Using intervention mapping to adapt an effective HIV, sexually transmitted disease, and pregnancy prevention program for high-risk minority youth

Reducing the risk of HIV/AIDS transmission using intervention mapping: a systematic review

Intervention mapping (IM) is a planning approach that reflects the intricate decision-making process involved in the design of behavior interventions. The development and implementation of IM is complex in preventing HIV/AIDS transmission. Therefore, it is significant to conduct a perfect preliminary work to successfully implement HIV/AIDS prevention. The objectives of this review were to collect and evaluate the data of the first three steps using IM to prevent HIV/AIDS transmission, and summarize the key points in the preliminary steps of IM. A total of 18 studies were identified, and six studies completely described the tasks in the first three steps of IM. Three studies described the logic model of the problem (n = 3). Six studies reported the matrix of behavior changes (n = 6), including personal and environmental determinants. Among the selected determinants, most studies reported the personal level determinants (self-efficacy and skills, knowledge, attitudes, and norms). The most used practical applications in reducing HIV/AIDS risk behaviors were video roles (n = 8) and role-model stories (n = 5). The review may be helpful for healthcare professionals to carefully design and implement the key procedures of the first three steps of the IM programs for people with HIV/AIDS in preventing HIV/AIDS transmission.

Evaluating a Future-Oriented Positive Youth Development Intervention to Reduce Sexual Risk Among Highly Mobile Youth: Results and Challenges

PURPOSE

Youth experiencing or at risk of experiencing homelessness need tailored prevention programming to prevent unplanned pregnancy and sexually transmitted infections. This study evaluated the efficacy of a small-group, future-oriented positive youth development (PYD) intervention to reduce sexual risk behaviors.

METHOD

Youth aged 14-19 (n = 483) experiencing or at risk of experiencing homelessness were recruited at youth-serving agencies and in alternative schools. Each cohort enrolled was randomized either to a 10-session, 5-week group future-oriented intervention to support them in adopting health-promoting behaviors such as using contraception, including condom use (n = 244) or to a no-treatment condition where they received usual services/schooling (n = 239). We assessed at baseline and 3-month and 9-month follow-up (1) vaginal intercourse without consistent contraception use, (2) vaginal and anal intercourse without consistent condom use, and (3) sexual risk behaviors, including current (last 3 months) effective contraception use by females who did not report current use at baseline.

RESULTS

There was no significant difference between treatment and control conditions for most outcomes. However, among females not currently using contraception at baseline, 34% in the treatment condition compared to 12.9% in the control condition reported using contraception in the 3 months before the 9-month survey, a statistically significant difference.

DISCUSSION

This sexual risk reduction intervention, grounded in PYD theory and tailored to address the needs of marginalized groups of youth, demonstrated efficacy at increasing contraceptive uptake among females. The need for PYD interventions that can be delivered in a variety of nontraditional school and service settings are discussed.

Systematic Development of an Intervention to Promote Self-Sampling for HIV and Sexually Transmitted Infections for Men Who Have Sex With Men: An Intervention Mapping Approach

Sexual healthcare aims to reduce HIV and sexually transmitted infections (STIs) by promoting testing and prevention. To better reach men who have sex with men (MSM), additional strategies are needed. Here, we describe development of an intervention, which is part of a broader HIV/STI home-care program, targeted to reach MSM and motivate them to use self-sampling tests. Self-sampling includes blood sampling (finger prick) for HIV, hepatitis B, and syphilis, and a urine sample and oral and anorectal swab samples for chlamydia and gonorrhea. Intervention mapping, a systematic six-step approach, was used to guide the development process: (1) needs assessment including interviews with MSM, (2) create a matrix of change, (3) selection of theory-based methods and practical strategies, (4) intervention development, (5) implementation plan, and (6) evaluation (not included in this paper). Stakeholders were involved to increase program support and feasibility. The needs assessment revealed that testing barriers among MSM related to stigma, time, and privacy concerns. Barriers among healthcare providers related to time, competing priorities, lack of expertise, and guideline restrictions. Included intervention components are designed to overcome these barriers, e.g., engaging role models, with a website with a role model story, and providing tailored information. Methods to reach MSM were a variety of information channels (posters, flyers, and audio-visual displays) and delivery modes, such as advertisements on websites and invitational cards (online and paper) distributed by healthcare providers and MSM themselves (social network testing/peer testing). Our intervention aims to encourage MSM to engage in testing, re-testing, and providing a test to peer MSM. Evidence-based methods to overcome barriers were included to reach and motivate an increased number of MSM. Using intervention mapping stimulated systematic evidence-based decision making and adapting the intervention to the target audience and setting. The next step (step 6) is to implement and evaluate the intervention.

Adapting a home telemonitoring intervention for underserved Hispanic/Latino patients with type 2 diabetes: an acceptability and feasibility study

BACKGROUND

Home telemonitoring is a promising approach to optimizing outcomes for patients with Type 2 Diabetes; however, this care strategy has not been adapted for use with understudied and underserved Hispanic/Latinos (H/L) patients with Type 2 Diabetes.

METHODS

A formative, Community-Based Participatory Research approach was used to adapt a home telemonitoring intervention to facilitate acceptability and feasibility for vulnerable H/L patients. Utilizing the ADAPT-ITT framework, key stakeholders were engaged over an 8-month iterative process using a combination of strategies, including focus groups and structured interviews. Nine Community Advisory Board, Patient Advisory, and Provider Panel Committee focus group discussions were conducted, in English and Spanish, to garner stakeholder input before intervention implementation. Focus groups and structured interviews were also conducted with 12 patients enrolled in a 1-month pilot study, to obtain feedback from patients in the home to further adapt the intervention. Focus groups and structured interviews were approximately 2 hours and 30 min, respectively. All focus groups and structured interviews were audio-recorded and professionally transcribed. Structural coding was used to mark responses to topical questions in the moderator and interview guides.

RESULTS

Two major themes emerged from qualitative analyses of Community Advisory Board/subcommittee focus group data. The first major theme involved intervention components to maximize acceptance/usability. Subthemes included tablet screens (e.g., privacy/identity concerns; enlarging font sizes; lighter tablet to facilitate portability); cultural incongruence (e.g., language translation/literacy, foods, actors "who look like me"); nursing staff (e.g., ensuring accessibility; appointment flexibility); and, educational videos (e.g., the importance of information repetition). A second major theme involved suggested changes to the randomized control trial study structure to maximize participation, including a major restructuring of the consenting process and changes designed to optimize recruitment strategies. Themes from pilot participant focus group/structured interviews were similar to those of the Community Advisory Board such as the need to address and simplify a burdensome consenting process, the importance of assuring privacy, and an accessible, culturally congruent nurse.

CONCLUSIONS

These findings identify important adaptation recommendations from the stakeholder and potential user perspective that should be considered when implementing home telemonitoring for underserved patients with Type 2 Diabetes.

TRIAL REGISTRATION

NCT03960424; ClinicalTrials.gov (US National Institutes of Health). Registered 23 May 2019. Registered prior to data collection. https://www.clinicaltrials.gov/ct2/show/NCT03960424?term=NCT03960424&draw=2&rank=1.

Culturally-Based Challenges to and Recommendations for Delivering Adherence Counseling in a Multicultural Biomedical HIV Prevention Trial in Four African Countries

Research is needed to identify how to effectively tailor evidence-based interventions across cultures with limited resources, particularly for behavioral components in large HIV prevention trials. Through surveys and interviews with counselors of sub-Saharan African women during an open-label microbicide trial (MTN-025), we examined language, education, and cultural barriers in delivering a motivational interviewing-based adherence counseling intervention (i.e., Options Counseling). Counselors encountered an array of barriers, most prominently that participants struggled to comprehend culturally incongruent pictorial guides, such as traffic light images, and to uphold product use when primary partners disapproved. Overwhelmingly, counselors cited the intervention's inherent flexibility as an asset; it encouraged them to tailor language and examples to be more culturally relevant to participants. Future resource-conscious researchers may preemptively offset similar barriers by consulting with communities during intervention development. Similarly, affording counselors flexibility while delivering the chosen intervention may enable them to troubleshoot barriers that arise on the ground.

