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Zango AB, Stutterheim SE, de Vries N, Crutzen R. Determinants of preventive sexual behaviours among first year university students in Beira city, central Mozambique: a cross-sectional study. Reprod Health 2024; 21:3. [PMID: 38191405 PMCID: PMC10773135 DOI: 10.1186/s12978-023-01733-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/28/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Understanding determinants of preventive sexual behaviours is important for intervention efforts to support these behaviours and, thereby, reduce STIs and HIV burden. In general, there is limited insight into determinants of preventive behaviours among university students in Mozambique. Therefore, this study set out to assess both the prevalence and the determinants of condom use and voluntary counselling and testing (VCT) service use in first year university students. METHODS We conducted a cross-sectional study in May-September 2021, at the Universidade Católica de Moçambique and the Universidade Licungo, in Beira central Mozambique. We collected data on sociodemographic characteristics, heterosexual relationship experiences and personal determinants posited to be associated with condom use and VCT service use. We included 819 participants, who were selected using a clustered and random sampling design. We used Pearson's chi-square test to compare proportion and estimate the crude odd ratio as the effect size measure at 95% confidence interval, and Confidence Interval-Based Estimation of Relevance to determine correlation coefficients of means and the behaviours of interest at 95% confidence interval. RESULTS Condoms were used by 96.1% of male participants and 95.0% of female participants. Additionally, 55.1% of male participants and 57.5% of female participants had previously used VCT services. Condom use was associated with discussing sexuality with mother, and self-efficacy for condom use negotiation, and negatively associated with attitudes that condoms reduce pleasure. VCT service use was associated with discussing sexuality with mother, sexual debut, having a sexual partner, and being in what they consider an important heterosexual relationship. Knowledge, attitude, self-efficacy and subjective norms were weakly associated with VCT service use. CONCLUSION In first year university students in Mozambique, reported condom use was high but VCT services were only used by about half of the participants. Interventions aiming to increase VCT service use should focus on improving communication between parents and their adolescent or young adult children, providing personalized risk information, demonstrating that VCT service use is pleasant and non-judgmental, improving users' confidence to schedule a visit, and preparing users for possible positive testing results.
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Affiliation(s)
- Arlinda Basílio Zango
- Departamento de Investigação, Faculdade de Ciências de Saúde, Universidade Católica de Moçambique, Beira, Mozambique.
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.
| | - Sarah E Stutterheim
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Nanne de Vries
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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Quiroz-Mora CA, Valencia-Molina CP. [Effectiveness of structural interventions to promote condom use in adolescents and young people: Systematic Review]. Rev Salud Publica (Bogota) 2023; 22:453-462. [PMID: 36753246 DOI: 10.15446/rsap.v22n4.85800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/16/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Evaluate the effectiveness of structural or multicomponent interventions aimed at increasing the use of condoms in adolescents and young adults, identifying the strategies that form the interventions evaluated, and recognizing the theoretical models that support these interventions. METHODOLOGY Design: Systematic review of literature. Data source: MEDLINE databases were consulted via OVID, Embase, and CENTRAL in order to search for studies on interventions aimed at increasing the use of condoms in adolescents and young adults. Selection of studies: A total of 7 primary investigations were selected, in which the effect of a structured or multicomponent intervention to increase the use of condoms in adolescents and young adults was evaluated. The quality of the studies was evaluated using the Cochrane bias risk assessment. RESULTS Five investigations show changes in the percentages of condom use with values between 53% and 68%. The interventions targeted guided their actions more at individual level with strategies such as sexual health education, reproductive health counseling, knowledge about the condom, knowledge about STIs / HIV, than at organizational and environ-mental levels, which were aimed at the provision of condoms. The theoretical models proposed in the studies are focused on human behavior, individual behavior, and social learning. CONCLUSION Structural interventions that aim to increase the use of condoms in adolescents and young adults seem to show significant changes at individual level, but possible changes generated at both organization and environment levels are unknown.
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Affiliation(s)
- Carlos A Quiroz-Mora
- CQ: Fisioterapeuta. M. Sc. Epidemiología. M. Sc. Neurorehabilitación, Ph.D. (c) Salud, Grupo de Investigación en Promoción de la Salud (PROMESA). Universidad del Valle. Cali, Colombia.
| | - Claudia P Valencia-Molina
- CV: Enfermera. Ph. D. Salud Pública. Doctorado Interfacultades en Salud Pública, Universidad Nacional de Colombia. Directora Grupo de Investigación en Promoción de la Salud (PROMESA). Universidad del Valle. Cali, Colombia.
