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Intervention Review

Theory-based interventions for contraception

  1. Laureen M Lopez1,*,
  2. Elizabeth E. Tolley1,
  3. David A Grimes1,
  4. Mario Chen-Mok2

Editorial Group: Cochrane Fertility Regulation Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 16 APR 2008

DOI: 10.1002/14651858.CD007249.pub2


How to Cite

Lopez LM, Tolley EE, Grimes DA, Chen-Mok M. Theory-based interventions for contraception. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD007249. DOI: 10.1002/14651858.CD007249.pub2.

Author Information

  1. 1

    Family Health International, Behavioral and Biomedical Research, Research Triangle Park, North Carolina, USA

  2. 2

    Family Health International, Division of Biostatistics, Research Triangle Park, North Carolina, USA

*Laureen M Lopez, Behavioral and Biomedical Research, Family Health International, P.O. Box 13950, Research Triangle Park, North Carolina, 27709, USA. llopez@fhi.org.

Publication History

  1. Publication Status: New
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

The explicit use of theory in research helps expand the knowledge base. Theories and models have been used extensively in HIV-prevention research and in interventions for preventing sexually transmitted infections (STIs). The health behavior field uses many theories or models of change. However, educational interventions addressing contraception often have no stated theoretical base.

Objectives

Review randomized controlled trials that tested a theoretical approach to inform contraceptive choice; encourage contraceptive use; or promote adherence to, or continuation of, a contraceptive regimen.

Search strategy

We searched computerized databases for trials that tested a theory-based intervention for improving contraceptive use (MEDLINE, POPLINE, CENTRAL, PsycINFO, EMBASE, ClinicalTrials.gov, and ICTRP). We also wrote to researchers to find other trials.

Selection criteria

Trials tested a theory-based intervention for improving contraceptive use. We excluded trials focused on high-risk groups. Interventions addressed the use of one or more contraceptive methods. The reports provided evidence that the intervention was based on a specific theory or model. The primary outcomes were pregnancy, contraceptive choice, initiating or changing contraceptive use, contraceptive regimen adherence, and contraception continuation.

Data collection and analysis

The primary author evaluated abstracts for eligibility. Two authors extracted data from included studies. We calculated the odds ratio for dichotomous outcomes and the mean difference for continuous data. No meta-analysis was conducted due to intervention differences.

Main results

Of 26 trials, 12 interventions addressed contraception (other than condoms), while 14 focused on condom use for preventing HIV or STIs. In 2 of 10 trials with pregnancy or birth data, a theory-based group showed better results. Four of nine trials with contraceptive use (other than condoms) showed better outcomes in an experimental group. For condom use, a theory-based group had favorable results in 14 of 20 trials, but the number was halved in a subgroup analysis. Social Cognitive Theory was the main theoretical basis for 12 trials, and 10 showed positive results. Of the other 14 trials, favorable results were shown for other social cognition models (N=2), motivational interviewing (N=5), and the AIDS Risk Reduction Model (N=2). No major patterns were detected by type of theory, intervention, or target population.

Authors' conclusions

Family planning researchers and practitioners could apply the relevant theories and effective interventions from HIV and STI prevention. More thorough use of single theories would help inform the field about what works. Better reporting is needed on research design and intervention implementation.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Improving birth control with programs based on theory

Theories and models help explain how behavior change occurs. HIV-prevention research has used theories and models. Programs to prevent sexually transmitted infections (STIs) are often based on behavioral science. The health field has used many theories and models of change. However, programs that address birth control often have no stated theory base.

We did computer searches to find randomized controlled trials that tested a theory-based program to improve birth control use (MEDLINE, POPLINE, CENTRAL, PsycINFO, EMBASE, ClinicalTrials.gov, and ICTRP). We also wrote to researchers to find other trials.

Trials tested a theory-based program for improving birth control use. We excluded trials focused on high-risk groups. Programs addressed the use of one or more birth control methods. The reports showed that the theory or model was part of the program design. The comparison could be usual care, another program based on theory, or no intervention.

The main outcomes were pregnancy, choice of birth control method, change in birth control use, and continuing to use birth control. We did not combine any trials since the programs studied were different from each other.

Of 26 trials, 12 interventions addressed using birth control (other than condoms) or preventing pregnancy. Fourteen focused on condom use to prevent HIV or STIs. Two of 10 trials with pregnancy or birth data showed better results for a theory-based group. Four of nine trials with birth control use (other than condoms) also showed better outcomes in a treatment group. For condom use, a theory-based group had better results in 14 of 20 trials. The number was halved in a subgroup analysis. Social Cognitive Theory was the main basis for 12 trials, of which 10 showed positive results. Of the other 14 trials, favorable results were shown for 9: other social cognition models (N=2), motivational interviewing (N=5), and the AIDS Risk Reduction Model (N=2). We did not find that any theory or program had a greater effect than others on any specific outcome or group.

Health care providers might want to use the programs that worked in their clinics. Family planning researchers could test the theories and programs used in HIV and STI prevention. More thorough use of single theories would help inform the field about what works. Better reporting is needed on how the research was done and how the program was provided.