة ٠ا٠اعراض ا٠٠تص٠ة با٠إج٠اد ا٠٠اح٠٠٠صد٠ة ا٠٠٠س٠ة ٠د ارتبطا ب٠ذ٠ا٠أ٠٠اط Ø Ù Ù Ø¯ ٠ا٠ت ا٠دراسة ا٠حا٠٠ة ببحث ا٠آثار ا٠٠س٠طة ا٠٠حت٠٠ة ٠٠ذ٠ا٠٠تغ٠رات. است٠٠٠113 ٠٠ا٠أ٠٠ات (4â 12 أسب٠ع بعد ا٠٠ضع) استب٠ا٠ا د٠٠٠غرا٠٠ا Ø Ù Ø§Ø³ØªØ¨Ù Ø§Ù Ø£Ù Ù Ø§Ø· ا٠تع٠٠ع٠د ا٠با٠غ٠٠(AAQ) Ø Ù Ø§Ø³ØªØ¨Ù Ø§Ù ØªÙ Ù Ù Ù Ø§Ù Ø§Ø±ØªØ¨Ø§Ø· بعد ا٠٠٠ادة (PBQ) Ø Ù Ø§Ù Ø§Ø³ØªØ¨Ù Ø§Ù Ø§Ù Ù Ø¹Ø¯Ù Ù Ø§Ø¶Ø·Ø±Ø§Ø¨ ا٠إج٠اد ا٠عصب٠٠٠صد٠ة ا٠٠اح٠ة ٠٠٠٠ادة (mPPQ) Ø Ù Ù Ù Ù Ø§Ø³ أد٠برة ٠ا٠تئاب ٠ا بعد ا٠٠٠ادة ((EPDSØ Ø¨Ø§Ø³ØªØ®Ø¯Ø§Ù Ø§Ø³ØªØ¨Ù Ø§Ù Ø¹Ù Ù Ø§Ù Ø¥Ù ØªØ±Ù Øª. ٠جاءت ا٠٠تائج ٠٠إطار ا٠ت٠٠عات Ø­Ù Ø« ارتبطت أ٠٠اط ا٠تع٠٠ا٠غ٠ر ا٠آ٠٠بصع٠بات ت٠٠٠٠ا٠ارتباط Ø Ø¨Ù Ù Ù Ø§ ارتبط ا٠تع٠٠ا٠٠٠٠â ا٠٠زد٠ج ب٠سبة أ٠بر ٠٠ا٠ت٠تر ا٠٠ر٠ز ع٠٠ا٠ط٠٠٠ت٠سط ٠ذ٠ا٠ع٠ا٠ة ا٠ا٠تئاب بعد ا٠٠٠ادة ٠٠٠٠٠٠س ا٠اعراض ا٠٠رتبطة با٠صد٠ات (PTSD). ٠ع٠٠ا٠٠٠٠ض Ù Ù Ø°Ù Ù Ø Ø§Ø±ØªØ¨Ø· أس٠٠ب ا٠تع٠٠ا٠تج٠ب٠با٠٠ز٠د ٠٠ا٠ر٠ض ٠ا٠غضب Ø Ù ØªÙ Ø³Ø· ٠ذ٠ا٠ع٠ا٠ة ا٠أعراض ا٠٠رتبطة با٠صد٠ات ٠٠٠٠٠٠س أعراض ا٠ا٠تئاب. ٠أ٠دت ا٠دراسة ا٠حا٠٠ة ع٠٠ارتباط أ٠٠اط ا٠تع٠٠ا٠٠خت٠٠ة بت٠٠٠٠ا٠ارتباط ٠٠ذ٠٠ا٠أد٠ار ا٠٠س٠طة ٠٠اضطرابات ا٠٠اح٠ة ٠٠صد٠ات ٠اعراض ا٠ا٠تئاب بعد ا٠٠٠ادة. ٠٠د تستخد٠ا٠تدخ٠ات ا٠٠٠سا٠٠ة ٠٠ا٠٠ست٠ب٠٠ذ٠ا٠اد٠٠٠است٠دا٠ا٠تدخ٠ات ا٠خاصة باضطرابات ت٠٠٠٠ا٠ارتباط ٠٠٠ا ٠٠اخت٠ا٠ات ا٠٠رد٠ة.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142928/1/imhj21695_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142928/2/imhj21695.pd

Reducing repeat pregnancies in adolescence: applying realist principles as part of a mixed-methods systematic review to explore what works, for whom, how and under what circumstances