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Downing MJ, Wiatrek SE, Zahn RJ, Mansergh G, Olansky E, Gelaude D, Sullivan PS, Stephenson R, Siegler AJ, Bauermeister J, Horvath KJ, Chiasson MA, Yoon IS, Houang ST, Hernandez AJ, Hirshfield S. Video selection and assessment for an app-based HIV prevention messaging intervention: formative research. Mhealth 2023; 9:2. [PMID: 36760783 PMCID: PMC9902231 DOI: 10.21037/mhealth-21-53] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (GBMSM) continue to be overrepresented in human immunodeficiency virus (HIV) infection in the United States. HIV prevention and care interventions that are tailored to an individual's serostatus have the potential to lower the rate of new infections among GBMSM. Mobile technology is a critical tool for disseminating targeted messaging and increasing uptake of basic prevention services including HIV testing, sexually transmitted infection (STI) testing, and pre-exposure prophylaxis (PrEP). Mobile Messaging for Men (M-Cubed) is a mobile health HIV prevention intervention designed to deliver video- and text-based prevention messages, provide STI and HIV information, and link GBMSM to prevention and healthcare resources. The current report describes an iterative process of identifying and selecting publicly available videos to be used as part of the M-Cubed intervention. We also conducted interviews with GBMSM to assess the acceptability, comprehension, and potential audience reach of the selected video messages. METHODS The selection of videos included balancing of specific criteria [e.g., accuracy of scientific information, video length, prevention domains: HIV/STI testing, antiretroviral therapy (ART), PrEP, engagement in care, and condom use] to ensure that they were intended for our GBMSM audiences: HIV-negative men who engage in condomless anal sex, HIV-negative men who do not engage in condomless anal sex, and men living with HIV. This formative study included in-person interviews with 26 GBMSM from three U.S. cities heavily impacted by the HIV epidemic-New York City, Detroit, and Atlanta. RESULTS Following a qualitative content analysis, the study team identified five themes across the interviews: participant reactions to the video messages, message comprehension, PrEP concerns, targeting of video messaging, and prompted action. CONCLUSIONS Study results informed a final selection of 12 video messages for inclusion in a randomized controlled trial of M-Cubed. Findings may serve as a guide for researchers who plan to develop HIV prevention interventions that utilize publicly available videos to promote behavioral change. Further, the findings presented here suggest the importance of developing videos with broad age and gender diversity for use in interventions such as M-Cubed, and in other health promotion settings.
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Affiliation(s)
| | - Sarah E. Wiatrek
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ryan J. Zahn
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Gordon Mansergh
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Deborah Gelaude
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rob Stephenson
- Department of Systems, Population and Leadership, School of Nursing & The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Aaron J. Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - José Bauermeister
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Keith J. Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Mary Ann Chiasson
- Department of Epidemiology, Columbia University Mailman School of Public Health and Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Steven T. Houang
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anthony Jimenez Hernandez
- Department of Natural Sciences and Mathematics, Eugene Lang College of Liberal Arts, New York, NY, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Bailey JV, Wayal S, Aicken CR, Webster R, Mercer CH, Nazareth I, Rait G, Peacock R, Murray E. Interactive digital interventions for prevention of sexually transmitted HIV. AIDS 2021; 35:643-653. [PMID: 33259345 PMCID: PMC7924981 DOI: 10.1097/qad.0000000000002780] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Digital technology offers good opportunities for HIV prevention. This systematic review assesses the effectiveness of interactive digital interventions (IDIs) for prevention of sexually transmitted HIV. METHODS We conducted a systematic search for randomized controlled trials (RCTs) of IDIs for HIV prevention, defining 'interactive' as producing personally tailored material. We searched databases including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, grey literature, reference lists, and contacted authors if needed.Two authors screened abstracts, applied eligibility and quality criteria and extracted data. Meta-analyses used random-effects models with standardized mean differences (SMD) for continuous outcomes and odds ratios (OR) for binary outcomes, assessing heterogeneity using the I2 statistic. RESULTS We included 31 RCTs of IDIs for HIV prevention. Meta-analyses of 29 RCTs comparing IDIs with minimal interventions (e.g. leaflet, waiting list) showed a moderate increase in knowledge (SMD 0.56, 95% CI 0.33 to 0.80), no effect on self-efficacy (SMD 0.13, 95% CI 0.00 to 0.27), a small improvement in intention (SMD 0.16, 95% CI 0.06 to 0.26), improvement in HIV prevention behaviours (OR 1.28, 95% CI 1.04 to 1.57) and a possible increase in viral load, but this finding is unreliable.We found no evidence of difference between IDIs and face-to-face interventions for knowledge, self-efficacy, intention, or HIV-related behaviours in meta-analyses of five small RCTs. We found no health economic studies. CONCLUSION There is good evidence that IDIs have positive effects on knowledge, intention and HIV prevention behaviours. IDIs are appropriate for HIV prevention in a variety of settings.Supplementary Video Abstract, http://links.lww.com/QAD/B934.
