Computerized intervention increases condom use
Computerized intervention increases condom use
Intervention is translatable to other clinics
Researchers have developed a computerized condom use intervention that significantly improved consistent condom use among participants randomly selected at a sexually transmitted disease (STD) clinic.1
The one-time intervention was tailored according to the stages of change behavioral theory, says Diane M. Grimley, PhD, an associate professor and chair of the department of health behavior at the University of Alabama at Birmingham (AL) School of Public Health.
For purposes of the study, the STD clinic patients were referred from the waiting room to a computer where they were randomly selected to go into a treatment/intervention group or a comparison group, Grimley explains.
"The people in the intervention group were given an assessment on the computer, and based on their own responses, they would get behavioral change feedback, and this is done continuously throughout the program," Grimley says.
The comparison group completed a multiple health risk assessment that covered STD/HIV risk behaviors, as well as smoking and violence, she notes.
"They kept giving answers, but never got any feedback," Grimley says.
At the end of the initial recruitment, the computer again randomized participants to be in the follow-up sample of more than 600 people, and they were told to come back in six months, she says.
"If they did come back, they did a paper and pencil, self-assessment on condom use and were also tested for chlamydia and gonorrhea, using one urine sample," Grimley says. "We found there was a significant increase in condom use at the six-month follow-up for the intervention group," Grimley says. "Actually, the intervention group's condom use went up 6.5%, and the comparison group's condom use went down 6.5%, which was interesting and significant."
At baseline, the intervention group had a higher proportion of STDs with a 28% STD rate in the intervention group and a 24% STD rate in the comparison group, Grimley says.
"After six months, 11.7% of the intervention group had STDs and 14.4% of the comparison group," she says. "Also, 78% of the people in the intervention group came back at six months, compared to 58% of the people in the comparison group who came back."
The intervention provided a clinical approach to risk assessment without having a health care worker there with the patient, Grimley notes.
A one-shot intervention might work best for the STD clinic population because the evaluation visit often is the only opportunity the clinic staff have to educate these patients, she says.
"If we were to increase the number of intervention sessions to maybe three, then maybe we'd see more positive change," Grimley says.
The intervention was designed with a National Institutes of Health (NIH) grant, and it's sustainable, developed so that it can be done with thousands of people, Grimley says.
"It's very cost-effective," she says.
It could be used at STD clinics in this way, she suggests:
- When patients register at the front desk, the receptionist could note whether they are new patients.
- If they are new patients, they could be told to come into a room to sit at the computer for an assessment, which would take less than 10 minutes. Plus they won't lose their place in line.
- They answer questions on the computer, and based on their gender and their answers, they are given information about prevention and behavior change.
For instance, if a person says they have a main sexual partner, then they are assessed for condom use based on the stages of change model, Grimley says.
"So if they say they are thinking about using condoms, which is the contemplation stage, then the computer grabs that file based on gender and orientation and puts it on the screen," Grimley says.
"It's an audio program too, and you can wear headsets for privacy," Grimley says.
The software was intentionally built into a regular office computer so that it could be disseminated to any STD clinic that has computers, she notes.
"It's a combination of a clinical approach and a public health/population approach, and we have back and forth interaction and can reach hundreds and hundreds of people," Grimley says.
[Editor's note: For more information about the condom-use intervention or to purchase the CD software copy for $5 plus shipping and handling, contact Diane Grimley at [email protected] or by writing to her at the UAB School of Public Health, RPHB 227, 1530 Third Ave. South, Birmingham, AL 35294-0022.]
Reference:
- Grimley DM, Annang L. Efficacy of a "one-shot" computerized, individualized intervention to increase consistent condom use and decrease STDs among STD clinic patients. Presented at the 2006 National STD Prevention Conference, held May 8-11, 2006, in Jacksonville, FL. Abstract: 235.
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