Computer-assisted instruction: an effective instructional method for HIV prevention education?

Educating to sexuality care: the nurse educator's experience in a multicenter study

BACKGROUND

Sexuality is an issue inherent in the lives of all human beings. Education for Sexuality takes place informally, through relationships with the environment, with the family as a model, and formally, as a pedagogical practice in Teaching. Education for sexuality is recognized as an instrument of social transformation that leads to changes in behaviors and norms related to sexuality.

OBJECTIVES

Knowing the perception of nursing professors about sexuality education in professional training, recognizing attitudes of these professors in relation to sexual education and identifying barriers in education for sexuality.

METHODS

Exploratory and descriptive study, using qualitative methodology. Data collection was carried out from semi-structured interviews and thematic analysis.

RESULTS

The interviewees consider sexuality education to be very important, being taught in the nursing course, addressing different themes. In general, they reported feeling comfortable teaching these topics. The identified barriers to the level of education students are in, students' knowledge and reactions to the topic, religious and cultural issues, and the time available to talk about the topic and professional aspects.

CONCLUSION

Sexuality is a fundamental theme in nursing education and needs to be further explored to overcome the barriers associated with its approach.

HIV Information Acquisition and Use Among Young Black Men Who Have Sex With Men Who Use the Internet: Mixed Methods Study

Background

HIV disproportionately affects young Black men who have sex with men (YBMSM) in the United States. eHealth holds potential for supporting linkage and engagement in HIV prevention and care and the delivery of HIV information to YBMSM.

Objective

This study aims to investigate HIV information acquisition and use among YBMSM who use the internet.

Methods

A web-based self-administered survey and semistructured interviews were conducted. The survey findings informed the development of the interview guide. Descriptive statistics were used to characterize the survey sample, and interview data were analyzed thematically using modified grounded theory methodologies.

Results

Among the internet sample (N=83), the average age was 29.2 (SD 3.5) years, 41% (n=34) of participants self-reported living with HIV, 43% (n=36) were HIV-negative, and 15% (n=13) were unsure of their HIV status. Most participants (n=79, 95%) acquired HIV information through the internet while using a mobile phone. Web-based HIV information was intentionally sought from consumer health information websites (n=31, 37%), government health information websites (n=25, 30%), and social media (n=14, 17%). Most men incidentally acquired HIV information via advertisements on social media sites and geospatial dating apps (n=54, 65%), posts on social media sites from their web-based social ties (n=44, 53%), and advertisements while browsing the internet (n=40, 48%). Although the internet is the top source of HIV information, health care providers were the most preferred (n=42, 50%) and trusted (n=80, 96%) source of HIV information. HIV information was used to facilitate the use of HIV prevention and care services. The qualitative sample included YBMSM across a range of ages and at different points of engagement in HIV prevention and care. Qualitative findings included the importance of the internet as a primary source of HIV information. The internet was used because of its ease of accessibility, because of its ability to maintain anonymity while searching for sensitive information, and to mitigate intersecting stigmas in health care settings. Participants used HIV information to assess their risk for HIV and AIDS, support their skill building for HIV prevention, inform patient–doctor communication, and learn about HIV prevention and treatment options. Men expressed concerns about their diminishing access to online spaces for HIV information exchange among YBMSM because of censorship policies on social media sites and the stigmatizing framing and tone of mass media HIV-prevention advertisements encountered while using the internet.

Conclusions

YBMSM in this sample had high utilization of eHealth for HIV information acquisition and use but diminished access to their preferred and most trusted source of HIV information: health care providers. Future eHealth-based HIV interventions culturally tailored for YBMSM should aim to reduce intersectional stigma at the point of care and support patient–provider communication. The findings demonstrate the need for community-informed, culturally tailored HIV messaging and online spaces for informational support exchange among YBMSM.

Interactive digital interventions for prevention of sexually transmitted HIV

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.

A Web-Based Game for Young Adolescents to Improve Parental Communication and Prevent Unintended Pregnancy and Sexually Transmitted Infections (The Secret of Seven Stones): Development and Feasibility Study

Background

Early adolescent unintended pregnancy and sexually transmitted infection prevention are significant public health challenges in the United States. Parental influence can help adolescents make responsible and informed sexual health decisions toward delayed sexual debut; yet parents often feel ill equipped to communicate about sex-related topics. Intergenerational games offer a potential strategy to provide life skills training to young adolescents (aged 11-14 years) while engaging them and their parents in communication about sexual health.

Objective

This study aims to describe the development of a web-based online sexual health intergenerational adventure game, the Secret of Seven Stones (SSS), using an intervention mapping (IM) approach for developing theory- and evidence-based interventions.

Methods

We followed the IM development steps to describe a theoretical and empirical model for young adolescent sexual health behavior, define target behaviors and change objectives, identify theory-based methods and practical applications to inform design and function, develop and test a prototype of 2 game levels to assess feasibility before developing the complete 18-level game, draft an implementation plan that includes a commercial dissemination strategy, and draft an evaluation plan including a study design for a randomized controlled trial efficacy trial of SSS.

Results

SSS comprised an adventure game for young adolescent skills training delivered via a desktop computer, a text-based notification system to provide progress updates for parents and cues to initiate dialogue with their 11- to 14-year-old child, and a website for parent skills training and progress monitoring. Formative prototype testing demonstrated feasibility for in-home use and positive usability ratings.

Conclusions

The SSS intergenerational game provides a unique addition to the limited cadre of home-based programs that facilitate parent involvement in influencing young adolescent behaviors and reducing adolescent sexual risk taking. The IM framework provided a logical and thorough approach to development and testing, attentive to the need for theoretical and empirical foundations in serious games for health.

The Pathways for African American Success: Does Delivery Platform Matter in the Prevention of HIV Risk Vulnerability Among Youth?

PURPOSE

Technology provides new possibilities for disseminating effective prevention programming to underserved families, such as those residing in rural communities. The present study is an evaluation of a technology-delivered HIV risk prevention program designed for rural African-American families, Pathways for African American Success (PAAS), to determine its promise for increasing access to evidence-based youth risk prevention programs among those in the greatest need.

