diane m. grimley, phd lucy annang, phd
DESCRIPTION
Efficacy of a “One-Shot” Computerized, Individualized Intervention to Increase Condom Use and Decrease STDs among Clinic Patients with Main Partners. Diane M. Grimley, PhD Lucy Annang, PhD. Special Acknowledgement. Jeffrey M. Bellis, PhD Co-Principal Investigator. Introduction. - PowerPoint PPT PresentationTRANSCRIPT
Efficacy of a “One-Shot” Computerized, Individualized
Intervention to Increase Condom Use and Decrease STDs among Clinic Patients
with Main Partners
Diane M. Grimley, PhDLucy Annang, PhD
Special Acknowledgement
Jeffrey M. Bellis, PhDCo-Principal Investigator
Introduction
• The STD clinic evaluation visit may be the only opportunity providers have to promote risk reduction behaviors.
• Prevention efforts are often difficult to emphasize in settings delivering STD care:– Time constraints– Differing priorities about the use of clinical
time
• To assist busy clinicians with prevention efforts we developed and implemented an interactive ACASI system that was programmed to:– assess individuals’ condom use behavior– determine their readiness for change– provide individualized feedback
Department of Health BehaviorSchool of Public Health
UAB
Specific Aims
1. To increase consistent condom use among patients with main partners.
2. To decrease the rates of STDs (GC and CT) among patients with main partners.
Study Design
• 5-year study funded by NIH: NIAID
• Randomized controlled trial
• Assessments at baseline and 6 months post intervention
Target Population
• Low-income, predominately African American males and females seeking care at the Jefferson County Department of Health (JCDH) STD Clinic
Recruitment Procedure
• Individuals seeking an evaluation visit were recruited in the clinic waiting area by trained project staff– Provided an overview of study and
invited to participate– Informed consent was obtained – Computer randomized patients by
gender to one of two conditions
Intervention Group
• A theory-based, interactive, multimedia, computer-based intervention – Assessment plus individualized feedback
• Underlying conceptual framework – Transtheoretical model of change – Social cognitive theory– Two paths based on sexual orientation
Control Group
• An ACASI multiple health risk assessment (MHRA) examining:– Health care seeking behavior– Sexual risk behaviors– Condom use– Substance use (smoking, alcohol, and
drug use)– Birth control use– Violence
Additional Data Collected
• Clinical data– Baseline visit GC & CT test results (chart
reviews)
Overall Recruitment Rate
• Recruitment ended April 2004
• 1,848 participants enrolled– 93% recruitment rate
Follow-up Selection Process
• Computer randomly selected a subsample of 625 patients (by gender and stage of change) to return in 6-months (post intervention)
• 580 agreed to come back (93%) • Of these, 430 reported having a main
partner and had complete data.
Overview of the Population
Intervention and Comparison Conditions at Enrollment
Characteristic Intervention
(n=203)
Comparison
(n=227)
P-value
Age
(mean yrs ± sd) 24.74 ± 5.7 25.14 ± 5.9 0.29
Gender
Male
Female
40.2 (82)
59.8 (121)
45.8 (104)
54.2 (123) 0.22
Race/Eth
African Am.
White
Other
90.4 (184)
7.5 (15)
1.7 (4)
87.7 (199)
10.1 (23)
2.2 (5) 0.55
Intervention and Comparison Conditions at Enrollment
Characteristic Intervention
(n=203)
Comparison
(n=227)
P-value
Education
< H.S.
H.S./GED
Some college/
degree
29.0 (59)
51.0 (104)
20.0 (40)
34.9 (79)
50.0 (113)
15.1 (34) 0.39
Single
Yes
87.4 (177) 89.9 (204) 0.47
Repeater to the clinic
Yes 68.2 (139) 74.4 (169) 0.14
Intervention and Comparison Conditions at Enrollment
Characteristic Intervention
(n=203)
Comparison
(n=227)
P-value
Age of sexual initiation
(mean yrs ± sd)
14.9 ± 2.4
14.9 ± 2.9 0.93
Number of partners (lifetime)
1-5
6 or more
30.3 (62)
68.7 (141)
28.9 (61)
72.7 (165) 0.33
Number of partners (past yr.)
< 3
>3
59.5 (121)
40.5 (82)
61.2 (139)
38.8 (88)
0.69
Intervention and Comparison Conditions at Enrollment
Characteristic Intervention
(n=239)
Comparison
(n=227)
P-value
Condom used last sexual encounter?
No
67.0 (159)
61.0 (147) 0.61
History of STDs
Yes
60.1 (140)
28.9 (61)
0.33
Follow-up: Assessing Consistent Condom Use and STDs (GC &
CT)
• 6-months post intervention• Return rate:
• 78% in the treatment group (n=158/203)• 58% in the comparison group (n=132/227)
Follow-up (cont.)
• Self-administered paper-and-pencil assessment on current condom use with their main partner
• Provided urine sample for LCR screening of chlamydia and gonorrhea
Results
Consistent Condom Use
___________________________________ Baseline 6-months
_______________________________________________
Intervention Control Intervention Control
14.5% 19.8% 21.0% 13.3%
p=0.25 p=0.03
_______________________________________________
Results (cont.)
STDs Rates (GC & CT)__________________________________
Baseline 6-months________________________________________________
Intervention Control Intervention Control28.0% 23.9% 11.7% 14.4% p>0.05 p>0.05
Difference of proportions 16.3% 9.5%
p=.0358 ________________________________________________
Conclusion
• This “one-shot” theory-based intervention showed modest, but statistically significant, changes in consistent condom use and rates of chlamydia and gonorrhea at 6 months post-intervention.
Implications
• Potentially cost-effective computerized interventions based on a patient’s readiness for change would benefit STD clinic patients if they were integrated into the routine evaluation visit.