Beyond the most willing audiences: a meta-intervention to increase exposure to HIV-prevention programs by vulnerable populations

Abstract

Objective: Enrollment in HIV-prevention interventions is more likely when the audience has safer rather than riskier HIV-relevant behavior. Thus, a meta-intervention was designed to increase participation by an audience of infrequent condom users in Florida.

Design: Participants (N = 400) were randomly assigned to 1 of 4 conditions varying the introduction to a counseling program. In the experimental condition, participants were told that the intervention gave participants options but might not change their behavior. In a standard-introduction condition, participants were told that the program was highly effective at changing participants' behaviors. There was also an information-control group containing a description of the program, and a no-information-control group solely containing an invitation.

Main outcome measures: The outcome measure was actual participation in the offered counseling.

Results: Findings indicated that the experimental introduction was the most successful at yielding participation in the counseling program when the audience had low intentions to use condoms in the future.

Conclusion: Intervention introductions countering participants' resistance to change increase participation in HIV-prevention counseling among reluctant clients. Other meta-interventions may be explored to systematically augment the effectiveness of evidence-based health-promotion interventions.

Figure 1

Percentage of participation in counseling as a function of experimental condition. The top panel presents all participants. The bottom panel presents participants with low intentions to use condoms at baseline.