METHODS

Four hundred and twelve parent/youth dyads were randomly assigned to one of three conditions: (1) in-person facilitator-led PAAS small group, (2) self-directed PAAS technology, or (3) a literature control with home-mailed educational materials.

RESULTS

Compared with families in the literature control condition, families assigned to the PAAS technology or small group conditions demonstrated significantly stronger intervention induced parent-child protective processes (e.g., enhanced discussion quality, clearly articulated norms, and parental expectations about risk engagement) and lower youth intentions to engage in risky behaviors 6 months postintervention. Although some important nuances were noted, this study suggests that the PAAS technology-delivered modality is just as efficacious as the in-person facilitator-led, small group modality in dissuading HIV-related risk behaviors among rural African-American youths.

CONCLUSIONS

Implications for having a menu of service delivery models that address the diverse needs and contexts of families are discussed, including the promise of technology as an alternative modality for reaching populations often characterized as difficult to reach and to engage in family-based preventive interventions.

Results from e-KISS: electronic-KIOSK Intervention for Safer Sex: A pilot randomized controlled trial of an interactive computer-based intervention for sexual health in adolescents and young adults

INTRODUCTION

Interactive computer-based interventions (ICBI) are potentially scalable tools for use in real-world settings to promote sexual health and prevent sexually transmitted infections (STIs) and unintended pregnancies. We developed and assessed the feasibility and acceptability of an ICBI for promoting adolescent and young adult sexual health, and the effectiveness of the intervention in reducing unprotected sex, STIs, and unintended pregnancy.

METHODS

This pilot randomized controlled trial enrolled STI Clinic patients, in Seattle, Washington, who were 14-24 years old and reported unprotected vaginal sex during the last 2 months. Both the control and intervention group used a computerized survey to enter their sexual health and only the intervention group received the ICBI. The ICBI included personalized sexual health feedback from a physician avatar; instructive video modules advocating sexual health; and identification of one behavior to change. At 3-month follow-up, participants reported on interim sexual and pregnancy histories and underwent repeat STI testing. We assessed intervention impact on unprotected vaginal sex, number of sexual partners, incident STIs, and unintended pregnancy.

RESULTS

Of 272 participants, 242 (89%) completed the study, of whom 65% were female. While these findings did not reach statistical significance, at 3-month follow-up, the intervention group reported a 33% lower rate of unprotected vaginal sex (no condom use) [IRR = 0.67, 95% CI: 0.44-1.02]; 29% fewer sex partners [IRR = 0.71, 95% CI: 0.50-1.03]; and 48% fewer STIs [IRR = 0.52, 95% CI: 0.25-1.08] when compared to the control group. Similarly, as compared to the control group, intervention females reported a lower rate of unprotected vaginal sex (no birth control) [IRR = 0.80, 95% CI: 0.47-1.35] and half as many unintended pregnancies (n = 5) versus control females (n = 10) [IRR = 0.51, 95% CI: 0.17-1.58]. In exploratory analyses, intervention females reported fewer partners [IRR = 0.71, 95% CI: 0.50-1.00] and a significantly lower rate of vaginal sex without condoms [IRR = 0.50, 95% CI: 0.30-0.85].

CONCLUSION

The intervention was acceptable to both males and females, and at 3-month follow-up, there were non-significant reductions in risk behavior for all outcomes. Among females, exploratory analysis showed a significant reduction in vaginal sex without condoms.

Improving Sexual Health Education Programs for Adolescent Students through Game-Based Learning and Gamification

An effective innovative pedagogy for sexual health education is required to meet the demands of technology savvy digital natives. This study investigates the extent to which game-based learning (GBL) and gamification could improve the sexual health education of adolescent students. We conducted a randomized control trial of GBL and gamification experimental conditions. We made a comparison with traditional teaching as a control condition in order to establish differences between the three teaching conditions. The sexual health education topics were delivered in a masked fashion, 40-min a week for five weeks. A mixed-method research approach was uses to assess and analyze the results for 120 students from a secondary school in Dar Es Salaam, Tanzania. Students were divided into groups of 40 for each of the three teaching methods: GBL, gamification, and the control group (the traditional teaching method). The average post-test scores for GBL (Mean = 79.94, SD = 11.169) and gamification (Mean = 79.23, SD = 9.186) were significantly higher than the control group Mean = 51.93, SD = 18.705 (F (2, 117) = 54.75, p = 0.001). Overall, statistically significant differences (p ≤ 0.05) were found for the constructs of Motivation, Attitude, Knowledge, and Engagement (MAKE). This study suggests that the two innovative teaching approaches can be used to improve the sexual health education of adolescent students. The methods can potentially contribute socially, particularly in improving sexual health behaviour and adolescents' knowledge in regions plagued by years of sexual health problems, including HIV/AIDS.

Key factors influencing comfort in delivering and receiving sexual health education: Middle school student and teacher perspectives

Sexual health education (SHE) provides students with knowledge and skills to establish healthy relationships, understand sexual development, and prevent risk behaviors; therefore, it is critical to understand how to optimize the delivery and receipt of this education. Using a grounded theory approach, interviews with middle school health education teachers (n=13) and focus groups with students (n=41) were conducted to examine factors that influence perceived comfort delivering and receiving SHE in a public school district. Findings identified key barriers including disruptive behavior, insufficient time, and lack of dedicated classrooms. Some key facilitators to comfort included professional development and establishing ground rules.

Effectiveness of a Brief Multi-Component Intervention to HIV Prevention Among Spanish Youth

The greater rate of HIV infection occurs before age 30 in Spain. Our aim was to evaluate the long-term impact of a brief HIV preventive intervention on key sexual risk behavior components in Spanish young population. Participants were 467 young people aged 18-25 years who participated in B-PAPY intervention. They were evaluated at four times: a week, a month, three months and one year after intervention. A self-administered instrument was used. It was found a significant increase from pre-test to follow-ups in HIV knowledge, HIV susceptibility perception, confidence in condom and use of condoms. There were decreases statistically significant in the perceived severity of AIDS. The HIV intervention showed effectiveness over time in the main risk variables for HIV infection. Brief multi-component HIV interventions would be a useful resource to generalize HIV prevention.