A Telehealth-Delivered Pulmonary Rehabilitation Intervention in Underserved Hispanic and African American Patients With Chronic Obstructive Pulmonary Disease: A Community-Based Participatory Research Approach

BACKGROUND

Although home telemonitoring (TM) is a promising approach for patients managing their chronic disease, rehabilitation using home TM has not been tested for use with individuals living with chronic obstructive pulmonary disease (COPD) residing in underserved communities.

OBJECTIVE

This study aimed to analyze qualitative data from focus groups with key stakeholders to ensure the acceptability and usability of the TM COPD intervention.

METHODS

We utilized a community-based participatory research (CBPR) approach to adapt a home TM COPD intervention to facilitate acceptability and feasibility in low-income African American and Hispanic patients. The study engaged community stakeholders in the process of modifying the intervention in the context of 2 community advisory board meetings. Discussions were audio recorded and professionally transcribed and lasted approximately 2 hours each. Structural coding was used to mark responses to topical questions in interview guides.

RESULTS

We describe herein the formative process of a CBPR study aimed at optimizing telehealth utilization among African American and Latino patients with COPD from underserved communities. A total of 5 major themes emerged from qualitative analyses of community discussions: equipment changes, recruitment process, study logistics, self-efficacy, and access. The identification of themes was instrumental in understanding the concerns of patients and other stakeholders in adapting the pulmonary rehabilitation (PR) home intervention for acceptability for patients with COPD from underserved communities.

CONCLUSIONS

These findings identify important adaptation recommendations from the stakeholder perspective that should be considered when implementing in-home PR via TM for underserved COPD patients.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03007485; https://clinicaltrials.gov/ct2/show/NCT03007485.

Condom Use for Sexually Transmitted Infection Prevention Among Hispanic Teenage Mothers: A Community-Based Randomized Trial

Background: Hispanics experience a higher prevalence of sexually transmitted infections (STIs) than non-Hispanics. Specifically, Hispanic teenagers are more at risk for HIV, have close to four times the rate of primary and secondary syphilis, and close to two times the rate of chlamydia and gonorrhea compared with non-Hispanic white teenagers. Hispanic youth engage in sexual activity at a younger age than non-Hispanic white youth and are less likely to use condoms in these encounters, thereby contributing to increased rates of teenage pregnancy and STIs. Prevention of STIs is needed for unmarried Hispanic teenage mothers. The purpose of this study was to examine whether Project Mothers and Schools (Project MAS), a support program for parenting teenagers, changed condom use to prevent STIs among Hispanic participants. Methods: A longitudinal study was conducted among 84 Hispanic teenage mothers. Generalized estimating equations were used to identify factors associated with participants' reported condom use to prevent STIs. Results: Overall, participants were 3.21 times more likely to report condom use to prevent STIs from baseline to 12-month follow-up (p = 0.030). Those using condoms to prevent pregnancy at 12-month follow-up were significantly more likely to report using a condom to prevent STIs (OR = 3.23, p = 0.017). Conclusions: Participation in Program MAS improved condom use patterns for STI prevention. These services and supports have potential to change unmarried Hispanic teenage mothers' condom use behaviors and decrease STI infection disparities among the teenage Hispanic population.

Adapting health interventions for local fit when scaling-up: a realist review protocol

INTRODUCTION

Scaling-up is essential to ensure universal access of effective health interventions. Scaling-up is a complex process, which occurs across diverse systems and contexts with no one-size-fits-all approach. To date, little attention has been paid to the process of scaling-up in how to make adaptations for local fit. The aim of this research is to develop theory on what actions can be used to make adaptations to health interventions for local fit when scaling-up across diverse contexts that will have practical application for implementers involved in scaling-up.

METHODS AND ANALYSIS

Given the complexity of this subject, a realist review methodology was selected. Specifically, realist review emphasises an iterative, non-linear process, whereby the review is refined as it progresses. The identification of how the context may activate mechanisms to achieve outcomes is used to generate theories on what works for whom in what circumstances. This protocol will describe the first completed stage of development of an initial programme theory framework, which identified potential actions, contexts, mechanisms and outcomes that could be used to make adaptations when scaling-up. It will then outline the methods for future stages of the review which will focus on identifying case examples of scale-up and adaptation in practice. This realist review consists of six stages: (i) clarifying scope and development of a theoretical framework, (ii) developing a search strategy, (iii) selection and appraisal, (iv) data extraction, (v) data synthesis and analysis and (vi) further theory refinement with stakeholders.

ETHICS AND DISSEMINATION

This review will develop theory on how adaptations can be made when scaling-up. Findings will be disseminated in a peer-reviewed journal and through stakeholder engagement as part of the research process. Ethical approval has been received through Health Policy and Management/Centre for Global Health Research Ethics Committee of Trinity College Dublin.

A scoping study of frameworks for adapting public health evidence-based interventions

Evidence-based public health translation of research to practice is essential to improve the public's health. Dissemination and implementation researchers have explored what happens once practitioners adopt evidence-based interventions (EBIs) and have developed models and frameworks to describe the adaptation process. This scoping study identified and summarized adaptation frameworks in published reports and grey literature. We followed the recommended steps of a scoping study: (a) identifying the research question; (b) identifying relevant studies; (c) selecting studies; (d) charting the data; (e) collating, summarizing, and reporting the results; and (f) consulting with experts. We searched PubMed, PsycINFO, PsycNET, and CINAHL databases for articles referencing adaptation frameworks for public health interventions in the published and gray literature, and from reference lists of framework articles. Two reviewers independently coded the frameworks and their steps and identified common steps. We found 13 adaptation frameworks with 11 program adaptation steps: (a) assess community, (b) understand the EBI(s), (c) select the EBI, (d) consult with experts, (e) consult with stakeholders, (f) decide on needed adaptations, (g) adapt the original EBI, (h) train staff, (i) test the adapted materials, (j) implement the adapted EBI, and (k) evaluate. Eight of these steps were recommended by more than five frameworks: #1-3, 6-7, and 9-11. This study is the first to systematically identify, review, describe, and summarize frameworks for adapting EBIs. It contributes to the literature by consolidating key steps in program adaptation of EBIs and describing the associated tasks in each step.

Teachers' competence, school policy and social context-HIV prevention needs of primary schools in Kagera, Tanzania

Sub-Saharan Africa carries a high burden of the HIV epidemic, with young adults being particularly affected. Well-designed school-based HIV prevention interventions can contribute to establishing protective behaviour. The aim of this study was to explore the needs of primary school students and teachers in the region of Kagera, Tanzania, regarding an HIV prevention intervention in the primary school setting. The needs assessment was structured according to the PRECEDE component of the PRECEDE-PROCEED model. Qualitative data was collected in six focus group discussions with primary school students and teachers. Key informant interviews with seven experts were conducted. We employed qualitative content analysis to analyse data in MAXQDA. The findings suggest that teachers need to be adequately trained to provide HIV and sex education and to support HIV-positive students. Enabling structural factors, such as an appropriate syllabus, are required. Stigmatization has been reported a major barrier to HIV prevention in schools. Teachers and students identified a more trustful relationship between each other as well as to legal guardians of children as a basis for HIV prevention. These findings will inform the development of a tailored HIV prevention intervention.