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Affiliation(s)
- Julia V. Bailey
- e-Health Unit, Research Department of Primary Care and Population Health, University College London
| | - Sonali Wayal
- e-Health Unit, Research Department of Primary Care and Population Health, University College London
- Development Media International
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London
| | - Catherine R.H. Aicken
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London
- School of Health Sciences, University of Brighton, Falmer, Brighton
| | - Rosie Webster
- e-Health Unit, Research Department of Primary Care and Population Health, University College London
| | - Catherine H. Mercer
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London
| | - Irwin Nazareth
- Research Department of Primary Care and Population Health, University College London
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London
| | - Richard Peacock
- Whittington Health Library, The Whittington Hospital, London, UK
| | - Elizabeth Murray
- e-Health Unit, Research Department of Primary Care and Population Health, University College London
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Evans R, Widman L, Stokes MN, Javidi H, Hope EC, Brasileiro J. Association of Sexual Health Interventions With Sexual Health Outcomes in Black Adolescents: A Systematic Review and Meta-analysis. JAMA Pediatr 2020; 174:676-689. [PMID: 32310261 PMCID: PMC7171582 DOI: 10.1001/jamapediatrics.2020.0382] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Black adolescents are at increased risk of contracting HIV and other sexually transmitted infections (STIs) and experiencing unplanned pregnancy. Although sexual health interventions aimed at decreasing these risks exist, evidence of the association between sexual health interventions and the sexual behavior of black adolescents has not been synthesized to our knowledge. OBJECTIVE To examine the associations between sexual health interventions and behavioral, biological, and psychological outcomes. DATA SOURCES For this systematic review and meta-analysis, a systematic search was conducted of studies published through January 31, 2019, using the PubMed, PsycINFO, and CINAHL databases and relevant review articles. The following key words were used: youth, adolesc* or teen*; sexual health or safe* sex or sexually transmitted disease or sexually transmitted infection or STD or STI or HIV or AIDS or pregnancy or reproductive health or condom* or contracept* or unprotected sex or abstinence; intervention or program or education or prevention or promotion or trial; latino* or latina* or latinx* or minorit* or ethnic* or hispanic or african american* or black* or race or racial or biracial. STUDY SELECTION Studies were included if they included a US-based sample of black adolescents, evaluated a sexual health intervention using experimental or quasi-experimental designs, included a behavioral outcome, and were published in English. DATA EXTRACTION AND SYNTHESIS Standardized mean differences and 95% CIs were extracted and meta-analyzed using random-effects models. MAIN OUTCOMES AND MEASURES Behavioral outcomes were abstinence, condom use, and number of sex partners. Biological outcomes were pregnancy and STI contraction. Psychological outcomes were sexual health intentions, knowledge, and self-efficacy. RESULTS Across 29 studies including 11 918 black adolescents (weighted mean age, 12.43 years), there was a significant weighted mean association of sexual health interventions with improvements in abstinence (Cohen d = 0.14; 95% CI, 0.05-0.24) and condom use (Cohen d = 0.25; 95% CI, 0.11-0.39). No significant mean association of these interventions with number of sex partners, pregnancy, or STI contraction was found. Sexual health interventions were significantly associated with improvements in psychological outcomes: sexual health intentions (Cohen d = 0.17; 95% CI, 0.05-0.30), knowledge (Cohen d = 0.46; 95% CI, 0.30-0.63), and self-efficacy (Cohen d = 0.19; 95% CI, 0.09-0.28). Intervention effect sizes were consistent across factors, such as participant sex and age and intervention dose. CONCLUSIONS AND RELEVANCE The findings suggest that sexual health interventions are associated with improvements in sexual well-being among black adolescents. There appears to be a need for wide-scale dissemination of these programs to address racial disparities in sexual health across the US.
