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Compendium of Evidence-Based Interventions and
Best Practices for HIV Prevention

Insights

GOOD-EVIDENCE

Intervention Description

Target Population
Heterosexually active, non-monogamous, young women

Goals of Intervention

  • Increase condom use

Brief Description

Insights is an individually-tailored minimal self-help intervention that consists of two prevention packets mailed to participants three months apart. The information in the packets is tailored to the individual based on a baseline risk assessment. The first packet includes a tailored 12-page self-help magazine-style booklet, called Insights, male and female condoms, a condom carrying case, and instructions on how to use condoms. The magazine-style booklet includes non-tailored and tailored elements. The tailored elements are pulled from a “library” of all possible prevention messages to coordinate with responses from the baseline risk assessment survey. The tailored messages are developed utilizing the stages of readiness to use condoms, beliefs and norms about condom use, intentions and efficacy to use condoms, perceived barriers/facilitators to use condoms, and perceived risk. Messages are also tailored based on the following participant characteristics: type of sex partner, ethnicity, binge drinking, STD history, number of sex partners, oral contraceptive use, and whether or not the participant had children. The booklet contains 11 sections – 4 generic sections and 7 sections with varying degrees of tailoring, including an advice column and testimonial stories. Three months later, the participants are mailed a follow-up tailored feedback newsletter, called Extra Insights. Extra Insights focuses on reinforcing messages, removing barriers, and enhancing facilitators to condom use and contains some information tailored to the 3-month telephone survey responses.

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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