The effectiveness of video-based interventions in promoting condom acquisition among STD clinic patients

Abstract

Goal of this study: This study examined the effectiveness of video-based patient education interventions on promoting condom use among men and women seeking services at a large public STD clinic in New York City.

Methods: Culturally sensitive video-based interventions designed to promote safer sex behaviors were evaluated in a randomized study of black and Hispanic male and female STD clinic patients. Subjects (n = 1,653) were randomly assigned to one of three groups: 1) control, 2) video viewing, and 3) video viewing followed by participation in an interactive group session led by a trained facilitator. The authors examined 1) the effectiveness of interventions in increasing STD and condom-related knowledge, positive attitudes about condoms, human immunodeficiency virus/STD risk perceptions, and self-efficacy and 2) the relationships among these variables, level of intervention, and condom acquisition, a behavioral measure of condom use.

Results: Compared with a control group, subjects assigned to video viewing demonstrated greater knowledge about condoms and STDs, more positive attitudes about condom use, increased human immunodeficiency virus/STD risk perceptions, greater self-efficacy, and higher rates of condom acquisition. Subjects assigned to video viewing followed by interactive sessions demonstrated still further increases in risk perceptions, self-efficacy, and condom acquisition, but not in knowledge or condom attitudes. A significant proportion of the association between the behavioral outcome of condom acquisition and level of intervention is attributable to the impact of interventions on risk perception and self-efficacy.

Conclusions: Based on extensive formative research that identified barriers to safer sex behaviors, video-based interventions were developed to promote condom use among black and Hispanic men and women attending STD clinics. Designed to be integrated into clinic services, these interventions help improve knowledge, promote positive attitudes about condoms, and increase condom acquisition among individuals at high risk of acquiring and transmitting human immunodeficiency virus infection and other STDs.

PIP: In 1992 in New York City, 1653 Black and Hispanic men and women at the Morrisania STD Clinic in the South Bronx were randomly assigned to one of three groups [routine clinic services (control); video viewing (video titles: "Porque Si" for Hispanics and "Let's Do Something Different" for Blacks); and video viewing plus an interactive session] for a study assessing the effectiveness of video interventions in promoting condom acquisition. Condom acquisition was a proxy for condom use. STD patients in the video viewing groups increased their knowledge about condom use and STDs/AIDS (p 0.001). They had more positive attitudes about condom use (p = 0.0021), perceived themselves at a greater risk of contracting an STD or AIDS (p = 0.0314), and had higher levels of self-efficacy (p 0.0001). The video viewing plus interactive session group made further gains in measures of risk perception and self-efficacy (p 0.01) but not in knowledge or positive condom attitudes. 27.4% of the video viewing group and 22% of the routine clinic service group redeemed coupons for condoms at a neighborhood pharmacy compared to 41.4% of those in the video viewing plus interactive session group (p 0.0001). The multiple logistic regression analysis confirmed that scores in knowledge, positive attitudes, perceived risk, and self-efficacy were greater among the video viewing group than the controls (odds ratio [OR] = 1.11, 1.07, 1.10, and 1.08, respectively; p 0.01). When comparing the video viewing group and the video viewing plus interactive session group, there were positive interactions between intervention and risk perception (OR = 1.08) and self-efficacy (OR = 1.07) (p 0.01) but not between intervention and positive condom attitudes. There was a negative interaction between intervention and knowledge for the video viewing plus interactive session group (OR = 0.92; p 0.01). These findings suggest that culturally sensitive video-based interventions improve knowledge, promote positive condom attitudes, and increase condom acquisition among persons at high risk of STDs and AIDS.