Intervention Description
Intervention Package Information
Evaluation Study and Results
References and Contact Information

Intervention Description

Target Population
Heterosexually active, non-monogamous, young women

Goals of Intervention

• Increase condom use

Theoretic Basis

• Transtheoretical Model of behavioral change
• AIDS risk reduction model
• Theory of Reasoned Action

Intervention Duration
Risk assessment followed by two rounds of materials mailed approximately 3 months apart

Intervention Settings
Residential

Deliverer
Materials delivered by mail

Delivery Methods

• Printed Materials
• Supplies (condoms)

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Intervention Package Information

An intervention package is currently being developed with funding from CDC’s Replicating Effective Programs (REP) Project. Contact Dr. Delia Scholes, Center for Health Studies, Group Health Cooperative, 1730 Minor Ave., Suite 1600, Seattle, WA 98101. email: scholes.d@ghc.org for details on intervention materials.

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Evaluation Study and Results

The original evaluation was conducted in two managed care settings in Washington State and North Carolina between 1999 and 2000.

Key Intervention Effects

• Increased condom use

Study Sample
The baseline study sample of 1,210 women is characterized by the following:

• 69% White, 19% African American, 12% other
• 100% Female
• 100% heterosexual
• Mean age of 21 years; 48% 18-20 years, 52% 21-25 years
• 70% completed high school education or more

Recruitment Settings
Two United States managed health care systems

Eligibility Criteria
Heterosexual women were eligible if they were between 18 and 24 years old, had a clinic visit to either health care system within the prior 6 months, were unmarried, had sex with a male partner in the prior 6 months, were not pregnant, and were not in a monogamous relationship for more than 12 months

Assignment Method
Women (N=1,210) were randomly assigned to 1 of 2 groups: Self-help Insights (n = 596) or comparison (n = 614).

Comparison Group
The comparison group received care as usual for each managed health care site.

Relevant Outcomes Measured and Follow-up Time

• Sex behaviors during past 3 months (including condom use with any, primary, or non-primary partner, percent of condom-protected sex acts, and consistent condom use) were measured at baseline and 3 and 6 months after randomization.
• Self-reported STD diagnosis during past 3 months was measured at baseline and 6 months after randomization.
• Because the Extra Insights newsletter was given to participants on average 21 days after the 3-month assessment, the 6-month assessment is equivalent to a 2-month post-intervention follow-up.

Participant Retention

• Self-Help Intervention:

  91% retained after 1st round of materials
  88% retained at 2 months after complete intervention

• Usual Care:

  87% retained after 1st round of materials
  85% retained at 2 months after complete intervention

Significant Findings

• At 2 months after intervention, sexually active participants in the intervention group were significantly more likely to use condoms during sex with any partner (p = .0005) and with a primary partner (p = .0003) than those in the comparison group. These findings were also demonstrated over the two assessment time points (p = .0005 and p = .0001, respectively).
• At 2 months after intervention, sexually active participants in the intervention group had a significantly greater percent of condom-protected sex with any partner (p = .05) than those in comparison group.

Considerations

• This intervention fails to meet the best-evidence criteria due to a short follow-up time.
• At 2 months after intervention, there were no differences in self-reported STD diagnoses among those sexually active in the prior 3 months between groups (p = .93). Detecting effects on STD diagnoses, however, was not a primary goal of the study.
• Sexually active participants who received the intervention in North Carolina were significantly more likely to report consistent condom use with all partners (p = .002) and reported a significantly greater percent of condom-protected sex with any partner (p = .001) than participants in the comparison group, at 2 months after the intervention.
• The intervention had a significantly positive effect on other non-relevant outcomes at 2 months after the intervention. Intervention participants were more likely to report carrying condoms in the prior 3 months (p < .0001), more likely to report discussing condom use with a male partner in the prior 3 months (p < .01), and had greater self-efficacy to use condoms (p = .03) than control participants.
• Almost all intervention participants (96%) recalled receiving one or both of the tailored self-help packets; and, of these, 60% reported reading at least some of the materials while another 33% reported “skimming” the materials.
• Face-to-face contact is not required to deliver this intervention; however, a risk assessment does need to be conducted to inform the prevention messages in the individually-tailored materials. In this study, the risk assessments were done using a computer-assisted telephone interview (CATI).
• Due to the intervention duration, the 6-month assessment is equivalent to a 2-month post-intervention follow-up for the intervention group but a 6-month follow-up for the comparison group.

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References and Contact Information

• Scholes, D., McBride, C., M., Grothaus, L., Civic, D., Ichikawa, L. E., Fish, L. J., et al. (2003). A tailored minimal self-help intervention to promote condom use in young women: Results from a randomized trial. AIDS, 17, 1547-1556.

  Researcher: Dr. Delia Scholes
  Center for Health Studies, Group Health Cooperative
  1730 Minor Ave., Suite 1600
  Seattle, WA 9810
  email: scholes.d@ghc.org 

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