Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Feb;65(2):100-10.
doi: 10.1136/jech.2008.085456. Epub 2009 Oct 12.

A systematic review of randomised controlled trials of interventions promoting effective condom use

Caroline Free  1 , Ian G Roberts, Tanya Abramsky, Molly Fitzgerald, Frances Wensley
Affiliations

A systematic review of randomised controlled trials of interventions promoting effective condom use

Caroline Free et al. J Epidemiol Community Health. 2011 Feb.

Abstract

Background: Effective condom use can prevent sexually transmitted infections (STIs) and unwanted pregnancy. We conducted a systematic review and methodological appraisal of randomised controlled trials (RCTs) of interventions to promote effective condom use.

Methods: We searched for all RCTs of interventions to promote effective condom use using the Cochrane Infectious Diseases Group's trials register (Oct 2006), CENTRAL (Issue 4, 2006), MEDLINE (1966 to Oct 2006), EMBASE (1974 to Oct 2006), LILACS (1982 to Oct 2006), IBSS (1951 to Oct 2006) and Psychinfo (1996 to Oct 2006). We extracted data on allocation sequence, allocation concealment, blinding, loss to follow-up and measures of effect. Effect estimates were calculated.

Results: We identified 139 trials. Seven out of ten trials reported reductions in 'any STI' with five statistically significant results. Three out of four trials reported reductions in pregnancy, although none was statistically significant. Only four trials met all the quality criteria. Trials reported a median of 11 (IQR 7-17) outcome measures. Few trials used the same outcome measure. Altogether, 10 trials (7%) used the outcome 'any STI', 4 (3%) self-reported pregnancy and 22 (16%) used 'condom use at last sex'.

Conclusions: The results are generally consistent with modest benefits but there is considerable potential for bias due to poor trial quality. Because of the low proportion of trials using the same outcome the potential for bias from selective reporting of outcomes is considerable. Despite the public health importance of increasing condom use there is little reliable evidence on the effectiveness of condom promotion interventions.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
Search strategy.
Figure 2
Figure 2
Associations of the effects of behavioural interventions on primary outcomes sexually transmitted infection (STI) and self-reported pregnancy.
Figure 3
Figure 3
Associations of the effects of behavioural interventions on secondary binary outcomes measuring condom use during sex.
Figure 4
Figure 4
Associations of the effects of behavioural interventions on continuous secondary outcomes looking at frequency or proportion of unprotected sex or condom use.
Figure 5
Figure 5
Flow chart of systematic review.
See this image and copyright information in PMC

References

    1. WHO Global prevalence and incidence of selected curable sexually transmitted infections: overview and estimates. World Health Organization: Geneva, 2001
    1. Alan Guttmacher Institute Sharing responsibility: women, society and abortion. New York: Alan Guttmacher Institute, 1999
    1. UNAIDS AIDS epidemic update. Geneva: UNAIDS, 2003
    1. Farr G, Gabelnick H, Sturgen K, et al. Contraceptive efficacy and acceptability of the female condom. Am J Public Health 1994;84:1960–4 - PMC - PubMed
    1. Spruyt A, Steiner MJ, Joanis C, et al. Identifying condom users at risk for breakage and slippage: findings from three international sites. Am J Public Health 1998;88:239–44 - PMC - PubMed

Publication types

MeSH terms