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Affiliation(s)
- Reina Evans
- Department of Psychology, North Carolina State University, Raleigh
| | - Laura Widman
- Department of Psychology, North Carolina State University, Raleigh
| | | | - Hannah Javidi
- Department of Psychology, North Carolina State University, Raleigh
| | - Elan C. Hope
- Department of Psychology, North Carolina State University, Raleigh
| | - Julia Brasileiro
- Department of Psychology, North Carolina State University, Raleigh
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Hirshfield S, Downing MJ, Chiasson MA, Yoon IS, Houang ST, Teran RA, Grov C, Sullivan PS, Gordon RJ, Hoover DR, Parsons JT. Evaluation of Sex Positive! A Video eHealth Intervention for Men Living with HIV. AIDS Behav 2019; 23:3103-3118. [PMID: 31011912 DOI: 10.1007/s10461-019-02498-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Sex Positive![+] is a two-arm, video-based web intervention aimed at reducing condomless anal sex (CAS) with partners of known and unknown serostatus that was delivered online to a racially and ethnically diverse sample of 830 gay, bisexual, and other men who have sex with men living with HIV. Men in each arm received 6 weekly videos after completing a baseline assessment and 4 weekly booster videos following a 6-month assessment. Follow-up assessments were conducted every 3 months for 1 year. At 3-month follow-up, men in the intervention arm reported significantly reduced risk of having unknown serodiscordant CAS partners than men in the control arm (RR 0.60, 95% CI 0.39-0.92), partially supporting study hypotheses. Aside from this finding, similar reductions in sexual risk behaviors were observed in both arms over the study period. There is much to be learned about video-based web interventions in terms of methodological development and intervention delivery, including frequency and duration of intervention components.
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Affiliation(s)
- Sabina Hirshfield
- Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA.
| | - Martin J Downing
- Department of Psychology, Lehman College, City University of New York (CUNY), Bronx, NY, USA
| | | | - Irene S Yoon
- Gartner L2, Research and Advisory, New York, NY, USA
| | - Steven T Houang
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Richard A Teran
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | | | - Rachel J Gordon
- Departments of Medicine and Epidemiology, Division of Infectious Diseases, Columbia University, New York, NY, USA
| | - Donald R Hoover
- Department of Statistics and Biostatistics and Institute for Health Care Policy and Aging Research, Rutgers University, Piscataway, NJ, USA
| | - Jeffrey T Parsons
- Department of Psychology, Hunter College, City University of New York (CUNY), New York, NY, USA
- Graduate Center, City University of New York (CUNY), New York, NY, USA
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Winston K, Grendarova P, Rabi D. Video-based patient decision aids: A scoping review. PATIENT EDUCATION AND COUNSELING 2018; 101:558-578. [PMID: 29102063 DOI: 10.1016/j.pec.2017.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 10/06/2017] [Accepted: 10/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study reviews the published literature on the use of video-based decision aids (DA) for patients. The authors describe the areas of medicine in which video-based patient DA have been evaluated, the medical decisions targeted, their reported impact, in which countries studies are being conducted, and publication trends. METHOD The literature review was conducted systematically using Medline, Embase, CINAHL, PsychInfo, and Pubmed databases from inception to 2016. References of identified studies were reviewed, and hand-searches of relevant journals were conducted. RESULTS 488 studies were included and organized based on predefined study characteristics. The most common decisions addressed were cancer screening, risk reduction, advance care planning, and adherence to provider recommendations. Most studies had sample sizes of fewer than 300, and most were performed in the United States. Outcomes were generally reported as positive. This field of study was relatively unknown before 1990s but the number of studies published annually continues to increase. CONCLUSION Videos are largely positive interventions but there are significant remaining knowledge gaps including generalizability across populations. PRACTICE IMPLICATIONS Clinicians should consider incorporating video-based DA in their patient interactions. Future research should focus on less studied areas and the mechanisms underlying effective patient decision aids.
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Affiliation(s)
- Karin Winston
- Alberta Children's Hospital, 2800 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada.