Développement et implantation d'une intervention ciblée encourageant le dépistage régulier du VIH chez les travailleuses du sexe au Bénin : application du protocole d' intervention mapping

Cet article présente le processus suivi pour développer et implanter une intervention ciblée encourageant les femmes travailleuses du sexe (TS) à se faire dépister régulièrement pour le virus de l'immunodéficience humaine (VIH) dans les services de santé adaptés au Bénin. Le modèle de planification d' intervention mapping (IM) de Bartholomew et al. (2006), structuré en six étapes, a servi de référence pour guider le développement et l'implantation de l'intervention. Une analyse des besoins a été réalisée à partir d'une revue de littérature et d'une étude basée sur la théorie du comportement planifié, d'Ajzen (1991). Cette analyse a permis d'identifier les déterminants associés au comportement sur lesquels ont porté les actions de changement. Les méthodes et stratégies d'intervention ont été basées sur des théories et adaptées aux besoins des femmes TS. Les résultats consistent en une intervention de neuf mois visant à couvrir plus de 1200 femmes TS, en impliquant divers acteurs (intervenants communautaires, agents de santé et pairs éducatrices). La perception de contrôle comportemental, la norme descriptive, les connaissances, l'attitude et l'intention d'adopter le dépistage régulier du VIH constituent les cibles d'action. L'intervention comporte des activités visant des changements individuels et environnementaux à travers diverses méthodes comme le counseling motivationnel, l'éducation par les pairs, le modeling, la communication persuasive, le renforcement de capacités et la réorganisation des services cliniques. L'IM a permis de structurer et d'implanter avec transparence une intervention ciblée visant l'adoption d'un comportement favorable à la santé chez les femmes TS. Les enjeux rencontrés et les leçons tirées de l'application de l'IM en contexte africain francophone peuvent inspirer les planificateurs et professionnels pour améliorer leurs interventions en promotion de la santé.

Qualitative interviews with healthcare staff in four European countries to inform adaptation of an intervention to increase chlamydia testing

OBJECTIVE

To determine the needs of primary healthcare general practice (GP) staff, stakeholders and trainers to inform the adaptation of a locally successful complex intervention (Chlamydia Intervention Randomised Trial (CIRT)) aimed at increasing chlamydia testing within primary healthcare within South West England to three EU countries (Estonia, France and Sweden) and throughout England.

DESIGN

Qualitative interviews.

SETTING

European primary healthcare in England, France, Sweden and Estonia with a range of chlamydia screening provision in 2013.

PARTICIPANTS

45 GP staff, 13 trainers and 18 stakeholders.

INTERVIEWS

The iterative interview schedule explored participants' personal attitudes, subjective norms and perceived behavioural controls around provision of chlamydia testing, sexual health services and training in general practice. Researchers used a common thematic analysis.

RESULTS

Findings were similar across all countries. Most participants agreed that chlamydia testing and sexual health services should be offered in general practice. There was no culture of GP staff routinely offering opportunistic chlamydia testing or sexual health advice, and due to other priorities, participants reported this would be challenging. All participants indicated that the CIRT workshop covering chlamydia testing and sexual health would be useful if practice based, included all practice staff and action planning, and was adequately resourced. Participants suggested minor adaptations to CIRT to suit their country's health services.

CONCLUSIONS

A common complex intervention can be adapted for use across Europe, despite varied sexual health provision. The intervention (ChlamydiA Testing Training in Europe (CATTE)) should comprise: a staff workshop covering sexual health and chlamydia testing rates and procedures, action planning and patient materials and staff reminders via computer prompts, emails or newsletters, with testing feedback through practice champions. CATTE materials are available at: www.STItraining.eu.

The role of intervention mapping in designing disease prevention interventions: A systematic review of the literature

Objective

To assess the role of Intervention Mapping (IM) in designing disease prevention interventions worldwide.

Methods

Systematic search and review of the relevant literature—peer-reviewed and grey—was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines.

Findings

Only five of the twenty two included studies reviewed were RCTs that compared intervention using IM protocol with placebo intervention, and provided the outcomes in terms of percentage increase in the uptake of disease-prevention programmes, and only one of the five studies provided an effect measure in the form of relative risk (RR = 1.59, 95% CI = 1.08–2.34, p = 0.02). Of the five RCTs, three were rated as strong evidences, one as a medium evidence and one as a weak evidence, and they all reported statistically significant difference between the two study groups, with disease prevention interventions that have used the intervention mapping approach generally reported significant increases in the uptake of disease-prevention interventions, ranging from 9% to 28.5% (0.0001 ≤ p ≤ 0.02), On the other hand, all the 22 studies have successfully identified the determinants of the uptake of disease prevention interventions that is essential to the success of disease prevention programmes.

Conclusion

Intervention Mapping has been successfully used to plan, implement and evaluate interventions that showed significant increase in uptake of disease prevention programmes. This study has provided a good understanding of the role of intervention mapping in designing disease prevention interventions, and a good foundation upon which subsequent reviews can be guided.

A Trusted Source of Information: How Systematic Reviews Can Support User Decisions About Adopting Evidence-Based Programs

BACKGROUND

Systematic reviews sponsored by federal departments or agencies play an increasingly important role in disseminating information about evidence-based programs and have become a trusted source of information for administrators and practitioners seeking evidence-based programs to implement. These users vary in their knowledge of evaluation methods and their ability to interpret systematic review findings. They must consider factors beyond program effectiveness when selecting an intervention, such as the relevance of the intervention to their target population, community context, and service delivery system; readiness for replication and scale-up; and the ability of their service delivery system or agency to implement the intervention.

OBJECTIVE

To support user decisions about adopting evidence-based practices, this article discusses current systematic review practices and alternative approaches to synthesizing and presenting findings and providing information.

METHOD

We reviewed the publicly available information on review methodology and findings for eight federally funded systematic reviews in the labor, education, early childhood, mental health/substance abuse, family support, and criminal justice topic areas.

CONCLUSION

The eight federally sponsored evidence reviews we examined all provide information that can help users to interpret findings on evidence of effectiveness and to make adoption decisions. However, they are uneven in the amount, accessibility, and consistency of information they report. For all eight reviews, there is room for improvement in supporting users' adoption decisions through more detailed, accessible, and consistent information in these areas.

School-based interventions for improving contraceptive use in adolescents

BACKGROUND

Young women, especially adolescents, often lack access to modern contraception. Reasons vary by geography and regional politics and culture. The projected 2015 birth rate in 'developing' regions was 56 per 1000 compared with 17 per 1000 for 'developed' regions.

OBJECTIVES

To identify school-based interventions that improved contraceptive use among adolescents

SEARCH METHODS

Until 6 June 2016, we searched for eligible trials in PubMed, CENTRAL, ERIC, Web of Science, POPLINE, ClinicalTrials.gov and ICTRP.

SELECTION CRITERIA

We considered randomized controlled trials (RCTs) that assigned individuals or clusters. The majority of participants must have been 19 years old or younger.The educational strategy must have occurred primarily in a middle school or high school. The intervention had to emphasize one or more effective methods of contraception. Our primary outcomes were pregnancy and contraceptive use.

DATA COLLECTION AND ANALYSIS

We assessed titles and abstracts identified during the searches. One author extracted and entered the data into RevMan; a second author verified accuracy. We examined studies for methodological quality.For unadjusted dichotomous outcomes, we calculated the Mantel-Haenszel odds ratio (OR) with 95% confidence interval (CI). For cluster randomized trials, we used adjusted measures, e.g. OR, risk ratio, or difference in proportions. For continuous outcomes, we used the adjusted mean difference (MD) or other measures from the models. We did not conduct meta-analysis due to varied interventions and outcome measures.

