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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.
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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 • 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 Behavior School of Public Health UAB
Specific Aims • 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.
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 Control 28.0% 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.