Theory-based interventions for contraception

 

Abstract

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 (RCTs) that tested a theoretical approach to inform contraceptive choice; encourage contraceptive use; or promote adherence to, or continuation of, a contraceptive regimen.

Search methods

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 and preventing sexually transmitted infections or HIV. Interventions addressed the use of one or more contraceptive methods for contraception. 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. No meta-analysis was conducted due to intervention differences.

Main results

Fourteen RCTs met our inclusion criteria. In 2 of 10 trials with pregnancy or birth data, a theory-based group showed better results. Four of 10 trials with contraceptive use data (other than condoms) showed better outcomes in an experimental group. For condom use, a theory-based group had favorable results in three of eight trials. Social Cognitive Theory was the main theoretical basis for five trials, of which three showed positive results. Two based on other social cognition models had favorable results, as did two of four focused on motivational interviewing. Thirteen trials provided multiple sessions or contacts. Of seven effective interventions, five targeted adolescents, including four with group sessions. Three effective trials had individual sessions. Seven trials were rated as having high or moderate quality; three of those had favorable results.

Authors' conclusions

Family planning researchers and practitioners could adapt the effective interventions. Reproductive health needs high-quality research on behavior change, especially for clinical and low-resource settings. More thorough use of single theories would help, as would better reporting on research design and intervention implementation.

 

Plain language summary

Improving birth control use 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 and programs to prevent sexually transmitted infections or HIV. 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 differed from each other.

We found 14 trials. Two of 10 trials with pregnancy or birth data had better results for a theory-based group. Four of 10 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 three of eight trials. Social Cognitive Theory was the main basis for five trials, of which three showed positive results. Two based on other social cognition models had good results, as did two of four that used motivational interviewing. Thirteen of the 14 trials had several sessions or contacts. Of seven programs with good results, five focused on teenagers of which four had group sessions. Three trials with good results worked with one person at a time. Seven trials were rated as good quality; three of those worked well.

Health care providers might want to use the programs that worked in their settings. We still need good quality research on preventing pregnancy. Clearer use of single theories would help with seeing what works. Better reporting is needed on how the research was done and how the program was provided.

 

摘要

背景

以理論為基礎的避孕措施

將研究中的理論拿來應用可以增進知識。已經有一些理論跟模式被廣泛應用於HIV防治以及性病預防。健康行為科學應用了許多行為改變模式或理論。然而，教導避孕卻往往缺乏理論基礎。

目標

回顧關於下列主題的隨機對照試驗:以理論為基礎來介紹避孕方式，鼓勵避孕，或是倡導堅持某種避孕方法。

搜尋策略

我們在電腦化的資料庫(MEDLINE, POPLINE, CENTRAL, PsycINFO, EMBASE, ClinicalTrials.gov,和ICTRP)中，搜尋用來檢驗具學理基礎的干預行為去改善避孕方式的試驗。為了找到其他試驗，我們也寫信給學者。

選擇標準

我們選擇那些為了改善避孕效果，而去測試避孕學理的研究。排除針對高危險族群的試驗。研究中有說明該干預行為是一種或多種避孕方式，並且能證明該干預行為是基於某個理論或模式。研究的主要結果是懷孕、避孕方式的選擇、開始或改變避孕方式、避孕方法的忠誠度、以及持續避孕。

資料收集與分析

先由主要作者評估文獻摘要之資格，再由其他兩位作者從已選入的研究摘錄資料。我們針對二分類結果(dichotomous outcomes)計算其勝算比，連續性資料則計算其平均差。因為各試驗的干預行為皆不同，所以沒有做統合分析。

主要結論

在26個試驗中，有12個描述了避孕方式(非使用保險套)，其餘14個則專注於使用保險套來預防HIV或性病。在10個有懷孕或生產資料的試驗中，其中2個顯示有理論基礎的干預行為可以得到較好的結果。在9個有使用避孕措施(非保險套)的試驗中，有4個顯示操作組的結果較好。至於保險套避孕的效果，在20個試驗中，有14個試驗顯示有理論基礎的組別效果較好，但次群組分析(subgroup analysis)後，此數量減半。社會認知理論(Social Cognitive Theory)是12個試驗的基礎理論，其中10個也顯示正向結果。至於其他14個試驗，正向結果分別基於其他社會認知模式(N = 2)，動機訪談(motivational interviewing)(N = 5)，以及愛滋病風險降低模型(AIDS Risk Reduction Model)(N = 2)。至於理論類型、干預行為、或是目標人口，則沒有表現出什麼重大的模式。

作者結論

家庭計劃研究者以及臨床工作者可以借鏡防治HIV以及性病的相關理論和有效措施。徹底施行單一理論有助於分辨哪一個理論在該領域是可行的。更好的回報系統將有助於研究設計以及干預行為的執行。

翻譯人

本摘要由臺灣大學附設醫院陳芊彣翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

理論基礎方案促進節育:理論跟模式可以幫忙釐清行為改變是如何發生的。HIV防治研究已應用理論跟模式。性病防治方案通常都有行為科學為基礎。健康行為科學應用了許多行為改變模式及理論。然而，節育方案往往缺乏理論基礎。我們在電腦化的資料庫(MEDLINE, POPLINE, CENTRAL, PsycINFO, EMBASE, ClinicalTrials.gov,和ICTRP)中，搜尋用來檢驗具學理基礎的干預行為去改善節育方式的隨機對照試驗。為了找到其他試驗，我們也寫信給學者。用來檢驗具學理基礎的干預行為去改善節育方案的試驗。我們排除針對高危險族群的試驗。方案包含使用一種或多種避孕方式。報告顯示，理論或模式都是方案設計的一部分。比較對象可以是常態照護，另一個有理論基礎的方案，或是不採取任何干預。主要結果為懷孕、節育方式的選擇、節育行為的改變及持續。我們沒有合併任何試驗，因為所研究的各方案都有很大的差異。在26個試驗中，有12個描述了節育(非使用保險套)或避孕，其餘14個則專注於使用保險套來預防HIV或性病。在10個有懷孕或生產資料的試驗中，其中2個顯示有理論基礎的干預行為可以得到較好的結果。在9個有使用避孕措施(非保險套)的試驗中，有4個顯示操作組的結果較好。至於保險套避孕的效果，在20個試驗中，有14個試驗顯示有理論基礎的組別效果較好，但次群組分析後，此數量減半。社會認知理論是12個試驗的基礎理論，其中10個也顯示正向結果。至於其他14個試驗，正向結果分別基於其他社會認知模式(N = 2)，動機訪談(N = 5)，以及愛滋病風險降低模型(N = 2)。沒有哪一個理論或方案在特定結果或族群上有格外傑出的貢獻。健康照護提供者也許會想要使用在診間有效的方法。家庭計畫研究員可以測試用在HIV及性病防治的理論或方案。徹底施行單一理論有助於分辨哪一個理論在該領域是可行的。更好的回報系統將有助於研究執行以及方案應用。