MAIN RESULTS

The 11 trials included 10 cluster RCTs and an individually randomized trial. The cluster RCTs had sample sizes from 816 to 10,954; the median number of clusters was 24. Most trials were conducted in the USA and UK; one was from Mexico and one from South Africa.We focus here on the trials with moderate quality evidence and an intervention effect. Three addressed preventing pregnancy and HIV/STI through interactive sessions. One trial provided a multifaceted two-year program. Immediately after year one and 12 months after year two, the intervention group was more likely than the standard-curriculum group to report using effective contraception during last sex (reported adjusted ORs 1.62 ± standard error (SE) 0.22) and 1.76 ± SE 0.29), condom use during last sex (reported adjusted ORs 1.91 ± SE 0.27 and 1.68 ± SE 0.25), and less frequent sex without a condom in the past three months (reported ratios of adjusted means 0.50 ± SE 0.31 and 0.63 ± SE 0.23). Another trial compared multifaceted two-year programs on sexual risk reduction and risk avoidance (abstinence-focused) versus usual health education. At 3 months, the risk reduction group was less likely than the usual-education group to report no condom use at last intercourse (reported adjusted OR 0.67, 95% CI 0.47 to 0.96) and sex without a condom in the last three months (reported adjusted OR 0.59, 95% CI 0.36 to 0.95). At 3 and after 15 months, the risk avoidance group was also less likely than the usual-education group to report no condom use at last intercourse (reported adjusted ORs 0.70, 95% CI 0.52 to 0.93; and 0.61, 95% CI 0.45 to 0.85). At the same time points, the risk reduction group had a higher score than the usual-education group for condom knowledge. The third trial provided a peer-led program with eight interactive sessions. At 17 months, the intervention group was less likely than the teacher-led group to report oral contraceptive use during last sex (OR 0.57, 95% CI 0.36 to 0.91). This difference may not have been significant if the investigators had adjusted for the clustering. At 5 and 17 months, the peer-led group had a greater mean increase in knowledge of HIV and pregnancy prevention compared with the control group. An additional trial showed an effect on knowledge only. The group with an emergency contraception (EC) session was more likely than the group without the EC unit to know the time limits for using hormonal EC (pill) and the non-hormonal IUD as EC.

AUTHORS' CONCLUSIONS

Since most trials addressed preventing STI/HIV and pregnancy, they emphasized condom use. However, several studies covered a range of contraceptive methods. The overall quality of evidence was low. Main reasons for downgrading the evidence were having limited information on intervention fidelity, analyzing a subsample rather than all those randomized, and having high losses.

A qualitative analysis to optimize a telemonitoring intervention for heart failure patients from disparity communities

Background

The use of telemonitoring is a promising approach to optimizing outcomes in the treatment of heart failure (HF) for patients living in the community. HF telemonitoring interventions, however, have not been tested for use with individuals residing in disparity communities.

Methods

The current study describes the results of a community based participatory research approach to adapting a telemonitoring HF intervention so that it is acceptable and feasible for use with a lower-income, Black and Hispanic patient population. The study uses the ADAPT-ITT framework to engage key community stakeholders in the process of adapting the intervention in the context of two consecutive focus groups. In addition, data from a third focus group involving HF telemonitoring patient participants was also conducted. All three focus group discussions were audio recorded and professionally transcribed and lasted approximately two hours each. Structural coding was used to mark responses to topical questions in the interview guide.

Results

This is the first study to describe the formative process of a community-based participatory research study aimed at optimizing telehealth utilization among African-American and Latino patients from disparity communities. Two major themes emerged from qualitative analyses of the focus group data. The first theme that arose involved suggested changes to the equipment that would maximize usability. Subthemes identified included issues that reflect the patient populations targeted, such as Spanish translation, font size and medical jargon. The second theme that arose involved suggested changes to the RCT study structure in order to maximize participant engagement. Subthemes also identified issues that reflect concerns of the targeted patient populations, such as the provision of reassurances regarding identity protection to undocumented patients in implementing an intervention that utilizes a camera, and that their involvement in telehealth monitoring would not replace their clinic care, which for many disparity patients is their only connection to medical care.

Conclusions

The adaptation, based on the analysis of the data from the three focus groups, resulted in an intervention that is acceptable and feasible for HF patients residing in disparity communities.

Trial registration

NCT02196922; ClinicalTrials.gov (US National Institutes of Health).

Electronic supplementary material

The online version of this article (doi:10.1186/s12911-016-0300-9) contains supplementary material, which is available to authorized users.

Intervention Mapping to Adapt Evidence-Based Interventions for Use in Practice: Increasing Mammography among African American Women

This paper describes and demonstrates the use of the systematic planning process, Intervention Mapping, to adapt an evidence-based public health intervention (EBI). We used a simplified version of Intervention Mapping (IM Adapt) to increase an intervention's fit with a new setting and population. IM Adapt guides researchers and practitioners in selecting an EBI, making decisions about whether and what to adapt, and executing the adaptation while guarding the EBI's essential elements (those responsible for effectiveness). We present a case study of a project in which we used IM Adapt to find, adapt, implement, and evaluate an EBI to improve mammography adherence for African American women in a new practice setting in Houston, Texas. IM Adapt includes the following (1) assess needs and organizational capacity; (2) find EBIs; (3) plan adaptations based on fit assessments; (4) make adaptations; (5) plan for implementation; and (6) plan for evaluation of the adapted EBI. The case study shows an example of how public health researchers and practitioners can use the tool to make it easier to find and use EBIs, thus encouraging greater uptake. IM Adapt adds to existing dissemination and adaptation models by providing detailed guidance on how to decide on effective adaptation, while maintaining the essential elements of the EBI.

Using the collaborative intervention planning framework to adapt a health-care manager intervention to a new population and provider group to improve the health of people with serious mental illness

Background

Health-care manager interventions improve the physical health of people with serious mental illness (SMI) and could be widely implemented in public mental health clinics. Local adaptations and customization may be needed to increase the reach of these interventions in the public mental health system and across different racial and ethnic communities. In this study, we describe how we used the collaborative intervention planning framework to customize an existing health-care manager intervention to a new patient population (Hispanics with SMI) and provider group (social workers) to increase its fit with our local community.

Methods

The study was conducted in partnership with a public mental health clinic that serves predominantly Hispanic clients. A community advisory board (CAB) composed of researchers and potential implementers (e.g., social workers, primary care physicians) used the collaborative intervention planning framework, an approach that combines community-based participatory research principles and intervention mapping (IM) procedures, to inform intervention adaptations.

Results

The adaptation process included four steps: fostering collaborations between CAB members; understanding the needs of the local population through a mixed-methods needs assessment, literature reviews, and group discussions; reviewing intervention objectives to identify targets for adaptation; and developing the adapted intervention. The application of this approach enabled the CAB to identify a series of cultural and provider level-adaptations without compromising the core elements of the original health-care manager intervention.

Conclusions

Reducing health disparities in people with SMI requires community engagement, particularly when preparing existing interventions to be used with new communities, provider groups, and practice settings. Our study illustrates one approach that can be used to involve community stakeholders in the intervention adaptation process from the very beginning to enhance the transportability of a health-care manager intervention in order to improve the health of people with SMI.

Electronic supplementary material

The online version of this article (doi:10.1186/s13012-014-0178-9) contains supplementary material, which is available to authorized users.

Perceptions of HIV/STI prevention among young adults in Sweden who travel abroad: a qualitative study with focus group and individual interviews

BACKGROUND

Young adults are at risk for HIV/STIs because they generally have an active sex life with multiple sexual partners; moreover, they use condoms to a lesser extent. Travelling increases sexually risky behaviour, and among both women and men, sexual contacts abroad are common. Better knowledge of how young adults experience prevention efforts prior to travelling, and what they prefer, is important when planning prevention efforts to this group. Experiences of and attitudes towards prevention efforts against HIV/STI among young adults in Sweden who have travelled abroad were investigated.

METHOD

We conducted 12 focus-group interviews and four individual interviews with young adults (20-29 years) who had travelled abroad within the last 12 months. The interviews were recorded, transcribed verbatim, and analysed using thematic content analysis. Results were discussed from a salutogenic perspective.

RESULTS

Only a few had any experience of prevention efforts against HIV/STIs. The majority welcomed the idea of prevention efforts prior to travelling and would have welcomed more, preferably short reminders or links to reliable websites, or someone professional to discuss the issue with. Most of the young adults would use the Internet to search for information. They proposed the possibility of reaching young adults through social media, and the importance of better basic knowledge in school.

CONCLUSION

It is difficult to reach young adults before their trips abroad. Prevention efforts on HIV/STI must therefore focus on the use of established forums. Setting the foundation for a positive attitude towards condom use is needed during school years. Even social media, where there is the possibility for dialogue, should be used as an information source.

