A Programmatic and Methodologic Review and Synthesis of Clinic-Based Risk-Reduction Interventions for Sexually Transmitted Infections: Research and Practice Implications
The over-arching goal of this article is to systematically review and synthesize empirical findings for sexually transmitted disease risk-reduction programs that were developed and implemented specifically for adolescents seeking health care services at clinical venues. The objective is to examine the reported efficacy of these programs in reducing adolescents' sexually transmitted infection (STI)-associated behavior, in enhancing theoretically and empirically important psychosocial mediators associated with the adoption of STI-preventive behaviors, and, most important, in reducing adolescents' risk of acquiring an STI. In addition, our review assesses program and methodologic characteristics of the studies, determines compliance with standardized reporting guidelines, identifies a subset of program characteristics that are related to efficacy in terms of modifying adolescents' sexual risk behaviors, and examines the research and practice implications of these findings for implementing evidence-based STI risk-reduction programs in clinics.
Available from: Ann Dadich
- "The limited use of evidence-based practice has significant consequences for patients, their communities, and the public purse . This is largely because evidence-based practice is said to enhance quality patient care (at least at the individual level) and optimize the allocation of limited resources [44-46]. This might partly explain current government and academic interest in knowledge translation . "
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ABSTRACT: The primary care sector represents the linchpin of many health systems. However, the translation of evidence-based practices into patient care can be difficult, particularly during healthcare reform. This can have significant implications for patients, their communities, and the public purse. This is aptly demonstrated in the area of sexual health. The aim of this paper is to determine what works to facilitate evidence-based sexual healthcare within the primary care sector.
431 clinicians (214 general practitioners and 217 practice nurses) in New South Wales, Australia, were surveyed about their awareness, their use, the perceived impact, and the factors that hindered the use of six resources to promote sexual healthcare. Descriptive statistics were calculated from the responses to the closed survey items, while responses to open-ended item were thematically analyzed.
All six resources were reported to improve the delivery of evidence-based sexual healthcare. Two resources -- both double-sided A4-placards -- had the greatest reach and use. Barriers that hindered resource-use included limited time, limited perceived need, and limited access to, or familiarity with the resources. Furthermore, the reorganization of the primary care sector and the removal of particular medical benefits scheme items may have hampered clinician capacity to translate evidence-based practices into patient care.
Findings reveal: (1) the translation of evidence-based practices into patient care is viable despite reform; (2) the potential value of a multi-modal approach; (3) the dissemination of relatively inexpensive resources might influence clinical practices; and (4) reforms to governance and/or funding arrangements may widen the void between evidence-based practices and patient care.
Available from: Jennifer L Brown
- "Typically, STI/HIV prevention interventions targeting adolescent females focus on increasing participants' knowledge regarding STI/HIV transmission dynamics, condom use self-efficacy, barriers to condom use, attitudes toward condom use, intentions to use condoms, condom use skills, and facilitating partner communication about sex and condom use      . A recent meta-analysis supports the inclusion of these components in interventions specifically tailored for African-American females: HIV prevention intervention efficacy was greatest in studies that specifically targeted African-American females, used gender-and/or culturally specific materials, addressed empowerment issues, provided skills training in condom use and negotiation of safer sex, and used role playing to teach negotiation skills . Thus, a strong emphasis on enhancing communication and negotiation strategies may be particularly salient for African- American females within the context of STI/HIV prevention interventions. "
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ABSTRACT: To enhance future STI/HIV prevention efforts, this study examined factors associated with adolescents' failure to improve their condom use behaviors after participating in an STI/HIV prevention intervention. African-American adolescent females (N = 205; M age = 17.9) in an STI/HIV prevention intervention trial completed ACASI interviews and provided self-collected vaginal swabs to assess two prevalent STIs at baseline and 6 months after intervention. Analyses compared those who increased condom use after intervention (change group) to those whose condom use did not increase (nonchange group). 43.4% did not increase their condom use after the intervention and were more likely to have an STI at followup (χ(2) = 4.64, P = .03). In a multivariate logistic regression model, the nonchange group was more likely to have (a) higher sensation seeking (AOR = .91, P = .023), (b) a boyfriend (AOR = .32, P = .046), and/or (c) a physical abuse history (AOR = .56, P = .057). There were also differences in the extent to which psychosocial mediators changed between the two groups. Findings highlight the need to tailor STI/HIV interventions to adolescents with a greater degree of sensation seeking and address key relationship characteristics and trauma histories to bolster intervention efficacy.
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ABSTRACT: Sexual behavior can threaten the physical and social well-being of young people in the United States in a variety of ways, as it can put them at risk for infection with the human immunodeficiency virus (HIV), other sexually-transmitted diseases (STDs) and unintended pregnancy. This review describes the current extent of HIV infection in American adolescents, identifies and characterizes particular high-risk groups and risk-bearing and protective behaviors, and identifies barriers to adopting preventive behaviors and using health care services. Our main focus is to present findings from intervention research; we summarize the effects of strategies that operate at the individual level (i.e. biomedical or behavioral, in and outside of the clinic) and environmental level (i.e. family, school and community behavioral) to influence behavioral change and the prevention of HIV infection. Overall, even though abstinence eliminates the risk altogether and the use of condoms can effectively reduce the risk of sexual transmission of HIV, adolescents do not optimally employ these practices. Various approaches to counseling by providers and other behavioral interventions aimed at reducing high-risk sexual behavior have been effective, but have met with limited and short-lived success. Among the areas receiving inadequate attention to date have been the link between biomedical and community-based behavior change interventions and the correspondence of biologic and behavioral outcomes. These areas are explored and directions for future research are suggested.
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