Applying the transtheoretical model to pregnancy and STD prevention: A review of the literature

Purpose. To conduct a systematic review of the peer-reviewed literature on the Trans-theoretical Model (TTM) and pregnancy and STD prevention. Data Sources. Computer database search (Applied Social Science Index and Abstracts [ASSIA], Biological Abstracts, Criminal Justice Abstracts, CINAHL-Allied Health, Current Contents, Current Index to Journals in Education, Education Index, ERIC, Excerpta Medica, Family Index, Index Medicus, Medline, Multicultural Education Abstracts, PsychInfo, Psychological Abstracts, Research Alert, Social Science Citation Index, Social Work Abstracts, and Sociological Abstracts), and manual journal search. Study Inclusion and Exclusion Criteria. All English, peer-reviewed, original articles on the TTM as it relates to Pregnancy and STD prevention published prior to December 31, 2001, were included. Editorials, commentaries, theses/dissertations, unpublished studies, technical reports, and books were not included. Data Extraction Methods. Articles were categorized as Intervention, Population (stage distribution), or Validation studies. Within each category, articles were subdivided into groups, summarized, and analyzed. Data Synthesis. The 32 articles reviewed included 9 intervention studies, 11 population studies, and 12 validation studies. Studies represented a variety of U.S. populations of a broad demographic range. Evidence both for and against criterion-related and construct validity of the TTM was found. Major Conclusions. Age, partner type, gender, reasons for engaging in safer sex behaviors (i.e., pregnancy vs. disease prevention), self-efficacy, sexual assertiveness, and perceived of condom use were related to stage of change. The use of the TTM to reduce risk of pregnancy and STDs is a relatively new, but important, area of research. However, because of the wide-ranging differences in methodologies and samples, no strong conclusions about its effectiveness can yet be made.