Adaptation Guidance for Evidence-Based Teen Pregnancy and STI/HIV Prevention Curricula: From Development to Practice

Evidence-based interventions (EBIs) are effective in preventing ado-lescent pregnancy and sexually transmitted infections; however, prevention practitioners are challenged when selecting and adapting the most appropriate programs. While there are existing adaptation frameworks, there is little practical guidance in applying research in the field. To address this need, the Centers for Disease Control and Prevention (CDC) Division of Reproductive Health initiated the Adaptation Guidance Project. The project included the development of a comprehensive adaptation guidance framework and adaptation kits for select evidence-based teen pregnancy and HIV prevention programs. In addition, three innovative concepts emerged that have application to other adaptation program and evaluation efforts, including moving research into practice. First, the authors defined the core components of an EBI in three distinct ways: core content, core pedagogy, and core implementation. Second, they piloted a practitioner-friendly adaptation guidance-messaging schema-Green, Yellow, and Red Light Adaptations, and last they included fidelity/adaptation monitoring logs. This article will describe the process used to develop the adaptation guidance kits, including the main features and tools.

Development of a framework and coding system for modifications and adaptations of evidence-based interventions

BACKGROUND

Evidence-based interventions are frequently modified or adapted during the implementation process. Changes may be made to protocols to meet the needs of the target population or address differences between the context in which the intervention was originally designed and the one into which it is implemented [Addict Behav 2011, 36(6):630-635]. However, whether modification compromises or enhances the desired benefits of the intervention is not well understood. A challenge to understanding the impact of specific types of modifications is a lack of attention to characterizing the different types of changes that may occur. A system for classifying the types of modifications that are made when interventions and programs are implemented can facilitate efforts to understand the nature of modifications that are made in particular contexts as well as the impact of these modifications on outcomes of interest.

METHODS

We developed a system for classifying modifications made to interventions and programs across a variety of fields and settings. We then coded 258 modifications identified in 32 published articles that described interventions implemented in routine care or community settings.

RESULTS

We identified modifications made to the content of interventions, as well as to the context in which interventions are delivered. We identified 12 different types of content modifications, and our coding scheme also included ratings for the level at which these modifications were made (ranging from the individual patient level up to a hospital network or community). We identified five types of contextual modifications (changes to the format, setting, or patient population that do not in and of themselves alter the actual content of the intervention). We also developed codes to indicate who made the modifications and identified a smaller subset of modifications made to the ways that training or evaluations occur when evidence-based interventions are implemented. Rater agreement analyses indicated that the coding scheme can be used to reliably classify modifications described in research articles without overly burdensome training.

CONCLUSIONS

This coding system can complement research on fidelity and may advance research with the goal of understanding the impact of modifications made when evidence-based interventions are implemented. Such findings can further inform efforts to implement such interventions while preserving desired levels of program or intervention effectiveness.

Cultural adaptations of behavioral health interventions: a progress report

OBJECTIVE

To reduce health disparities, behavioral health interventions must reach subcultural groups and demonstrate effectiveness in improving their health behaviors and outcomes. One approach to developing such health interventions is to culturally adapt original evidence-based interventions. The goals of the article are to (a) describe consensus on the stages involved in developing cultural adaptations, (b) identify common elements in cultural adaptations, (c) examine evidence on the effectiveness of culturally enhanced interventions for various health conditions, and (d) pose questions for future research.

METHOD

Influential literature from the past decade was examined to identify points of consensus.

RESULTS

There is agreement that cultural adaptation can be organized into 5 stages: information gathering, preliminary design, preliminary testing, refinement, and final trial. With few exceptions, reviews of several health conditions (e.g., AIDS, asthma, diabetes) concluded that culturally enhanced interventions are more effective in improving health outcomes than usual care or other control conditions.

CONCLUSIONS

Progress has been made in establishing methods for conducting cultural adaptations and providing evidence of their effectiveness. Future research should include evaluations of cultural adaptations developed in stages, tests to determine the effectiveness of cultural adaptations relative to the original versions, and studies that advance our understanding of cultural constructs' contributions to intervention engagement and efficacy.

The development of a web-based brief alcohol intervention in reducing heavy drinking among college students: an Intervention Mapping approach

In the Netherlands, young adults' drinking practices have become an issue of public concern since their drinking levels are high. Heavy drinking can place young adults at an increased risk for developing short- and long-term health-related problems. Current national alcohol prevention programmes focus mainly on adolescents and their parents and paying less systematic attention to young adults. The present study describes the theory and evidence-based development of a web-based brief alcohol intervention entitled What Do You Drink (WDYD). We applied the Intervention Mapping (IM) protocol to combine theory and evidence in the development and implementation of WDYD. The WDYD intervention aims to detect and reduce heavy drinking of young adults who are willing to decrease their alcohol consumption, preferably below the Dutch guidelines of low-risk drinking. According to the IM protocol, the development of WDYD resulted in a structured intervention. Reducing heavy drinking to low-risk drinking was proposed as the behavioural outcome. Motivational interviewing principles and parts of the I-Change Model were used as methods in the development of WDYD, whereas computer tailoring was selected as main strategy. An effect and a process evaluation of the intervention will be conducted. IM was found to be a practical instrument for developing the WDYD intervention tailored to a specific target population in the area of alcohol prevention.

Adaptation of a U.S. evidence-based Positive Prevention intervention for youth living with HIV/AIDS in Kinshasa, Democratic Republic of the Congo

Effective HIV prevention programs for people living with HIV/AIDS (PLWH) are important to reduce new infections and to ensure PLWH remain healthy. This paper describes the systematic adaptation of a U.S.-developed Evidence Based Intervention (EBI) using the Centers for Disease Control and Prevention (CDC) Map of Adaption Process for use at a Pediatric Hospital in Kinshasa, Democratic Republic of the Congo (DRC). The adapted intervention, Supporting Youth and Motivating Positive Action or SYMPA, a six-session risk reduction intervention targeted for youth living with HIV/AIDS (YLWH) in Kinshasa was adapted from the Healthy Living Project and guided by the Social Action Theory. This paper describes the process of implementing the first four steps of the ADAPT framework (Assess, Select, Prepare, and Pilot). Our study has shown that an EBI developed and implemented in the U.S. can be adapted successfully for a different target population in a low-resource context through an iterative process following the CDC ADAPT framework. This process included reviewing existing literature, adapting and adding components, and focusing on increasing staff capacity. This paper provides a rare, detailed description of the adaptation process and may aid organizations seeking to adapt and implement HIV prevention EBIs in sub-Saharan Africa and beyond.

The Global HIV Archive: Facilitating the Transition from Science to Practice of Efficacious HIV Prevention Interventions

This paper describes the development, content, and capabilities of the online Global HIV Archive (GHA). With the goal of facilitating widespread adaptation and appropriate use of efficacious HIV prevention programs throughout the globe, GHA has: first, expanded and updated the search for HIV prevention programs originating in low-resource countries; second, identified those meritorious HIV prevention programs meeting established efficacy criteria of technical merit, replicability, and positive outcomes; third, prepared both implementation and evaluation materials from the efficacious programs for public use; fourth, developed interactive wizards or capacity-building tools to facilitate appropriate program selection, implementation, and adaptation; and, fifth, made the efficacious programs and accompanying wizards available to health practitioners throughout the globe in both printed and online formats.

Filling the Gaps in a Fragmented Health Care System: Development of the Health and Welfare Information Portal (ZWIP)

BACKGROUND

Current health care systems are not optimally designed to meet the needs of our aging populations. First, the fragmentation of care often results in discontinuity of care that can undermine the quality of care provided. Second, patient involvement in care decisions is not sufficiently facilitated.

OBJECTIVE

To describe the development and the content of a program aimed at: (1) facilitating self-management and shared decision making by frail older people and informal caregivers, and (2) reducing fragmentation of care by improving collaboration among professionals involved in the care of frail older people through a combined multidisciplinary electronic health record (EHR) and personal health record (PHR).

METHODS

We used intervention mapping to systematically develop our program in six consecutive steps. Throughout this development, the target populations (ie, professionals, frail older people, and informal caregivers) were involved extensively through their participation in semi-structured interviews and working groups.

