A Health Belief Model-Social Learning Theory Approach to Adolescents' Fertility Control

Findings from a Controlled Field Trial

Published in: Health Education Quarterly, v. 19, no. 2, Summer 1992, p. 249-262

Posted on RAND.org on January 01, 1992

by Marvin Eisen, Gail L. Zellman, Alfred L. Mcalister

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The authors evaluated an 8- to 12-hour Health Belief Model-Social Learning Theory (HBM-SLT)-based sex education program against several community- and school-based interventions in a controlled field experiment. Data on sexual and contraceptive behavior were collected from 1,444 adolescents unselected for gender, race/ethnicity, or virginity status in a pretest-posttest design. Over 60% completed the one-year follow-up. Multivariate analyses were conducted separately for each preintervention virginity status by gender grouping. The results revealed differential program impacts. First, for preintervention virgins, there were no gender or intervention differences in abstinence maintenance over the follow-up year. Second, female preintervention Comparison program virgins used effective contraceptive methods more consistently than those who attended the HBM-SLT program (p less than 0.01); among males, the intervention programs were equally effective. Third, both interventions significantly increased contraceptive efficiency for teenagers who were sexually active before attending the programs. For males, the HBM-SLT program led to significantly greater follow-up contraceptive efficiency than the Comparison program with preintervention contraceptive efficiency controlled (p less than 0.05); for females, the programs produced equivalent improvement. Implications for program planning and evaluation are discussed. Between June 1986-August 19867, social scientists conducted 1 year controlled field trial of a pilot community or school based sexuality and contraceptive education program based on a Health Belief Model-Social Learning Theory (HBM-SLT) among 1444 adolescents from Texas and California. This program aimed to increase their knowledge of probability of conception, negative personal consequences of pregnancy, personal and interpersonal benefits of delayed and/or protected sexual intercourse, and to decrease misperceptions about abstinence and consistent contraceptive use. 60% of the youth were not lost to follow up. For preintervention virgins, no gender or intervention differences in maintaining virginity over the year existed between the HBM-SLT and programs other than the HBM-SLT program (comparison programs). Female preintervention virgins attending comparison programs tended to use an effective contraceptive at most recent intercourse and be more capable of using contraceptive than those who went to the HBM-SLT program (p.01). Yet they depended highly on condoms. For males, both programs proved to be equally effective at contraceptive use. Both programs significantly improved contraceptive efficiency for preintervention nonvirgins. For males, the HBM-SLT program resulted in a more significant improvement in contraceptive efficiency than the comparison programs (p.05). For females, both programs equally improved efficiency. The proportion of variance explained by the intervention programs and time 2 HBM-SLT programs was not as great for males and females as the researchers expected. Contributing factors to this included sexual activity was relatively low (52% of follow up participants remained virgins), HBM-SLT was assessed against other programs rather than a no treatment group, and the length of the HBM-SLT was shorter than the comparison programs.

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