diane m. grimley, phd lucy annang, phd

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.