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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, PhD Lucy Annang, PhD. Special Acknowledgement. Jeffrey M. Bellis, PhD Co-Principal Investigator. Introduction.

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Diane M. Grimley, PhD Lucy Annang, PhD

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  1. 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

  2. Special Acknowledgement Jeffrey M. Bellis, PhD Co-Principal Investigator

  3. 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

  4. 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

  5. Department of Health Behavior School of Public Health UAB

  6. 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.

  7. Study Design • 5-year study funded by NIH: NIAID • Randomized controlled trial • Assessments at baseline and 6 months post intervention

  8. Target Population • Low-income, predominately African American males and females seeking care at the Jefferson County Department of Health (JCDH) STD Clinic

  9. 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

  10. 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

  11. 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

  12. Additional Data Collected • Clinical data • Baseline visit GC & CT test results (chart reviews)

  13. Overall Recruitment Rate • Recruitment ended April 2004 • 1,848 participants enrolled • 93% recruitment rate

  14. 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.

  15. Overview of the Population

  16. Intervention and Comparison Conditions at Enrollment

  17. Intervention and Comparison Conditions at Enrollment

  18. Intervention and Comparison Conditions at Enrollment

  19. Intervention and Comparison Conditions at Enrollment

  20. 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)

  21. 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

  22. 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 _______________________________________________

  23. 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 ________________________________________________

  24. 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.

  25. 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.

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