Health literacy in the eHealth era: A systematic review of the literature

OBJECTIVES

This study aimed to identify studies on online health service use by people with limited health literacy, as the findings could provide insights into how health literacy has been, and should be, addressed in the eHealth era.

METHODS

To identify the relevant literature published since 2010, we performed four rounds of selection-database selection, keyword search, screening of the titles and abstracts, and screening of full texts. This process produced a final of 74 publications.

RESULTS

The themes addressed in the 74 publications fell into five categories: evaluation of health-related content, development and evaluation of eHealth services, development and evaluation of health literacy measurement tools, interventions to improve health literacy, and online health information seeking behavior.

CONCLUSION

Barriers to access to and use of online health information can result from the readability of content and poor usability of eHealth services. We need new health literacy screening tools to identify skills for adequate use of eHealth services. Mobile apps hold great potential for eHealth and mHealth services tailored to people with low health literacy.

PRACTICE IMPLICATIONS

Efforts should be made to make eHealth services easily accessible to low-literacy individuals and to enhance individual health literacy through educational programs.

Promoting Parent-Child Sexual Health Dialogue with an Intergenerational Game: Parent and Youth Perspectives

OBJECTIVES

Sexual health discussions between parents and their preadolescent youth can delay sexual debut and increase condom and contraceptive use. However, parents frequently report being uncomfortable talking with their youth about sex, often reporting a lack of self-efficacy and skills to inform and motivate responsible decision making by youth. Intergenerational games may support parent-youth sexual health communication. The purpose of this study was to explore parent and youth perspectives on a proposed intergenerational game designed to increase effective parent-youth sexual health communication and skills training.

MATERIALS AND METHODS

Eight focus groups were conducted: four with parents (n=20) and four with their 11-14-year-old youth (n=19), to identify similarities and differences in perspectives on gaming context, delivery channel, content, and design (components, features, and function) that might facilitate dyadic sexual health communication.

RESULTS

Participants concurred that a sex education game could improve communication while being responsive to family time constraints. They affirmed the demand for an immersive story-based educational adventure game using mobile platforms and flexible communication modalities. Emergent themes informed the development of a features inventory (including educational and gaming strategies, communication components, channel, and setting) and upper-level program flow to guide future game development.

CONCLUSIONS

This study supports the potential of a game to be a viable medium to bring a shared dyadic sexual health educational experience to parents and youth that could engage them in a motivationally appealing way to meaningfully impact their sexual health communication and youth sexual risk behaviors.

Evaluating the Effectiveness of an Interactive Multimedia Computer-Based Patient Education Program in Cardiac Rehabilitation

The authors have developed a computer-assisted patient education program on exercise and heart health that uses hypermedia-programming techniques. The program design integrated interactive behavioral instructional strategies with attractive multimedia presentations. It also employed user-friendly computer input methods like touch screens to facilitate elderly clients' participation. The learning outcome of patients who were using the computer-assisted educational method was compared to that of patients using the conventional tutorial method. There were 48 cardiac patients (mean age = 58.81) participating in the tutorial-based education, and another 48 (mean age = 56.12) participating in the computer-assisted education program. Results of repeated measures analysis of variance showed that both the computer-assisted instruction (CAI) and tutorial groups had significant improvement in their exercise knowledge (F = 70.68, p, .001) and self-efficacy in applying exercise principles (F = 54.33, p, .002 before and after the training program. A test of between-subjects effects showed that there was a significant main group effect on the exercise knowledge change (F = 29.22, p, .002), but not on the exercise self-efficacy change CF = 1.68, p, .05). In spite of this, the results showed that the CAI group had significantly better exercise knowledge than the tutorial group in both the post-training and follow-up phases. The better learning outcome of the CAI group might be attributed to allowing students to study at their own pace, repeat the difficult parts, and interact with the program contents. Most of the subjects in the computer-assisted group stated they preferred this mode of learning. However, some of them preferred the tutorial method because they could seek help from the tutor when in doubt. From the present results, an interactive multimedia computer-assisted patient education program was demonstrated to be effective for cardiac education. The computer-assisted instructional method is recommended for public health education, such as disease prevention and patients' self-management of chronic diseases.

A Cervical Cancer CD-ROM Intervention for College-Age Women: Lessons Learned from Development and Formative Evaluation

Despite the decline of incidence rates of cervical cancer over the past 50 years, data suggest an increase of precervical cancer among college women. This increase may be the result of the high prevalence of the Human Papillomavirus (HPV) among this population. To increase cervical cancer prevention behaviors, we developed a computer-based intervention targeting women ages 18 to 24. Through the use of story scripts, role models, and demonstrations (both animated and videotaped procedures), women learn the importance of regular Pap smear screenings, personal risks for developing cervical cancer, the meaning of and dealing with abnormal Pap smears, communication with health care providers, and sexual practices that impact the transmission of HPV. Results from the formative evaluation support the viability of CD-ROM interventions in health education and emphasize the importance of addressing women’s cognitive and affective perceptions surrounding cancer, sexual health, and gynecological exams. Lessons learned from the development process are presented.

Sexual health promotion for young people delivered via digital media: a scoping review

Background

Young 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.

Objectives

To 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.

Design

Literature 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.

Results

There 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.

Conclusions

IDIs 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 work

More 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.

Funding

The National Institute for Health Research Public Health Research programme.

Enhancing Lay Counselor Capacity to Improve Patient Outcomes with Multimedia Technology

Multimedia technologies offer powerful tools to increase capacity of health workers to deliver standardized, effective, and engaging antiretroviral medication adherence counseling. Masivukeni-is an innovative multimedia-based, computer-driven, lay counselor-delivered intervention designed to help people living with HIV in resource-limited settings achieve optimal adherence. This pilot study examined medication adherence and key psychosocial outcomes among 55 non-adherent South African HIV+ patients, on antiretroviral therapy (ART) for at least 6 months, who were randomized to receive either Masivukeni or standard of care (SOC) counseling for ART non-adherence. At baseline, there were no significant differences between the SOC and Masivukeni groups on any outcome variables. At post-intervention (approximately 5-6 weeks after baseline), -clinic-based pill count adherence data available for 20 participants (10 per intervention arm) showed a 10 % improvement for-participants and a decrease of 8 % for SOC participants. Masivukeni participants reported significantly more positive attitudes towards disclosure and medication social support, less social rejection, and better clinic-patient relationships than did SOC participants. Masivukeni shows promise to promote optimal adherence and provides preliminary evidence that multimedia, computer-based technology can help lay counselors offer better adherence counseling than standard approaches.

