Using theory to understand how interventions work: Project RESPECT, condom use, and the Integrative Model.

Department of Psychology (Emeritus), California State University Long Beach, Long Beach, USA.
AIDS and Behavior (Impact Factor: 3.49). 06/2007; 11(3):393-407. DOI: 10.1007/s10461-007-9208-9
Source: PubMed

ABSTRACT The Integrative Model of Behavioral Prediction (IM) provides guidelines for the development of successful HIV/STD interventions, yet few HIV prevention programs have identified which components of the IM have been associated with successful behavioral outcomes. Using structural equation modeling, this study examines in detail how components of the IM assessed prior to, and immediately after, the delivery of an intervention are associated with reported condom use 3 months later among participants in Project RESPECT, a multisite randomized controlled trial testing HIV/STD risk reduction strategies among clients attending public health clinics for sexually transmitted diseases. Overall, the IM predicted condom use at 3 months; there were, however, variations in the relative contribution of differing IM components as a function of gender and type of sexual partner as well as the type of intervention the participant had received.

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    ABSTRACT: The emphasis on evidence-based practice requires attention to fidelity in translation of programs. Few studies have assessed fidelity of HIV/STI behavioral counseling and testing programs, including RESPECT. We examined client fidelity for 26 public health departments (HD) and community-based organizations (CBO) delivering RESPECT across the U.S.. Using anonymous client reports on the counseling session (N=808) we constructed agency-level fidelity scores. Seventy percent of agencies demonstrated high fidelity (range: 0-6). We examined client (i.e., demographics, sexual orientation, risk) and agency (i.e., locale, type) characteristics with regard to fidelity. Variables significant at the univariate level were included in multivariate analyses. Multivariate logistic analyses, controlling for clusters, and client risk (OR=1.9; 95% CI= 1.4, 2.6), showed that type of organization (CBO vs. HD; (OR=2.5; 95% CI= 1.3, 4.7)) and client race/ethnicity were significantly associated with high fidelity ((OR= 2.6, CI= 1.8, 3.8) Hispanics vs. whites). Trends were found for repeat testing (OR=1.4, CI .99-1.9) and being African American vs. white (OR= .16, CI .95-2.8.). As expected, results indicated that program delivery was adapted for low risk clients. Unexpectedly, fidelity was lower for whites and for clients attending HD clinics. Qualitative findings on adaptations reported by program staff (n= 62), offer additional insight into adaptations (e.g., time constraints, client factors). Together these findings suggest that: (a) many agencies deliver RESPECT well, but one-third have moderate to poor fidelity, (b) staff may use client stereotypes in adapting the program in ways that impact fidelity, and (c) organizational factors (e.g., training, time constraints) may influence fidelity.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
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    ABSTRACT: Dissemination of HIV behavioral prevention programs has increased the reach of evidence-based interventions, but there is a paucity of data on implementation and diffusion. The present mixed methods study focused on RESPECT, a brief counseling and testing intervention, examining compliance fidelity and the extent to which Centers for Disease Control and Prevention (CDC) policies and training have diffused to practice settings. Using client exit surveys (N = 830) and counselor interviews (N = 64), we examined implementation in 26 community-based agencies (CBOs) and public health departments (DPHs) in the USA. Multivariate analyses showed that at-risk clients, ethnic minority clients, and those who were primarily seeking services other than HIV/STI testing, were more likely to receive the program with fidelity. Counselor data suggested that multiple factors (e.g., client characteristics, agency structure) impact program adaptations. RESPECT is being delivered with good fidelity and reaching at-risk clients. The data provide support for CDC diffusion efforts. Future studies should continue to examine compliance fidelity and program sustainability.
    12/2014; 4(4):424-33. DOI:10.1007/s13142-014-0268-x
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    ABSTRACT: Korean Americans represent one of the fastest growing Asian subpopulations in the United States. Despite a dramatic reduction in incidence nationwide, cervical cancer remains a major threat for Korean American women. By preventing the strains of the Human Papillomavirus (HPV) known to cause cervical cancer, the HPV vaccines appear to be a promising solution to reduce the persistent disparities in cervical cancer among not only Korean Americans, but also other racial and ethnic minorities more generally. However, current literature lacks a better understanding of how cultural and behavioral factors influence Korean American women's intention to vaccinate their adolescent daughters against HPV. This manuscript presents the results of testing the mechanisms through which interdependent self-construal (an orientation of self in which individuals define themselves primarily through their relationships with others), attitudes, and subjective norms impact Korean American mothers' intention to vaccinate their daughters. Our findings suggest that self-construal holds promise for health communication research to not only uncover the rich variance of health-related beliefs among individuals of shared cultural descent, but also to understand the context in which these beliefs are embedded.
    06/2014; 5(2):96-105. DOI:10.1037/a0036097


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May 31, 2014