BACKGROUND: Previous research has demonstrated emotional, psychological and educational harm to young mothers following unintended conceptions. The UK has one of the highest rates of pregnancies in adolescence in Western Europe with a high proportion of these being repeat pregnancies, making it a topic of interest for public health policy makers, and health and social care practitioners. As part of a wider mixed-methods systematic review, realist principles were applied to synthesise evidence about interventions aiming to reduce repeat pregnancies in adolescence.METHODS: A multi-streamed, mixed-methods systematic review was conducted searching 11 major electronic databases and 9 additional databases from 1995 onwards, using key terms such as pregnancy, teen or adolescent. The principles of realist synthesis were applied to all included literature to uncover theories about what works, for whom, how and in what context. Initial theory areas were developed through evidence scoping, group discussion by the authors and stakeholder engagement to uncover context + mechanism = outcome (CMO) configurations and related narratives.RESULTS: The searches identified 8,664 documents initially, and 403 in repeat searches, filtering to 81 included studies, including qualitative studies, randomised controlled trials, quantitative studies and grey literature. Three CMO configurations were developed. The individual experiences of young mothers' triggered self-efficacy, notions of perceived risks, susceptibility and benefits of pregnancy, resulting in the adolescent taking control of their fertility and sexual encounters. The choice between motherhood and other goals triggered notions of motivations, resulting in the adolescent managing their expectations of motherhood and controlling their fertility and sexual encounters. Barriers and facilitators to accessing services triggered notions of connectedness and self-determination; resulting in interventions that are tailored so they are relevant to young persons, and improve access to services and engagement with the issue of pregnancy in adolescence.CONCLUSIONS: Pregnancy in adolescence is a complex issue with many factors to consider. The conceptual platform described here could help guide policy makers and professionals towards a number of areas that need to be attended to in order to increase the likelihood of an intervention working to prevent rapid repeat pregnancy in adolescence.TRIAL REGISTRATION: PROSPERO CRD42012003168

Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, and qualitative and realist synthesis of implementation factors and user engagement

Background The UK has one of the highest rates of teenage pregnancies in Western Europe. One-fifth of these are repeat pregnancies. Unintended conceptions can cause substantial emotional, psychological and educational harm to teenagers, often with enduring implications for life chances. Babies of teenage mothers have increased mortality and are at a significantly increased risk of poverty, educational underachievement and unemployment later in life, with associated costs to society. It is important to identify effective, cost-effective and acceptable interventions. Objectives To identify who is at the greatest risk of repeat unintended pregnancies; which interventions are effective and cost-effective; and what the barriers to and facilitators of the uptake of these interventions are. Data sources We conducted a multistreamed, mixed-methods systematic review informed by service user and provider consultation to examine worldwide peer-reviewed evidence and UK-generated grey literature to find and evaluate interventions to reduce repeat unintended teenage pregnancies. We searched the following electronic databases: MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and the Health Technology Assessment Database), EMBASE (Excerpta Medica database), British Nursing Index, Educational Resources Information Center, Sociological Abstracts, Applied Social Sciences Index and Abstracts, BiblioMap (the Evidence for Policy and Practice Information and Co-ordinating Centre register of health promotion and public health research), Social Sciences Citation Index (supported by Web of Knowledge), Research Papers in Economics, EconLit (American Economic Association’s electronic bibliography), OpenGrey, Scopus, Scirus, Social Care Online, National Research Register, National Institute for Health Research Clinical Research Network Portfolio and Index to THESES. Searches were conducted in May 2013 and updated in June 2014. In addition, we conducted a systematic search of Google (Google Inc., Mountain View, CA, USA) in January 2014. Database searches were guided by an advisory group of stakeholders. Review methods To address the topic’s complexities, we used a structured, innovative and iterative approach combining methods tailored to each evidence stream. Quantitative data (effectiveness, cost-effectiveness, risk factors and effect modifiers) were synthesised with reference to Cochrane guidelines for evaluating evidence on public health interventions. Qualitative evidence addressing facilitators of and barriers to the uptake of interventions, experience and acceptability of interventions was synthesised thematically. We applied the principles of realist synthesis to uncover theories and mechanisms underpinning interventions (what works, for whom and in what context). Finally, we conducted an overarching narrative of synthesis of evidence and gathered service user feedback. Results We identified 8664 documents initially, and 816 in repeat searches. We filtered these to 12 randomised controlled trials (RCTs), four quasi-RCTs, 10 qualitative studies and 53 other quantitative studies published between 1996 and 2012. None of the RCTs was based in the UK. The RCTs evaluated an emergency contraception programme and psychosocial interventions. We found no evidence for effectiveness with regard to condom use, contraceptive use or rates of unprotected sex or use of birth control. Our primary outcome was repeat conception rate: the event rate was 132 of 308 (43%) in the intervention group versus 140 of 289 (48%) for the control goup, with a non-significant risk ratio (RR) of 0.92 [95% confidence interval (CI) 0.78 to 1.08]. Four studies reported subsequent birth rates: 29 of 237 (12%) events for the intervention arm versus 46 out of 224 (21%) for the control arm, with a RR of 0.60 (95% CI 0.39 to 0.93). Many repeat conceptions occurred in the context of poverty, low expectations and aspirations, and negligible opportunities. Service user feedback suggested that there were specific motivations for many repeat conceptions, for example to replace loss or to please a partner. Realist synthesis highlighted that context, motivation, planning for the future and letting young women take control with connectedness and tailoring provide a conceptual framework for future research. Limitations Included studies rarely characterised adolescent pregnancy as intended or unintended, that is interventions to reduce repeat conceptions rarely addressed whether or not pregnancies were intended. Furthermore, interventions were often not clearly defined, had multiple aims and did not indicate which elements were intended to address which aims. Nearly all of the studies were conducted in the USA and focused largely on African American or Hispanic and Latina American populations. Conclusions We found no evidence to indicate that existing interventions to reduce repeat teenage pregnancy were effective; however, subsequent births were reduced by home-based interventions. Qualitative and realist evidence helped to explain gaps in intervention design that should be addressed. More theory-based, rigorously evaluated programmes need to be developed to reduce repeat teenage pregnancy in the UK. Study registration This study is registered as PROSPERO CRD42012003168. Cochrane registration number: i=fertility/0068. Funding The National Institute for Health Research Health Technology Assessment programme