Efficacy of a group-based multimedia HIV prevention intervention for drug-involved women under community supervision: project WORTH

IMPORTANCE

This study is designed to address the need for evidence-based HIV/STI prevention approaches for drug-involved women under criminal justice community supervision.

OBJECTIVE

We tested the efficacy of a group-based traditional and multimedia HIV/STI prevention intervention (Project WORTH: Women on the Road to Health) among drug-involved women under community supervision.

DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION

We randomized 306 women recruited from community supervision settings to receive either: (1) a four-session traditional group-based HIV/STI prevention intervention (traditional WORTH); (2) a four-session multimedia group-based HIV/STI prevention intervention that covered the same content as traditional WORTH but was delivered in a computerized format; or (3) a four-session group-based Wellness Promotion intervention that served as an attention control condition. The study examined whether the traditional or multimedia WORTH intervention was more efficacious in reducing risks when compared to Wellness Promotion; and whether multimedia WORTH was more efficacious in reducing risks when compared to traditional WORTH.

MAIN OUTCOMES AND MEASURES

Primary outcomes were assessed over the 12-month post-intervention period and included the number of unprotected sex acts, the proportion of protected sex acts, and consistent condom use. At baseline, 77% of participants reported unprotected vaginal or anal sex (n = 237) and 63% (n = 194) had multiple sex partners.

RESULTS

Women assigned to traditional or multimedia WORTH were significantly more likely than women assigned to the control condition to report an increase in the proportion of protected sex acts (β = 0.10; 95% CI = 0.02-0.18) and a decrease in the number of unprotected sex acts (IRR = 0.72; 95% CI = 0.57-0.90).

CONCLUSION AND RELEVANCE

The promising effects of traditional and multimedia WORTH on increasing condom use and high participation rates suggest that WORTH may be scaled up to redress the concentrated epidemics of HIV/STIs among drug-involved women in the criminal justice system.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01784809.

Use of digital media technology for primary prevention of STIs/HIV in youth

STUDY OBJECTIVE

The relevant literature was reviewed to identify issues in research evaluating digital media technology (DMT) interventions for the primary prevention of STIs/HIV in adolescents and young adults.

METHOD

A literature search with relevant key terms was conducted in PubMed, for articles with studies that included: (a) participants between 11-29 years; (b) use of one or more of the following forms of DMT: interactive digital video or CD-ROM, computer, text messaging, or Internet; (c) evaluation of an STI/HIV primary prevention intervention; and (d) use of a cognitive, psychosocial, behavioral, or biological outcome.

RESULTS

Twenty-nine studies were identified and included in the review. Based on the review of these studies, 7 main issues were discussed and recommendations for improving future research were offered. The 7 main issues were: (a) need for a balance between universal application and specific sub-group focus, (b) lack of a developmental framework, (c) challenge of applying DMT in resource limited contexts, (d) rapidly changing nature of DMT, (e) lack of biological outcomes, (f) lack of comparison/control groups to assess the impact of DMT, and (g) limited temporal follow-up.

CONCLUSIONS

There is increasing literature evaluating the effectiveness of DMT for preventing STIs/HIV among adolescents and young adults. A careful consideration of 7 main issues identified in the literature can improve the design and evaluation of these interventions and enhance our understanding of their effectiveness.

Conventional vs. tablet computer-based patient education following lung transplantation--a randomized controlled trial

BACKGROUND

Accurate immunosuppression is of critical importance in preventing rejection, while avoiding toxicity following lung transplantation. The mainstay immunosuppressants are calcineurin inhibitors, which require regular monitoring due to interactions with other medications and diet. Adherence to immunosuppression and patient knowledge is vital and can be improved through patient education. Education using tablet-computers was investigated.

OBJECTIVE

To compare tablet-PC education and conventional education in improving immunosuppression trough levels in target range 6 months after a single education. Secondary parameters were ratio of immunosuppression level measurements divided by per protocol recommended measurements, time and patient satisfaction regarding education.

DESIGN

Single-centre, open labelled randomised controlled trial.

PARTICIPANTS

Patients >6 months after lung-transplantation with <50% of calcineurin inhibitor trough levels in target range.

INTERVENTION

Tablet-pc education versus personal, nurse-led education.

MEASUREMENTS

Calcineurin inhibitor levels in target range 6 months after education, level variability, interval adherence, knowledge and adherence was studied. As outcome parameter, renal function was measured and adverse events registered.

RESULTS

Sixty-four patients were 1:1 randomised for either intervention. Levels of immunosuppression 6 months after education were equal (tablet-PC 58% vs. conventional 48%, p = 0.27), both groups improved in achieving a CNI trough level within target range by either education method (delta tablet-PC 29% vs. conventional 20%). In all patients, level variability decreased (-20.4%), whereas interval adherence remained unchanged. Knowledge about immunosuppression improved by 7% and compliance tests demonstrated universal improvements with no significant difference between groups.

CONCLUSION

Education is a simple, effective tool in improving adherence to immunosuppression. Tablet-PC education was non-inferior to conventional education.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01398488 http://clinicaltrials.gov/ct2/show/NCT01398488? term=gottlieb+tablet+pc+education&rank=1.