RESULTS

We developed the Health and Welfare Information Portal (ZWIP), a personal, Internet-based conference table for multidisciplinary communication and information exchange for frail older people, their informal caregivers, and professionals. Further, we selected and developed methods for implementation of the program, which included an interdisciplinary educational course for professionals involved in the care of frail older people, and planned the evaluation of the program.

CONCLUSIONS

This paper describes the successful development and the content of the ZWIP as well as the strategies developed for its implementation. Throughout the development, representatives of future users were involved extensively. Future studies will establish the effects of the ZWIP on self-management and shared decision making by frail older people as well as on collaboration among the professionals involved.

Development of a multilevel intervention to increase HIV clinical trial participation among rural minorities

Minorities are disproportionately affected by HIV/AIDS in the rural Southeast; therefore, it is important to develop targeted, culturally appropriate interventions to support rural minority participation in HIV/AIDS research. Using intervention mapping, we developed a comprehensive multilevel intervention for service providers (SPs) and people living with HIV/AIDS (PLWHA). The authors collected data from both groups through 11 focus groups and 35 individual interviews. Resultant data were used to develop matrices of behavioral outcomes, performance objectives, and learning objectives. Each performance objective was mapped with changeable, theory-based determinants to inform components of the intervention. Behavioral outcomes for the intervention included the following: (a) eligible PLWHA will enroll in clinical trials and (2) SPs will refer eligible PLWHA to clinical trials. The ensuing intervention consists of four SPs and six PLWHA educational sessions. Its contents, methods, and strategies were grounded in the theory of reasoned action, social cognitive theory, and the concept of social support. All materials were pretested and refined for content appropriateness and effectiveness.

Sexual health professionals' evaluations of a prototype computer-based contraceptive planning intervention for adolescents: implications for practice

BACKGROUND

This paper aims to demonstrate how an online planning intervention to enhance contraceptive and condom use among adolescents was viewed by sexual health professionals. It identifies feedback that has facilitated improvement of the intervention both in terms of potential effectiveness and sustainability in practice. The data illustrate how professionals' feedback can enhance intervention development.

METHOD

Ten practitioners (two male; eight female) representing a range of roles in sexual health education and healthcare were given electronic copies of the prototype intervention. Interviews were conducted to elicit feedback. Transcripts of the interviews were subjected to thematic analysis.

RESULTS

Practitioners provided positive feedback about the intervention content, use of on-line media, the validity of planning techniques and the inclusion of males in contraceptive planning. Issues with rapport building, trust, privacy, motivation, and time and resources were raised, however, and the promotion of condom carrying was contentious.

CONCLUSIONS

Professionals' feedback provided scope for developing the intervention to meet practitioners' concerns, thus enhancing likely feasibility and acceptability in practice. Ways in which particular feedback was generalisable to wider theory-based and online intervention development are explored. Some responses indicated that health practitioners would benefit from training to embed theory-based interventions into sexual health education and healthcare.

Health behaviors and mental health of students attending alternative high schools: a review of the research literature

PURPOSE

The purpose of this review is to describe current knowledge about health-risk behaviors and mental health among alternative high school students.

CONCLUSIONS

Substance use, diet and/or physical activity, sexual-risk behaviors, mental health, and violence were reviewed. Students were described as marginalized youth facing significant social environmental challenges. Findings from 43 studies published from 1997-2010 suggested a high prevalence of health-risk behaviors among alternative high school students. Very few studies were conducted by nurse researchers. Suggestions for future research include addressing social environmental factors, resiliency, and emotional/mental health outcomes.

PRACTICE IMPLICATIONS

Alternative high schools offer a venue to conduct research and implement nursing interventions with high-risk, yet resilient, youth.

Cultural tailoring and feasibility assessment of a sexual health middle school curriculum: a pilot test in Puerto Rico

BACKGROUND

To assess the need for cultural tailoring of an effective sexual health middle school curriculum, "It's Your Game: Keep It Real" (IYG), prior to implementation in Puerto Rican (PR) middle schools.

METHODS

Seventy-three seventh-grade bilingual students participated in IYG curriculum activities (both group-based and computer-based) in two 2-hour testing sessions in spring 2008. Rating scales of acceptability, understandability, credibility, ease of use, and motivational appeal and qualitative feedback via open-ended responses and group process provided insight into needed surface and deep structure cultural tailoring.

RESULTS

Students rated IYG highly on cultural tailoring and motivational parameters and were highly engaged by the lesson content. School personnel rated IYG as a feasible strategy for use in PR middle schools. While surface cultural elements (eg, characters, attire, body language) were identified as important foci for adaptation, content related to deeper cultural elements such as core behaviors, risky situations, attitudes, and specific skills were considered as relevant to PR youth as to their US counterparts.

CONCLUSION

Effective human immunodeficiency virus, sexually transmitted disease, and pregnancy skills training prevention programs such as IYG that are developed for minority US youth may offer a feasible option for international implementation when extensive cultural adaptation is not a viable option.

Collaborative planning approach to inform the implementation of a healthcare manager intervention for Hispanics with serious mental illness: a study protocol

BACKGROUND

This study describes a collaborative planning approach that blends principles of community-based participatory research (CBPR) and intervention mapping to modify a healthcare manager intervention to a new patient population and provider group and to assess the feasibility and acceptability of this modified intervention to improve the physical health of Hispanics with serious mental illness (SMI) and at risk for cardiovascular disease (CVD).

METHODS

The proposed study uses a multiphase approach that applies CBPR principles and intervention-mapping steps--an intervention-planning approach--to move from intervention planning to pilot testing. In phase I, a community advisory board composed of researchers and stakeholders will be assembled to learn and review the intervention and make initial modifications. Phase II uses a combination of qualitative methods--patient focus groups and stakeholder interviews--to ensure that the modifications are acceptable to all stakeholders. Phase III uses results from phase II to further modify the intervention, develop an implementation plan, and train two care managers on the modified intervention. Phase IV consists of a 12-month open pilot study (N = 30) to assess the feasibility and acceptability of the modified intervention and explore its initial effects. Lastly, phase V consists of analysis of pilot study data and preparation for future funding to develop a more rigorous evaluation of the modified intervention.

DISCUSSION

The proposed study is one of the few projects to date to focus on improving the physical health of Hispanics with SMI and at risk for CVD by using a collaborative planning approach to enhance the transportability and use of a promising healthcare manager intervention. This study illustrates how blending health-disparities research and implementation science can help reduce the disproportionate burden of medical illness in a vulnerable population.

'Waste the Waist': the development of an intervention to promote changes in diet and physical activity for people with high cardiovascular risk

OBJECTIVES

To identify an evidence-based intervention to promote changes in diet and physical activity and adapt it for a UK primary care setting for people with high cardiovascular risk.

DESIGN

A three-stage mixed-methods design was used to facilitate a strategic approach to programme selection and adaptation.

METHOD

Stage 1: Criteria for scientific quality and local appropriateness were developed for the selection/adaptation of an intervention to promote lifestyle change in people of high cardiovascular risk through (1) patient interviews, (2) a literature search to extract evidence-based criteria for behavioural interventions, and (3) stakeholder consultation. Stage 2: Potential interventions for adaptation were identified and ranked according to their performance against the criteria developed in Stage 1. Stage 3: Intervention mapping (IM) techniques were used to (1) specify the behavioural objectives that participants would need to reach in order to attain programme outcomes, and (2) adapt the selected intervention to ensure that evidence-based strategies to target all identified behavioural objectives were included.

RESULTS

Four of 23 potential interventions identified met the 11 essential criteria agreed by a multi-disciplinary stakeholder committee. Of these, the Greater Green Triangle programme (Laatikainen et al., 2007) was ranked highest and selected for adaptation. The IM process identified 13 additional behaviour change strategies that were used to adapt the intervention for the local context.

CONCLUSIONS

IM provided a useful set of techniques for the systematic adaptation of an existing lifestyle intervention to a new population and context, and facilitated transparent working processes for a multi-disciplinary team.

