Lopez Laureen M, Tolley Elizabeth E, Grimes David A, Chen-Mok Mario
Clinical Sciences, FHI, P.O. Box 13950, Research Triangle Park, North Carolina, USA, 27709.
Cochrane Database Syst Rev. 2011 Mar 16(3):CD007249. doi: 10.1002/14651858.CD007249.pub3.
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.
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.
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.
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.
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.
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.
在研究中明确运用理论有助于拓展知识基础。理论和模型已广泛应用于艾滋病预防研究以及预防性传播感染（STIs）的干预措施中。健康行为领域运用了许多变革理论或模型。然而，针对避孕的教育干预措施往往没有明确的理论基础。
回顾随机对照试验（RCTs），这些试验测试了一种理论方法以指导避孕选择、鼓励使用避孕措施或促进对避孕方案的依从性或持续性。
我们在计算机化数据库中搜索测试基于理论的干预措施以改善避孕使用情况的试验（MEDLINE、POPLINE、CENTRAL、PsycINFO、EMBASE、ClinicalTrials.gov和ICTRP）。我们还写信给研究人员以查找其他试验。
试验测试了基于理论的干预措施以改善避孕使用情况。我们排除了专注于高危人群以及预防性传播感染或艾滋病的试验。干预措施涉及一种或多种避孕方法的使用以达到避孕目的。报告提供了证据表明干预措施基于特定的理论或模型。主要结局包括妊娠、避孕选择、开始或改变避孕措施的使用、避孕方案的依从性以及避孕措施的持续性。
第一作者评估摘要的合格性。两位作者从纳入研究中提取数据。我们计算二分结局的比值比。由于干预措施存在差异，未进行荟萃分析。
14项随机对照试验符合我们的纳入标准。在10项有妊娠或生育数据的试验中，有2项试验显示基于理论的组有更好的结果。在10项有避孕使用数据（避孕套除外）的试验中，有4项试验显示实验组有更好的结局。对于避孕套使用，在8项试验中有3项试验显示基于理论的组有良好结果。社会认知理论是5项试验的主要理论基础，其中3项试验显示出积极结果。基于其他社会认知模型的2项试验有良好结果，专注于动机访谈的4项试验中的2项也有良好结果。13项试验提供了多次疗程或接触。在7项有效干预措施中，有5项针对青少年，其中4项有小组疗程。3项有效试验有个体疗程。7项试验被评为高质量或中等质量；其中3项有良好结果。
计划生育研究人员和从业者可以采用有效的干预措施。生殖健康需要高质量的行为改变研究，特别是针对临床和资源匮乏的环境。更全面地运用单一理论会有所帮助，更好地报告研究设计和干预措施的实施情况也会如此。