Smartphone Delivery of Mobile HIV Risk Reduction Education

We sought to develop and deploy a video-based smartphone-delivered mobile HIV Risk Reduction (mHIVRR) intervention to individuals in an addiction treatment clinic. We developed 3 video modules that consisted of a 10-minute HIVRR video, 11 acceptability questions, and 3 knowledge questions and deployed them as a secondary study within a larger study of ecological momentary and geographical momentary assessments. All 24 individuals who remained in the main study long enough completed the mHIVRR secondary study. All 3 videos met our a priori criteria for acceptability "as is" in the population: they achieved median scores of ≤2.5 on a 5-point Likert scale; ≤20% of the individuals gave them the most negative rating on the scale; a majority of the individuals stated that they would not prefer other formats over video-based smartphone-delivered one (all P < 0.05). Additionally, all of our video modules met our a priori criteria for feasibility: ≤20% of data were missing due to participant noncompliance and ≤20% were missing due to technical failure. We concluded that video-based mHIVRR education delivered via smartphone is acceptable, feasible and may increase HIV/STD risk reduction knowledge. Future studies, with pre-intervention assessments of knowledge and random assignment, are needed to confirm these findings.

Masivukeni: development of a multimedia based antiretroviral therapy adherence intervention for counselors and patients in South Africa

Effective medical treatment for HIV/AIDS requires patients' optimal adherence to antiretroviral therapy (ART). In resource-constrained settings, lack of adequate standardized counseling for patients on ART remains a significant barrier to adherence. Masivukeni ("Let's Wake Up" in Xhosa) is an innovative multimedia-based intervention designed to help people living with HIV in resource-limited settings achieve and maintain high levels of ART adherence. Adapted from a couples-based intervention tested in the United States (US), Masivukeni was developed through community-based participatory research with US and South African partners and informed by Ewart's Social Action Theory. Innovative computer-based multimedia strategies were used to translate a labor- and training-intensive intervention into one that could be readily and widely used by lay counselors with relatively little training with low-literacy patients. In this paper, we describe the foundations of this new intervention, the process of its development, and the evidence of its high acceptability and feasibility.

It's Your Game…Keep It Real: can innovative public health prevention research thrive within a comparative effectiveness research framework?

The federal comparative effectiveness research (CER) initiative is designed to evaluate best practices in health care settings where they can be disseminated for immediate benefit to patients. The CER strategic framework comprises four categories (research, human and scientific capital, data infrastructure, and dissemination) with three crosscutting themes (conditions, patient populations, and types of intervention). The challenge for the field of public health has been accommodating the CER framework within prevention research. Applying a medicine-based, research-to-practice CER approach to public health prevention research has raised concerns regarding definitions of acceptable evidence (an evidence challenge), effective intervention dissemination within heterogeneous communities (a dissemination and implementation challenge), and rewards for best practice at the cost of other promising but high-risk approaches (an innovation challenge). Herein, a dynamic operationalization of the CER framework is described that is compatible with the development, evaluation, and dissemination of innovative public health prevention interventions. An effective HIV, STI, and pregnancy prevention program, It's Your Game…Keep It Real, provides a case study of this application, providing support that the CER framework can compatibly coexist with innovative, community-based public health prevention research.

Computer-based interventions for sexual health promotion: systematic review and meta-analyses

This systematic review was conducted to determine the effects of self-help interactive computer-based interventions (ICBIs) for sexual health promotion. We searched 40 databases for randomized controlled trials (RCTs) of computer-based interventions, defining 'interactive' as programmes that require contributions from users to produce personally relevant material. We conducted searches and analysed data using Cochrane Collaboration methods. Results of RCTs were pooled using a random-effects model with standardized mean differences for continuous outcomes and odds ratios (ORs) for binary outcomes, with heterogeneity assessed using the I(2) statistic. We identified 15 RCTs of ICBIs (3917 participants). Comparing ICBIs to minimal interventions, there were significant effects on sexual health knowledge (standardized mean difference [SMD] 0.72, 95% confidence interval [CI] 0.27-1.18); safer sex self-efficacy (SMD 0.17, 95% CI 0.05-0.29); safer-sex intentions (SMD 0.16, 95% CI 0.02-0.30); and sexual behaviour (OR 1.75, 95% CI 1.18-2.59). ICBIs had a greater impact on sexual health knowledge than face-to-face interventions did (SMD 0.36, 95% CI 0.13-0.58). ICBIs are effective tools for learning about sexual health, and show promising effects on self-efficacy, intention and sexual behaviour. More data are needed to analyse biological outcomes and cost-effectiveness.

The promise of multimedia technology for STI/HIV prevention: frameworks for understanding improved facilitator delivery and participant learning

There is increasing excitement about multimedia sexually transmitted infection (STI) and HIV prevention interventions, yet there has been limited discussion of how use of multimedia technology may improve STI/HIV prevention efforts. The purpose of this paper is to describe the mechanisms through which multimedia technology may work to improve the delivery and uptake of intervention material. We present conceptual frameworks describing how multimedia technology may improve intervention delivery by increasing standardization and fidelity to the intervention material and the participant's ability to learn by improving attention, cognition, emotional engagement, skills-building, and uptake of sensitive material about sexual and drug risks. In addition, we describe how the non-multimedia behavioral STI/HIV prevention intervention, Project WORTH, was adapted into a multimedia format for women involved in the criminal justice system and provide examples of how multimedia activities can more effectively target key mediators of behavioral change in this intervention.

eHealth interventions for HIV prevention

The rapidly changing media landscape and proliferation of new technologies creates vast new opportunities for HIV prevention. The fast growth of the relatively new eHealth field is a testament to the excitement and promise of these new technologies. eHealth interventions in HIV prevention tested to date include computer- and Internet-based interventions; chat room interventions; text messaging interventions; and social media. The current article provides a brief review of these types of interventions in HIV prevention, including their unique advantages and evidence of efficacy. Implications for future research in the eHealth HIV prevention field are discussed.