| | - Petra Grendarova
- University of Calgary, Division of Radiation Oncology, Calgary, Canada
| | - Doreen Rabi
- University of Calgary, Department of Medicine, Calgary, Canada
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Hatzenbuehler LA, Starke JR, Smith EO, Turner TL, Balmer DF, Arif Z, Guzman F, Cruz AT. Increased adolescent knowledge and behavior following a one-time educational intervention about tuberculosis. PATIENT EDUCATION AND COUNSELING 2017; 100:950-956. [PMID: 27923675 DOI: 10.1016/j.pec.2016.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 11/25/2016] [Accepted: 11/27/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate the impact of a tuberculosis (TB) educational intervention (EI) on change in adolescent student knowledge and participation in a TB prevention program. METHODS From 2/2013-5/2015, students from 2 high schools in Houston, TX participated. The 25-min EI discussed TB bacteriology, epidemiology, symptoms, and indications for TB testing/treatment. Students completed pre- and post-quizzes. Immediately after the EI, students were invited to participate in voluntary TB risk-factor screening, testing and treatment. At 6 months, focus groups were conducted. RESULTS 895 students attended the EI. 827 students (92%) completed the EI quizzes. Knowledge improved by 12% (pre: 70%; post: 82%, p<0.001); 78% shared their TB knowledge. Following the EI, 671/827 (81%) enrolled in a TB prevention program. Focus groups indicated that the EI stimulated student learning about TB and increased their willingness to participate. CONCLUSION A brief, one-time, TB EI is an effective method to encourage adolescents to learn about TB and motivate their uptake of TB risk-factor screening, testing and treatment. Similar EIs should accompany TB prevention programs targeting adolescents. PRACTICE IMPLICATIONS The study's procedures could be considered for incorporation into school-based TB prevention programs to improve the identification, testing and treatment of adolescents at risk for TB.
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Affiliation(s)
- Lindsay A Hatzenbuehler
- Sections of Infectious Diseases, Baylor College of Medicine, Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Jeffrey R Starke
- Sections of Infectious Diseases, Baylor College of Medicine, Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
| | - E O'Brian Smith
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; Baylor College of Medicine and Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Teri L Turner
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Doreen F Balmer
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Zainab Arif
- Baylor College of Medicine's, Michael E. DeBakey High School for Health Professions, Houston, TX, 77021, USA.
| | - Francisco Guzman
- Baylor College of Medicine's, Michael E. DeBakey High School for Health Professions, Houston, TX, 77021, USA.
| | - Andrea T Cruz
- Sections of Infectious Diseases, Baylor College of Medicine, Houston, TX 77030, USA; Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
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9
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Long L, Abraham C, Paquette R, Shahmanesh M, Llewellyn C, Townsend A, Gilson R. Brief interventions to prevent sexually transmitted infections suitable for in-service use: A systematic review. Prev Med 2016; 91:364-382. [PMID: 27373209 DOI: 10.1016/j.ypmed.2016.06.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 05/26/2016] [Accepted: 06/27/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are more common in young people and men who have sex with men (MSM) and effective in-service interventions are needed. METHODS A systematic review of randomized controlled trials (RCTs) of waiting-room-delivered, self-delivered and brief healthcare-provider-delivered interventions designed to reduce STIs, increase use of home-based STI testing, or reduce STI-risk behavior was conducted. Six databases were searched between January 2000 and October 2014. RESULTS 17,916 articles were screened. 23 RCTs of interventions for young people met our inclusion criteria. Significant STI reductions were found in four RCTs of interventions using brief one-to-one counselling (2 RCTs), video (1 RCT) and a STI home-testing kit (1 RCT). Increase in STI test uptake was found in five studies using video (1 RCT), one-to-one counselling (1 RCT), home test kit (2 RCTs) and a web-based intervention (1 RCT). Reduction in STI-risk behavior was found in seven RCTs of interventions using digital online (web-based) and offline (computer software) (3 RCTs), printed materials (1 RCT) and video (3 RCTs). Ten RCTs of interventions for MSM met our inclusion criteria. Three tested for STI reductions but none found significant differences between intervention and control groups. Increased STI test uptake was found in two studies using brief one-to-one counselling (1 RCT) and an online web-based intervention (1 RCT). Reduction in STI-risk behavior was found in six studies using digital online (web-based) interventions (4 RCTs) and brief one-to-one counselling (2 RCTs). CONCLUSION A small number of interventions which could be used, or adapted for use, in sexual health clinics were found to be effective in reducing STIs among young people and in promoting self-reported STI-risk behavior change in MSM.