The World Starts With Me: using intervention mapping for the systematic adaptation and transfer of school-based sexuality education from Uganda to Indonesia

Evidence-based health promotion programmes, including HIV/AIDS prevention and sexuality education programmes, are often transferred to other cultures, priority groups and implementation settings. Challenges in this process include the identification of retaining core elements that relate to the programme’s effectiveness while making changes that enhances acceptance in the new context and for the new priority group. This paper describes the use of a systematic approach to programme adaptation using a case study as an example. Intervention Mapping, a protocol for the development of evidence-based behaviour change interventions, was used to adapt the comprehensive school-based sexuality education programme ‘The World Starts With Me’. The programme was developed for a priority population in Uganda and adapted to a programme for Indonesian secondary school students. The approach helped to systematically address the complexity and challenges of programme adaptation and to find a balance between preservation of essential programme elements (i.e. logic models) that may be crucial to the programme’s effectiveness, including key objectives and theoretical behaviour change methods, and the adaptation of the programme to be acceptable to the new priority group and the programme implementers.

Using intervention mapping to develop and adapt a secondary stroke prevention program in Veterans Health Administration medical centers

Secondary stroke prevention is championed by the stroke guidelines; however, it is rarely systematically delivered. We sought to develop a locally tailored, evidence-based secondary stroke prevention program. The purpose of this paper was to apply intervention mapping (IM) to develop our locally tailored stroke prevention program and implementation plan. We completed a needs assessment and the five Steps of IM. The needs assessment included semi-structured interviews of 45 providers; 26 in Indianapolis and 19 in Houston. We queried frontline clinical providers of stroke care using structured interviews on the following topics: current provider practices in secondary stroke risk factor management; barriers and needs to support risk factor management; and suggestions on how to enhance secondary stroke risk factor management throughout the continuum of care. We then describe how we incorporated each of the five Steps of IM to develop locally tailored programs at two sites that will be evaluated through surveys for patient outcomes, and medical records chart abstraction for processes of care.

Efetividade das ações voltadas à diminuição da gravidez não-planejada na adolescência: revisão da literatura

A gravidez na adolescência é um problema de saúde pública devido à alta ocorrência de morbi-mortalidade materna e infantil e por constituir um possível elemento desestruturador da vida das adolescentes. O objetivo desta revisão foi verificar quais estudos demonstram os resultados da diminuição do índice de gravidez na adolescência a partir de ações estratégicas. Foram identificadas 671 citações na pesquisa às bases de dados, das quais apenas nove foram consideradas apropriadas e utilizadas na análise deste artigo. As abordagens com impacto para redução da ocorrência de gestações precoces foram: a) educação sexual compreensiva (100% com resultados positivos), prevenção de reincidência de gravidez (60%) e programas de abstinência (50%). Apesar de os programas apresentados terem sido focalizados unicamente na população americana, pois foram os que se enquadraram nos critérios de inclusão do presente estudo, observou-se que a utilização de metodologias com abordagens sociais que levam em consideração as diferentes particularidades sócio-demográficas e comportamentais dos adolescentes foram pontos relevantes para o sucesso e reconhecimento das intervenções analisadas, pois são estratégias que remetem à reflexão dos adolescentes sobre as escolhas para sua vida futura.

Using intervention mapping to promote the receipt of clinical preventive services among women with physical disabilities

This article describes the development of Promoting Access to Health Services (PATHS), an intervention to promote regular use of clinical preventive services by women with physical disabilities. The intervention was developed using intervention mapping (IM), a theory-based logical process that incorporates the six steps of assessment of need, preparation of matrices, selection of theoretical methods and strategies, program design, program implementation, and evaluation. The development process used methods and strategies aligned with the social cognitive theory and the health belief model. PATHS was adapted from the workbook Making Preventive Health Care Work for You, developed by a disability advocate, and was informed by participant input at five points: at inception through consultation by the workbook author, in conceptualization through a town hall meeting, in pilot testing with feedback, in revision of the curriculum through an advisory group, and in implementation by trainers with disabilities. The resulting PATHS program is a 90-min participatory small-group workshop, followed by structured telephone support for 6 months.

Cultural adaptation of a U.S. evidence-based parenting intervention for rural Western Kenya: from parents matter! To families matter!

Evidence-based interventions (EBIs) are critical for effective HIV prevention, but time and resources required to develop and evaluate new interventions are limited. Alternatively, existing EBIs can be adapted for new settings if core elements remain intact. We describe the process of adapting the Parents Matter! Program, an EBI originally developed for African American parents to promote effective parent-child communication about sexual risk reduction and parenting skills, for use in rural Kenya. A systematic process was used to assess the community's needs, identify potential EBIs, identify and make adaptations, pilot-test the adapted intervention, and implement and monitor the adapted EBI. Evaluation results showed the adapted EBI retained its effectiveness, successfully increasing parent-child sexual communication and parenting skills. Our experience suggests an EBI can be successfully adapted for a new context if it is relevant to local needs, the process is led by a multidisciplinary team with community representation, and pilot-testing and early implementation are well monitored.

Intervention mapping as a participatory approach to developing an HIV prevention intervention in rural African American communities

Southeastern states are among the hardest hit by the HIV epidemic in this country, and racial disparities in HIV rates are high in this region. This is particularly true in our communities of interest in rural eastern North Carolina. Although most recent efforts to prevent HIV attempt to address multiple contributing factors, we have found few multilevel HIV interventions that have been developed, tailored or tested in rural communities for African Americans. We describe how Project GRACE integrated intervention mapping (IM) methodology with community-based participatory research (CBPR) principles to develop a multilevel, multigenerational HIV prevention intervention. IM was carried out in a series of steps from review of relevant data through producing program components. Through the IM process, all collaborators agreed that we needed a family-based intervention involving youth and their caregivers. We found that the structured approach of IM can be adapted to incorporate the principles of CBPR.

How to adapt effective programs for use in new contexts

A wide variety of underused effective HIV prevention programs exist. This article describes sources for obtaining such effective programs and issues to consider in selecting an existing effective program for use with one's priority population. It also discusses seven steps involved in adapting an effective program to meet the needs of a new context while preserving core components (what made, or is believed to have made, the intervention effective in the first place) and best practices (characteristics common to effective programs). Although the examples presented are from the HIV prevention field, the seven-step framework is applicable to the adaptation of effective programs in other health promotion and disease prevention arenas.

An adapted version of Intervention Mapping (AIM) is a tool for conducting community-based participatory research

The field of public health is increasingly using community-based participatory research (CBPR) to address complex health problems such as childhood obesity. Despite the growing momentum and funding base for doing CBPR, little is known about how to undertake intervention planning and implementation in a community-academic partnership. An adapted version of Intervention Mapping (AIM) was created as a tool for university and elementary school partners to create school-level environment and policy changes aimed at increasing student physical activity and healthy eating. After AIM was completed, interviews were conducted with school partners. Findings indicate AIM is closely aligned to 7 of 9 CBPR principles. Examples include equitable involvement of all partners, co-learning, and balancing knowledge generation and community improvement. Shortcomings, lessons learned, and suggestions for strengthening the AIM process are described.

Integrating multiple health behavior theories into program planning: the PER worksheet

The foundation of a logic model or any theory-based planning model is the identification of the behavioral antecedents and the relationship of these variables to the target behavior. Applying theoretical concepts to specific behaviors and populations is often challenging for practitioners and program planning students. The challenge comes from the abstract definition of theoretical constructs, the duplication of similar constructs in multiple theories, and the need to combine multiple theories. To simplify the planning process when utilizing logic models and health behavior theory, we recommend the use of the PER Worksheet. The PER Worksheet is a planning tool that provides layman-term prompts for identifying health behavior antecedents. It encompasses five common health behavior theories-health belief model, theory of planned behavior, social cognitive theory, an ecological perspective, and transtheoretical model. The PER Worksheet is organized into three columns: Predisposing, Enabling, and Reinforcing factors, terms of the PRECEDE/PROCEED model.