Preliminary efficacy of a computer-based HIV intervention for African-American women

This study evaluated the preliminary efficacy of a computer-based HIV intervention to enhance HIV-protective sexual behaviours, based on a randomised controlled trial among 135 African-American women, 21-29 years of age, seeking services at Planned Parenthood in Atlanta, GA. Participants were randomised either to a control session two, 60-minute computer-based HIV intervention sessions administered on a laptop computer that each concluded with a 15-minute small group session or to a control session of general health information including discussion on HIV prevention. Relative to controls, participants in the computer-based HIV intervention were more knowledgeable about HIV/STD prevention and reported higher scores on the measure of condom use self-efficacy at 3 months post-intervention; they also reported a higher percentage of condom-protected sex and were more likely to use condoms consistently for vaginal sex (odds ratio, OR = 5.9; p < 0.039) and were more likely to use condoms consistently for oral sex (OR = 13.83; p < 0.037). This relatively brief intervention provides preliminary support that an evidence-based group-based HIV prevention intervention for young African-American women can be adapted to a computer-based HIV intervention.

Translating an effective group-based HIV prevention program to a program delivered primarily by a computer: methods and outcomes

We describe development of SAHARA (SISTAS Accessing HIV/AIDS Resources At-a-click), an innovative HIV prevention program that uses a computer to deliver an updated version of SiSTA, a widely used, effective group-level HIV prevention intervention for African American women ages 18-29. Fidelity to SiSTA's core components was achieved using: (1) video clips featuring group discussions and modeling of appropriate sexual- and contraceptive-related behavior; and (2) interactive Flash modules facilitating cognitive rehearsal, providing learning experiences through games and quizzes, and providing opportunities for simulated role-play. A preliminary outcome study of SAHARA conducted at Planned Parenthood, Atlanta, found that SAHARA, when followed by a brief 20-minute wrap-up group session facilitated by a health educator, was effective in promoting consistent condom use for vaginal sex. We discuss the potential advantages and challenges of an intervention like SAHARA delivered by computer to an individual, versus one like SiSTA delivered by a health educator to a small group.

Testing the Efficacy of a Computer-Based Parent-Adolescent Sexual Communication Intervention for Latino Parents

The efficacy of a computer-based intervention to increase parent-adolescent communication among Latino parents and adolescents was tested in a randomized controlled trial. Parents assigned to receive the 2-session intervention reported greater general communication, sexual communication, and comfort with communication at 3 month follow-up than did parents assigned to the wait-list control condition. Adolescents, whose parents received the intervention, reported higher sexual communication than did adolescents whose parents were in the wait-list control condition. Results provide support for the efficacy of brief parent interventions designed to maximize adolescent support systems. The acceptability of the computer-based format for an underserved population provides an important venue for the delivery and use of health information.

Wireless Technologies, Ubiquitous Computing and Mobile Health: Application to Drug Abuse Treatment and Compliance with HIV Therapies

Beneficial advances in the treatment of substance abuse and compliance with medical therapies, including HAART, are possible with new mobile technologies related to personal physiological sensing and computational methods. When incorporated into mobile platforms that allow for ubiquitous computing, these technologies have great potential for extending the reach of behavioral interventions from clinical settings where they are learned into natural environments.

Interactive computer-based interventions for sexual health promotion

BACKGROUND

Sexual health promotion is a major public health challenge; there is huge potential for health promotion via technology such as the Internet.

OBJECTIVES

To determine effects of interactive computer-based interventions (ICBI) for sexual health promotion, considering cognitive, behavioural, biological and economic outcomes.

SEARCH STRATEGY

We searched more than thirty databases for randomised controlled trials (RCTs) on ICBI and sexual health, including CENTRAL, DARE, MEDLINE, EMBASE, CINAHL, British Nursing Index, and PsycINFO. We also searched reference lists of published studies and contacted authors. All databases were searched from start date to November 2007, with no language restriction.

SELECTION CRITERIA

RCTs of interactive computer-based interventions for sexual health promotion, involving participants of any age, gender, sexual orientation, ethnicity or nationality. 'Interactive' was defined as packages that require contributions from users to produce tailored material and feedback that is personally relevant.

DATA COLLECTION AND ANALYSIS

Two review authors screened abstracts, applied eligibility and quality criteria and extracted data. Results of RCTs were pooled using a random-effects model with standardised mean differences (SMDs) for continuous outcomes and odds ratios (ORs) for binary outcomes. We assessed heterogeneity using the I(2) statistic. Separate meta-analyses were conducted by type of comparator: 1) minimal intervention such as usual practice or leaflet, 2) face-to-face intervention or 3) a different design of ICBI; and by type of outcome (cognitive, behavioural, biological outcomes).

MAIN RESULTS

We identified 15 RCTs of ICBI conducted in various settings and populations (3917 participants). Comparing ICBI to 'minimal interventions' such as usual practice, meta-analyses showed statistically significant effects as follows: moderate effect on sexual health knowledge (SMD 0.72, 95% CI 0.27 to 1.18); small effect on safer sex self-efficacy (SMD 0.17, 95% CI 0.05 to 0.29); small effect on safer-sex intentions (SMD 0.16, 95% CI 0.02 to 0.30); and also an effect on sexual behaviour (OR 1.75, 95% CI 1.18 to 2.59). Data were insufficient for meta-analysis of biological outcomes and analysis of cost-effectiveness.In comparison with face-to-face sexual health interventions, meta-analysis was only possible for sexual health knowledge, showing that ICBI were more effective (SMD 0.36, 95% CI 0.13 to 0.58). Two further trials reported no difference in knowledge between ICBI and face-to-face intervention, but data were not available for pooling. There were insufficient data to analyse other types of outcome.No studies measured potential harms (apart from reporting any deterioration in measured outcomes).

AUTHORS' CONCLUSIONS

ICBI are effective tools for learning about sexual health, and they also show positive effects on self-efficacy, intention and sexual behaviour. More research is needed to establish whether ICBI can impact on biological outcomes, to understand how interventions might work, and whether they are cost-effective.

A systematic review of the literature reporting on studies that examined the impact of interactive, computer-based patient education programs

OBJECTIVE

To evaluate studies that examined the impact of interactive, computer-based education (ICBE) programs on patient education.

METHODS

The Medline and CINAHL databases were searched to identify randomized controlled studies that evaluated the impact of ICBE programs.

RESULTS

The 25 studies that met the selection criteria generally supported the ability of ICBE programs to promote knowledge gains. Results related to economic or clinical outcomes were less consistent. Significant variations were noted across studies in program features, implementation and integration strategies, and in comparison program attributes and quality. It is likely that these differences contributed to the disparity in findings across studies.

