Randomized trial in family practice of a brief intervention to reduce STI risk in young adults

Abstract

Background: Young adults represent a high-risk group for sexually transmissible infections (STIs). No randomized controlled trials of interventions in family practice to reduce sexual risk have been reported.

Objectives: We evaluated the impact of brief advice initiated in routine consultations in 20 family practices to modify young adults' risk perception and self-reported risk behaviour for STIs, particularly human immunodeficiency virus (HIV) and hepatitis.

Methods: Patients aged 18-25 years completed self-administered confidential questionnaires in the waiting-room before seeing participating family physicians (FPs). Patients were unobtrusively randomized to receive advice about safe sex and complementary resources from their FP (INT group) or usual care (CONTROL group). Three months later, patients completed mailed follow-up questionnaires to assess changes in risk perception and behaviour.

Results: Three hundred and twelve patients completed baseline questionnaires. Of 237 who agreed to follow-up, 156 (68%) returned self-administered follow-up questionnaires. At post-test, we found equivalent self-reported use of questions to assess any new sexual partner's risk (33 versus 36%) and equivalent self-reported use of condoms on first occasion of sex with a new partner (73 versus 77%). While self-reported behaviour did not change significantly, we demonstrated significant change from pre- to post-test for knowledge of hepatitis risk, for both intervention and control groups. Multiple regression showed that the odds of risk perceptions were significantly higher at post-test than at pre-test for the CONTROL group but not the INT group.

Conclusion: FPs remain to be convinced that allocation of time within consultations to opportunistic health promotion is worthwhile. Indeed, there are many competing demands for such time. Our results do not yet provide compelling evidence for the impact of a brief intervention about STI risk by FPs. As primary prevention efforts for young adults remain important, randomized controlled trials of larger scope are needed.