Evaluating a social cognitive theory–based empowerment program to promote opium use prevention in young men aged 18–29: a non-randomized cluster-controlled study

Opium use remains a major public health concern in Iran and is associated with serious health and social consequences. This study aimed to evaluate the effect of a Social Cognitive Theory-based virtual empowerment intervention on opium-use preventive behaviors. This quasi-experimental study recruited 94 young men aged 18–29 years from comprehensive health service centers in northeastern Iran. Eight health service centers were non-randomly allocated to the intervention and control groups before participant recruitment; participants were not individually randomized. The intervention consisted of four Social Cognitive Theory–based WhatsApp sessions delivered over two weeks. Data were collected at baseline and three months post-intervention using a validated researcher-developed questionnaire assessing opium-use preventive behaviors and theoretical constructs. Complete-case analyses were performed using non-parametric tests and a linear mixed-effects model accounting for clustering within health centers in SPSS. Preventive behavior scores were similar between groups after the intervention, and the adjusted linear mixed-effects model showed no statistically significant difference between the intervention and control groups (β = 0.67, 95% CI − 1.83 to 3.17; p = 0.537). Post-intervention between-group differences were not observed for SCT constructs. Within-group analysis in the intervention group showed improvements in knowledge, outcome expectations and experiences, situational perception, environment, self-control, and emotional coping, whereas self-efficacy, barrier self-efficacy, and preventive behavior did not change significantly. Although the brief, fully virtual theory-informed program was associated with improvements in some SCT constructs within the intervention group, it did not result in a statistically significant improvement in preventive behaviors. Future interventions should prioritize feedback-rich skills rehearsal and incorporate mechanisms that address social and contextual influences to improve behavioral impact.