CONCLUSION

Although significant inconsistencies in results were noted, the research provided collective evidence that ICBE programs had the potential to add great value to the patient education process. Programs must be properly designed and implementation and integration processes effectively planned in order to achieve consistently positive outcomes.

PRACTICE IMPLICATIONS

Consideration of the "best practices" derived from the research and noted in this report will assist healthcare providers in designing, selecting, and implementing effective ICBE programs.

High-volume rapid HIV testing in an urban emergency department

New Centers for Disease Control and Prevention (CDC) guidelines recommend routine HIV screening in locations including emergency departments. This study evaluates a novel approach to HIV counseling and testing (C&T) in a high-volume inner-city emergency department in terms of the number of patients who can be recruited, tested, test positive, and are linked to care. This prospective evaluation was conducted for 26 months. Noncritically ill or injured patients presenting to an inner-city emergency department were recruited. Patients used a multimedia program that facilitated data entry and viewed previously evaluated HIV counseling videos. Demographic characteristics, risk factors, and sexual history were collected. Data were collected on the number of patients tested, number of HIV-positive patients identified, and number linked to care. Demographic characteristics of the participants were as follows: 48.7% males, mean age 32.6 +/- 11.3, 34.6% Hispanic, and 37.9 % African American. Of the 7109 eligible patients approached, 6214 (87.4%) agreed to be HIV tested. There were 57 newly diagnosed or confirmed HIV-positive patients, representing a seroprevalence of 0.92%. Of those testing positive, 49 (84.2%) were linked to care and had a mean initial CD4 count of 238 cells/mm(3). In conclusion, a video-assisted rapid HIV program in a busy inner-city hospital emergency department can effectively test a high volume of patients and successfully link HIV-positive individuals to care, while providing high-quality education and prevention messages for all those who test.

A randomized control trial evaluating the educational effectiveness of a rapid HIV posttest counseling video

OBJECTIVE

Many of the individuals most at risk for HIV infection (i.e., minority populations, women, adolescents) are also the most marginalized by our health care system. Lacking primary care providers, they rely on the Emergency Department (ED) for their health care needs and education. In this prospective randomized controlled trial, we compared the educational effectiveness of a 15-minute posttest counseling video with the normal practice of a session with an HIV counselor. The study population was composed of ambulatory patients recruited for rapid HIV testing in the ED.

METHODS

The RAs (research assistants) recruited a convenience sample of stable patients presenting to the walk-in section of an inner-city adult ED for rapid HIV testing. Eligible patients for this study included patients who consented for the rapid HIV test and completed measures on condom intention and condom use self-efficacy. Before receiving their results, participants who consented to be in this study were randomized to either a 15-minute HIV posttest educational video available in English/Spanish or to a posttest educational session with an HIV counselor. Afterwards, both groups completed an assessment tool concerning HIV prevention and transmission.

RESULTS

Of the 128 participants, 61 and 67 patients were randomized to the video and counselor groups, respectively. The groups were similar with respect to gender, ethnicity and experience with prior HIV testing. Mean knowledge scores were higher in the video group (76.20% vs. 69.3%; 90% CI for the difference, 2.8, 11.2). As the lower bound of the CI for the difference was higher than the lower equivalence boundary (-5%), we infer that the video was at least as effective as the counselor educational session.

CONCLUSIONS

The use of an educational counseling video is a valid alternative for providing posttest education and prevention information during the waiting period associated with the 20-minute HIV rapid test. Without disruption in clinical flow, both testing and education can be accomplished in a meaningful way in a busy ED.

Feasibility of using computer-assisted interviewing to enhance HIV test counseling in community settings

OBJECTIVES

Significant advances in the treatment of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) place a premium on early detection and linkage to care. Recognizing the need to efficiently yet comprehensively provide HIV counseling, we assessed the feasibility of using audio computer-assisted self-inventory (A-CASI) in a community-based HIV counseling and testing facility.

METHODS

A convenience sample of 50 adults presenting for HIV testing was recruited to complete an 85-item computerized HIV Assessment of Risk Inventory (HARI) containing domains of demographics, sexual behaviors, alcohol and substance use, emotional well-being, past experiences with HIV testing, and attitudes about taking HARI.

RESULTS

Client acceptance rate was limited by the completion time outlined during the intake process. However, the majority of respondents who completed HARI felt that it took only a short to moderate time to complete and was easy to understand. A majority also reported a preference for using a computerized format in the future. Further, HARI identified a number of risk-taking behaviors, including unprotected anal sex and substance use prior to past sexual encounters. Additionally, more than half of the sample reported moderate to severe depressive symptoms.

CONCLUSIONS

Those respondents who had time to complete the survey accepted the A-CASI interview, and it was successful at identifying a substantial level of risk-taking behaviors. A-CASI has the potential to guide HIV counselors in providing risk-reduction counseling and referral activities. However, results suggested the need to shorten the instrument, and further studies are needed to determine applicability in other HIV testing sites.

Internet interventions for traumatic stress: a review and theoretically based example

Trauma recovery Web sites are proliferating with limited supportive evidence for effectiveness. In this article, the authors review the current very early studies on trauma recovery Web sites highlighting the different approaches, the empirical support provided, and the critical development issues facing this exciting frontier. An example site based on social cognitive theory is also reviewed.

Can media promote responsible sexual behaviors among adolescents and young adults?

PURPOSE OF REVIEW

The paper reviews the most recent US and non-US literature on media interventions designed to decrease sexual risk behaviors among adolescents and young adults, and their impact on youth's sexual knowledge, attitudes and behaviors. This review focuses on interventions using mass media, computers and the Internet.

RECENT FINDINGS

Recent research suggests that a variety of media sources and strategies that include mass media communication, computer-assisted instruction and the Internet can be used effectively for increasing knowledge and changing attitudes on sexual health issues and for promoting responsible sexual behaviors among young people. Media interventions seem to be more effective to achieve these goals when an array of channels are used simultaneously and when these efforts are sustained over time.