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Affiliation(s)
- L Long
- Psychology Applied to Health Group, University of Exeter Medical School, University of Exeter, UK
| | - C Abraham
- Psychology Applied to Health Group, University of Exeter Medical School, University of Exeter, UK.
| | - R Paquette
- Research Department of Infection and Population Health, University College London, UK
| | - M Shahmanesh
- Research Department of Infection and Population Health, University College London, UK
| | - C Llewellyn
- Division of Public Health and Primary Care, Brighton and Sussex Medical School, UK
| | - A Townsend
- Psychology Applied to Health Group, University of Exeter Medical School, University of Exeter, UK
| | - R Gilson
- Research Department of Infection and Population Health, University College London, UK
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10
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Fisher CB, Arbeit MR, Dumont MS, Macapagal K, Mustanski B. Self-Consent for HIV Prevention Research Involving Sexual and Gender Minority Youth: Reducing Barriers Through Evidence-Based Ethics. J Empir Res Hum Res Ethics 2016; 11:3-14. [PMID: 26956988 PMCID: PMC4842126 DOI: 10.1177/1556264616633963] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This project examined the attitudes of sexual and gender minority youth (SGMY) toward guardian permission for a pre-exposure prophylaxis (PrEP) adherence trial and their preparedness to provide informed, rational, and voluntary self-consent. Sixty sexually active SGMY (ages 14-17) participated in online survey and asynchronous focus group questions after watching a video describing a PrEP adherence study. Youth responses highlighted guardian permission as a significant barrier to research participation, especially for those not "out" to families. Youth demonstrated understanding of research benefits, medical side effects, confidentiality risks, and random assignment and felt comfortable asking questions and declining participation. Reasoning about participation indicated consideration of health risks and benefits, personal sexual behavior, ability to take pills every day, logistics, and post-trial access to PrEP. Results demonstrate youth's ability to self-consent to age- and population-appropriate procedures, and underscore the value of empirical studies for informing institutional review board (IRB) protections of SGMY research participants.
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Bailey J, Mann S, Wayal S, Hunter R, Free C, Abraham C, Murray E. Sexual health promotion for young people delivered via digital media: a scoping review. PUBLIC HEALTH RESEARCH 2015. [DOI: 10.3310/phr03130] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundYoung people are at risk of poor sexual health and are, therefore, in need of comprehensive, effective sexual health education. Young people are confident and constant users of digital technology, such as the internet and mobile phones, and there are many innovative possibilities for sexual health education involving these technologies.ObjectivesTo summarise evidence on effectiveness, cost-effectiveness and mechanism of action of interactive digital interventions (IDIs) for sexual health; optimal practice for intervention development; contexts for successful implementation; research methods for digital intervention evaluation; and the future potential of sexual health promotion via digital media.DesignLiterature review of evidence on digital interventions for sexual health for young people, integrating the findings with the views of young people, parents and experts in digital media/sexual health. IDIs are defined as digital media programmes that provide health information and tailored decision support, behaviour-change support and/or emotional support. We focus on sexual well-being for young people aged 13–24 years in the UK.ResultsThere are many imaginative IDIs for sexual health promotion, but few interventions address issues that are important to young people, such as sexual pleasure and relationships. It is vital to collaborate with young people and to use Behaviour-Change Theory in designing interventions. We located 19 randomised controlled trials of IDIs for sexual health promotion for young people, finding a moderate effect on sexual health knowledge [standardised mean difference (SMD) 0.54, 95% confidence interval (CI) 0.17 to 0.92], a small effect on confidence (self-efficacy) (SMD 0.11, 95% CI 0.02 to 0.20) and a positive effect on sexual behaviour (odds ratio 1.28, 95% CI 1.01 to 1.61), but no significant effects on safer sex intention or biological outcomes. One study suggests that IDIs may be as good as face-to-face interventions for sexual health knowledge and safer sex intention. There are no existing data on the cost-effectiveness of IDIs for sexual health promotion. The impact of an IDI will be determined by the proportion of the target population reached, intervention efficacy, adoption in a setting, how well it is delivered and maintenance/sustainability. All of these elements must be addressed for IDIs to be successful. More collaboration is needed to capitalise on the knowledge of users and stakeholders, the design and software skills of the commercial sector and the theoretical expertise and evaluation skills of academia.ConclusionsIDIs are effective for knowledge acquisition and sexual behaviour, and could usefully contribute to sexual health education in schools, in clinic settings and online; however, there are obstacles to overcome, such as access to information technology and ensuring the quality and safety of interventions.Future workMore evidence is needed on the best designs for interventions (e.g. choice of behaviour-change mechanisms and interactive features) and the best models of delivery (e.g. setting, modes of delivery, methods of facilitation and support for engagement) to improve sexual behaviour, biological outcomes and sexual well-being in a cost-effective way.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Julia Bailey
- e-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sue Mann
- Camberwell Sexual Health Centre, King’s College Hospital, London, UK
| | - Sonali Wayal
- e-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Rachael Hunter
- PRIMENT Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Caroline Free
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Elizabeth Murray
- e-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
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