Leadership and diversity: a call for new directions in reproductive health education and practice

The Health Belief Model can guide modern contraceptive behavior research and practice

INTRODUCTION

Theory-based research is needed to understand poor contraceptive behavior and related reproductive health sequelae. The purpose of this review was to examine the Health Belief Model (HBM) as a comprehensive, well-tested social-cognitive framework suitable for explaining and predicting contraceptive behavior.

METHODS

Existing literature, including editorials and research reports, describing HBM-guided contraceptive research between January 1966 and February 2011 was retrieved from established electronic databases. After consideration of inclusion/exclusion criteria, 10 articles were included in the review.

RESULTS

Issues in original family planning applications of HBM included inconsistent conceptualizations of contraceptive behavior and limited use of all HBM constructs in research surveys, interventions, and analyses. Knowledge of contraceptive behavior has evolved, warranting more comprehensive use of the HBM for pertinent reproductive health contexts, behaviors, and methods.

DISCUSSION

With more rigorous applications, the HBM can help us understand modern contraceptive behavior determinants and facilitate strategies to prevent unintended pregnancy and promote positive family planning outcomes.

Measuring oral contraceptive knowledge: a review of research findings and limitations

OBJECTIVE

Poor oral contraceptive (OC) knowledge may contribute to premature OC discontinuation and unintended pregnancy. Yet, to understand relationships between OC knowledge and contraceptive behavior, knowledge must be adequately measured. This review evaluates the findings and methodological limitations of research in which OC knowledge has been measured.

METHODS

We performed a systematic review of primary research from January 1965 to January 2009. Studies were audited for study characteristics, purpose for measuring OC knowledge, key findings and measurement properties including administration method, knowledge domains, reliability, validity, health literacy and cultural sensitivity.

RESULTS

We reviewed 21 studies: 18 cohort studies, including one psychometric evaluation, and three randomized trials. Results on OC knowledge outcomes were variable. Measures were largely self-administered survey (n=15) and lacked assessment of all OC knowledge domains. Information on measures' characteristics, reliability, validity, health literacy and cultural sensitivity was limited.

CONCLUSION

Existing OC knowledge measures lack critical psychometric elements, leading to inconsistent and unreliable findings.

PRACTICE IMPLICATIONS

Poor OC knowledge measurement precludes identifying counseling needs and developing interventions for contraceptive behavior change. Future research considerations include: measurement information in publications, psychometric evaluations, formal reliability/validity techniques, and attention to all OC knowledge domains, health literacy and cultural sensitivity.