SUMMARY

Policymakers, school systems, parents and health providers need to be aware that media can be used effectively to decrease sexual risk behaviors in adolescents and young adults, especially when complemented with interpersonal strategies. These interventions can be implemented in different settings such as clinics, schools and colleges and even at a national level through large media campaigns.

A computer-based approach to preventing pregnancy, STD, and HIV in rural adolescents

A computer- and Internet-based intervention was designed to influence several variables related to the prevention of pregnancy, sexually transmitted diseases (STDs), and human immunodeficiency virus (HIV) in rural adolescents. The intervention was guided by the extended parallel process model and was evaluated using a pretest-post-test control group design with random assignment at the school level. Three hundred and twenty-six tenth-grade males and females enrolled in two rural Appalachian public high schools completed the survey at both points in time. Results indicate the vast majority (88.5%) of students in the experimental school completed at least one activity (M = 3.46 for those doing at least one activity). Further, both the overall program and all but one of the activities were rated positively by participants. Regarding the effects of the intervention, results indicate that students in the experimental school were less likely to initiate sexual activity and had greater general knowledge, greater condom negotiation self-efficacy, more favorable attitudes toward waiting to have sex, and greater situational self-efficacy than in the control school. In tandem, the results suggest that the computer-based programs may be a cost-effective and easily replicable means of providing teens with basic information and skills necessary to prevent pregnancy, STDs, and HIV.

The effects of a computer-based pregnancy, STD, and HIV prevention intervention: a nine-school trial

A computer-based intervention was designed to change perceived threat, perceived efficacy, attitudes, and knowledge regarding pregnancy, STD, and HIV prevention in rural adolescents. The intervention, which was guided largely by the extended parallel process model (Witte, 1992), was implemented and evaluated in nine rural high schools using an institutional cycle pretest-posttest control-group design (Campbell & Stanley, 1963; Cook & Campbell, 1979). Eight-hundred eighty-seven ninth-graders completed the survey at both points in time. Process evaluation results indicated that the intervention was implemented as intended, and that over 91% of students in the treatment group completed at least one of the six computer-based activities (M = 3.46, SD = 1.44 for those doing at least one activity). Two-way mixed-model repeated-measures analysis of variance revealed that students in the treatment group outperformed students in the control group on knowledge, condom self-efficacy, attitude toward waiting to have sex, and perceived susceptibility to HIV. These results suggest that computer-based programs may be a cost-effective and easily replicable means of providing teens with basic information and skills necessary to prevent pregnancy, STDs, and HIV.

A brief individualized computer-delivered sexual risk reduction intervention increases HIV/AIDS preventive behavior

PURPOSE

One objective of translational science is to identify elements of human immunodeficiency virus (HIV) risk-reduction interventions that have been shown to be effective and find new ways of delivering these interventions to the community to ensure that they reach the widest possible audience of at-risk individuals. The current study reports the development and evaluation of a computer-delivered, theory-based, individually tailored HIV risk-reduction intervention.

METHODS

This study evaluated the effectiveness of a custom computerized HIV/AIDS risk reduction intervention at increasing HIV/AIDS preventive behaviors in a randomized trial with 157 college students. The intervention content and delivery were based on the Information-Motivation-Behavioral Skills Model of Health Behavior Change and used Motivational Interviewing techniques. Participants completed a baseline assessment of HIV prevention information, motivation, behavioral skills and behavior, attended two brief computer-delivered intervention sessions, and completed a follow-up assessment.

RESULTS

As compared to the control group (a nutrition education tutorial), participants who interacted with the computer-delivered HIV/AIDS risk reduction intervention exhibited a significant increase in risk reduction behavior. Specifically, participants reported a greater frequency of keeping condoms available and displayed greater condom-related knowledge at a four-week follow-up session; among sexually active participants, there was a significant increase in self-reported condom use.

CONCLUSIONS

Delivery of brief individually tailored HIV/AIDS risk reduction interventions via computer may be an effective HIV/AIDS prevention approach for adolescents. More research is needed to further support the effectiveness of this type of intervention and determine the generalizability of these findings to economically and educationally disadvantaged adolescents.

Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence

Numerous theories in social and health psychology assume that intentions cause behaviors. However, most tests of the intention- behavior relation involve correlational studies that preclude causal inferences. In order to determine whether changes in behavioral intention engender behavior change, participants should be assigned randomly to a treatment that significantly increases the strength of respective intentions relative to a control condition, and differences in subsequent behavior should be compared. The present research obtained 47 experimental tests of intention-behavior relations that satisfied these criteria. Meta-analysis showed that a medium-to-large change in intention (d = 0.66) leads to a small-to-medium change in behavior (d = 0.36). The review also identified several conceptual factors, methodological features, and intervention characteristics that moderate intention-behavior consistency.

An experimental evaluation of a group- versus computer-based intervention to improve food portion size estimation skills

The ability to accurately estimate and measure food portion sizes is important for preventing and treating obesity. This study describes the development, implementation and evaluation of a group- versus computer-based intervention to improve food portion estimation abilities using real food and food models. A convenience sample of 76 women was randomly assigned to one of three conditions: computer training, group training or a waitlist control condition. Assessments at baseline and 2 weeks post-intervention included portion size testing using real foods and food models, self-efficacy for judging portion sizes and using measuring utensils, and knowledge of portion information. At baseline, greater estimation errors were observed for amorphous foods. No group by time interaction was observed on estimation of real foods; however, both the computer and group training resulted in significant improvements in estimating the size of food models, greater self-efficacy for judging portion sizes and more accurate knowledge of portion information compared with the control condition. Process measures indicated that the group training was deemed more helpful and more personally relevant to the participants.

Health benefits and risks of the Internet

The linking of the Internet with health and medicine involves all levels of society, including individuals, health care providers, professional organizations, communities, and local and federal governments. A growing body of evidence suggests that despite the benefits of the Internet, this means of communication also figures into the creation of new forms of health risk for some users. This paper examines the effects of the Internet on the promotion of both health and illness. The discussion focuses on those factors of online communication that produce positive health outcomes and also the potential for health risk. Implications for health providers and for better serving patients are analyzed together with recommendations for improving services for those who go online to access health information.