Abstinence-plus programs for HIV infection prevention in high-income countries

BACKGROUND

Abstinence-plus interventions promote sexual abstinence as the best means of preventing acquisition of HIV, but also encourage safer-sex strategies (eg condom use) for sexually active participants.

OBJECTIVES

To assess the effects of abstinence-plus programs for HIV prevention in high-income countries.

SEARCH STRATEGY

We searched 30 electronic databases (eg CENTRAL, PubMed, EMBASE, AIDSLINE, PsycINFO) ending February 2007. Cross-referencing, hand-searching, and contacting experts yielded additional citations.

SELECTION CRITERIA

We included randomized and quasi-randomized controlled trials evaluating abstinence-plus interventions in high-income countries (as defined by the World Bank). Interventions were any efforts that encouraged sexual abstinence as the best means of HIV prevention, but also promoted safer sex. Results were self-reported biological outcomes, behavioral outcomes, and HIV knowledge.

DATA COLLECTION AND ANALYSIS

Three reviewers independently appraised 20070 citations and 325 full-text papers for inclusion and methodological quality; 39 evaluations were included. Due to heterogeneity and data unavailability, we presented the results of individual studies instead of a meta-analysis.

MAIN RESULTS

Studies enrolled 37724 North American youth; participants were ethnically diverse. Programs took place in schools (10), community facilities (24), both schools and community facilities (2), healthcare facilities (2), and family homes (1). Median final follow-up occurred 12 months after baseline. Results showed no evidence that abstinence-plus programs can affect self-reported sexually transmitted infection (STI) incidence, and limited evidence that programs can reduce self-reported pregnancy incidence. Results for behavioral outcomes were promising; 23 of 39 evaluations found a significantly protective intervention effect for at least one behavioral outcome. Consistently favorable program effects were found for HIV knowledge.No adverse effects were observed. Several evaluations found that one version of an abstinence-plus program was more effective than another, suggesting that more research into intervention mechanisms is warranted. Methodological strengths included large samples and statistical controls for baseline values. Weaknesses included under-utilization of relevant outcomes, self-report bias, and analyses neglecting attrition and clustered randomization.

AUTHORS' CONCLUSIONS

Many abstinence-plus programs appear to reduce short-term and long-term HIV risk behavior among youth in high-income countries. Evidence for program effects on biological measures is limited. Evaluations consistently show no adverse program effects for any outcomes, including the incidence and frequency of sexual activity. Trials comparing abstinence-only, abstinence-plus, and safer-sex interventions are needed.

Communication and Information About "Safer Sex:" Intervention Issues Within Communities of African Migrants Living in Poorer Neighbourhoods in Portugal

The aims of this study are to determine the influence of migrant status on sexual behavior and communication about "safer sex" and to identify ethnic-specific prevention issues. Data were obtained from a special administration of the Health Behavior in School-Aged Children Survey in a special sample of Portuguese schools located in low-income Lisbon neighborhoods with large proportions of African migrants.Survey participants included 919 6th, 8th and 10th graders (52.3% female), of whom 19.2% were migrant foreigners from African Portuguese-speaking countries, including Cape Verde (60.8%), Mozambique (1.6%), Angola (16.8%), S. Tomé (8%), and Guinea-Bissau (14.8%). Subsequently, four focus groups were held with adolescent who had participated in the survey (n = 45), three focus group with health and education professionals (n = 25), and one focus group with parents (n = 6).Compared with Portuguese adolescents, African migrant teens reported initial sexual intercourse at earlier ages, less frequent condom use, and less frequent and less comfortable communications with parents about sexual issues.Implications for selective prevention of STD are discussed and recommendations are made.

The experience of having become sexually active for teen mothers

The purpose of this phenomenological study was to describe teen mothers' experience of having become sexually active. Most scholars who have studied teen sexual behavior have used quantitative methods and measured constructs such as self-esteem. Prior to data-gathering, literature about teen sexual behavior was reviewed and set aside to enable a more direct focus on data. Parental consent for participation was obtained for participants under 18. Of the 10 participants (aged 16 to 19 years), all had at least one living child. Each participant took part in 3 audiotaped interviews. Data about perceptions, actions, and intentions were compared across each participant's interviews and interviews of all participants. Four phenomena were discerned as ways in which participants had structured their experiences: (a) making a safe place, (b) redefining myself, (c) creating my own life story, and (c) engaging with the unknown. Compared to prior literature, the phenomena offer a richer and deeper perspective on teen sexual behavior. Findings suggest that efforts to increase perceptions of safety, to support personal identity, to bolster creativity, and to offer exploratory opportunities beyond sexual encounters could enhance effectiveness of programs designed to prevent early-onset sexual activity.

Using Intervention Mapping to develop a programme to prevent sexually transmittable infections, including HIV, among heterosexual migrant men

Background

There is little experience with carefully developed interventions in the HIV/STI prevention field aimed at adult heterosexual target groups in the Netherlands. The ability to apply intervention development protocols, like Intervention Mapping, in daily practice outside of academia, is a matter of concern. An urgent need also exists for interventions aimed at the prevention of STI in migrant populations in the Netherlands. This article describes the theory and evidence based development of HIV/STI prevention interventions by the Municipal Public Health Service Rotterdam Area (MPHS), the Netherlands, for heterosexual migrant men with Surinamese, Dutch-Caribbean, Cape Verdean, Turkish and Moroccan backgrounds.

Methods

First a needs assessment was carried out. Then, a literature review was done, key figures were interviewed and seven group discussions were held. Subsequently, the results were translated into specific objectives ("change objectives") and used in intervention development for two subgroups: men with an Afro-Caribbean background and unmarried men with a Turkish and Moroccan background. A matrix of change objectives was made for each subgroup and suitable theoretical methods and practical strategies were selected. Culturally-tailored interventions were designed and were pre-tested among the target groups.

Results

This development process resulted in two interventions for specific subgroups that were appreciated by both the target groups and the migrant prevention workers. The project took place in collaboration with a university center, which provided an opportunity to get expert advice at every step of the Intervention Mapping process. At relevant points of the development process, migrant health educators and target group members provided advice and feedback on the draft intervention materials.

Conclusion

This intervention development project indicates that careful well-informed intervention development using Intervention Mapping is feasible in the daily practice of the MPHS, provided that sufficient time and expertise on this approach is available. Further research should test the effectiveness of these interventions.

Safer choices 2: rationale, design issues, and baseline results in evaluating school-based health promotion for alternative school students

BACKGROUND

Students attending 'alternative' high schools form relatively small, highly mobile high-risk populations, presenting challenges for the design and implementation of HIV-, other STI-, and pregnancy-prevention interventions. This paper describes the rationale, study design, and baseline results for the Safer Choices 2 program.

STUDY DESIGN

Modified group-randomized intervention trial with cross-over of schools but not of students. The study cohort was defined a priori as those who completed the baseline measures and were still enrolled at the time of first follow-up. DESIGN RESULTS: Of 940 students initially enrolled in the study, 711 (76%) formed the study cohort. There were significant demographic differences between those included and those excluded from the study cohort in sex, age, sexual experience, experience with pregnancy, drug use, and some psychosocial measures. There were no significant differences between the intervention and control groups within the study cohort. The only significant difference between those students excluded from the intervention group and those excluded from the control group was reported age at first intercourse. BASELINE DATA RESULTS: Students (n=940) enrolled were predominately African-American (29.7%) and Hispanic (61.3%); 57.3% were female; 66% had ever had sex; and reported drug use in the previous 30 days ran from 4.3% (cocaine) to 26.9% (marijuana). Of the 627 sexually experienced, 41.8% reported their age at first intercourse as 13 years or younger; 28.5% reported ever being or having gotten someone pregnant; 74% reported sex in the past 3 months. Of the 464 sexually active in the last 3 months, 55.4% reported unprotected intercourse and 31.3% reported using drugs beforehand.

CONCLUSION

The cross-over design will provide a rigorous test of the intervention; however, loss to follow-up of this population can result in some selection bias. Students attending dropout prevention and recovery schools are at high risk for HIV, STIs, and pregnancy, and are in need of interventions.