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.