Sexually Transmitted Diseases  >  Program Guidelines  >  Community and Individual Behavior Change Interventions

Program Operations Guidelines for STD Prevention
Community and Individual Behavior Change Interventions

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Sections on this page:

• Important Factors for Effective Behavioral Intervention Programs
• Implementation Considerations
• Key Questions for the Development of Interventions
• CONCLUSIONS

Important Factors for Effective Behavioral Intervention Programs

Behavioral research has identified the following characteristics of effective programs (AED, 1997):

• are designed according to the results of a comprehensive needs assessment, including the identification of target group members' level of motivation to change risk behaviors
• are affordable and easy to access by the target population and are able to respond to other expressed needs of the community
• are culturally competent, relevant to the targeted population (i,e., consistent with norms, attitudes, and beliefs), and include members of the target population in program planning and implementation
• have clearly defined target group(s), interventions and program components, and objectives
• focus on behavioral skills that include how to carry out low-risk, safer behaviors as well as how to avoid and cope with high-risk situations
• do not provide messages that are judgmental, moralistic, or that attempt to instill fear
• have ample duration and intensity to achieve lasting behavior change, and provide support and skills necessary to cope with lapses and setbacks in maintaining safe behavior
• address the social and community norms of the target population so that program participants receive consistent messages and reinforcement for the prescribed behavior change
• are offered to the target group as part of a continuum of health care (e.g., drug and alcohol abuse treatment, HIV testing, family planning, and other health services)
• address other basic needs of the targeted population (e.g., housing, food) for STD prevention to be considered a priority
• are regularly monitored to assure implementation is according to plan and that outcomes are being achieved

Implementation Considerations

Several factors may influence the implementation of risk behavior interventions within the United States (NIH, 1997). First, adherence to interventions is improved when targeted individuals and communities are involved in every phase of devising, developing, and implementing the programs. Input of these individuals is crucial.

Second, programs need to be culturally sensitive. This requires attention not only to ethnicity and language but also to other factors including social class, age, developmental stage, and sexual orientation. Programs conducting interventions with individuals and populations who feel stigmatized by society or intimidated by governmental programs should carefully consider who can most effectively conduct the interventions and what training is needed for those individuals to be most effective with the targeted individuals.

Third, an appropriate intervention dosage must be selected for the population; this includes the number, length, and intensity of the interventions. Studies demonstrate that numerous intervention points over extended periods of time are more efficacious than once only approaches for most populations. Almost all reported studies have short follow-up (3-18 months), which suggests that attention must be paid to maintenance efforts. It may be necessary to include additional, periodic intervention points for subsets of the population; longer-term follow-up would assist in determining that fact.

Fourth, it is important to address political barriers, community myths, and misinformation. For example, scientifically derived results do not support assertions that needle exchange programs will lead to increased needle-injecting by current users or to an increase in the number of users. Nor do the data indicate that sex education programs result in earlier initiation of sexual behavior or in more sexual partners or that condom distribution fosters riskier behavior. To the contrary, outcomes of these programs are quite consistent with the values of most communities. For example, behavioral interventions lead injecting drug users to inject less frequently, and the numbers of users in a community may decrease; after interventions, young people tend to delay initiation of intercourse or, if they are already sexually active, to have fewer partners; and adults, following interventions, engage in fewer incidents of risky sexual behavior. Armed with this knowledge, those who implement programs should confidently solicit the support and involvement of local government, educational, and religious leaders.

Despite gains relevant to implementation of prevention programs, very little cost analysis information has been available to guide state and local health departments, community-based organizations, and other practitioners. These analyses are important in determining the most cost-effective interventions for implementation. In addition, communities lack fiscal resources to support such interventions once they are proven effective. Finally, there are social and cultural barriers to implementation of programs; these include sexual inequality, racism, and homophobia.

Sufficient training of personnel, monitoring of procedures to ensure fidelity to key components and established methods, and strong evaluation plans are essential components of any implementation strategy. When training and local capacity-building are necessary for implementation, training and technical assistance should be available to facilitate prevention programs at the state and local levels. Evaluation results should be reported and widely disseminated so as to advance both science and practice. Newly implemented programs yielding results different from established findings should be carefully compared with original designs in order to explain the variance in outcomes. Some variations in outcomes depend on staff expertise, program quality assurance, or target populations. Other variations seem to be inexplicable.

 

Key Questions for the Development of Interventions

The following key questions may help planners and program managers select or design a more effective prevention program (AED, 1997):

• Did you consider the theoretical basis for the proposed intervention?

  Which theoretical approaches or factors did you use in selecting or developing interventions?

• What are the key features of the intervention selected?

  Are you able to answer the following questions:

  • Who is being targeted?
  • What is the proposed intervention?
  • Where is the intervention being delivered?
  • How is the intervention being delivered?

• Did you consider the general characteristics of effective prevention programs in selecting or developing the intervention?

  Which did you use in the proposed intervention?

• Did you look for and find research on the effectiveness of interventions for target populations similar to the group(s) you are targeting?

  If available, did you use the results in selecting or designing a proposed intervention?

• Have resources been dedicated to research and development, implementation and evaluation?

CONCLUSIONS

In conjunction with the biomedical approaches to the treatment and prevention of STDs, the use of complementary behavioral interventions will have a significant effect on the prevention of STDs. It is important for program managers to conduct logical approaches to behavioral interventions due to limited resources. Emphasis should be placed on reaching the target population with the appropriate intervention at the optimal time. A manager should be knowledgeable of accepted and effective interventions and should use the framework of the intervention as a starting point - do not "reinvent the wheel." Most important, in developing the intervention, careful attention must be taken to ensure that a strong evaluation component is developed which includes a procedure for quality assurance and feedback to further strengthen the approach taken.

A critical next step in the area of behavioral interventions involves the criteria for choosing interventions most ready for implementation in the community. The most obvious is evidence of strong program effects observed under rigorous, controlled research conditions. For those programs with strong effects, priority should be given to reliable interventions that can be delivered with fidelity to the original program model. Usually such programs do not require significant new demands or elaborate research at the delivery site. The lack of evaluation of numerous interventions developed by community organizations means that they have not been demonstrated to be effective. However, because community workers have developed a number of innovative and promising programs, there is a great need for them to work together with researchers to evaluate their programs, thereby advancing risk behavior intervention science and practice (NIH, 1997).

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