Insights: A Minimal, Self-help, Tailored Intervention for Sexually Active, Non-monogamous Women Who Have Sex With Men

The Research

The Science Behind the Package
  Insights is a minimal, self-help, tailored intervention designed to increase condom use among young women. Specialized software is used to generate two magazines which include tailored and non-tailored messages and are delivered to intervention participants twice over a six month period. The messages in the magazine were developed based on the Transtheoretical Model of behavior change, AIDS Risk Reduction Model (ARRM), and Theory of Reasoned Action (TRA). Thus, the messages address readiness to use condoms, intentions for condom use, self-efficacy and increased condom use, as well as perceived risk for STD/HIV.

Target Population
Insights was tested with non-monogamous women between 18 and 24 years old who are not married and not pregnant and who have sex with men. Although the intervention’s efficacy trial only included women 18 to 24 years of age, researchers believe that the messages in Insights may be appropriate for women up to 29 years old if they are also non-monogamous, not married, and not pregnant.

Intervention
Insights is implemented in six phases. Phase I focuses on recruitment of eligible participants through active outreach or active screening and filtering of an agency’s client base. Upon recruitment, participants are asked to complete a computer-based survey that collects demographic information and data about their sexual behavior (Phase II). In Phase II, participants have the option of completing the survey face-to-face with agency staff, over the telephone, in person at the agency, or off-site without agency assistance.

The participant’s survey data are immediately entered into a software program which contains algorithms for selecting pre-written, tailored, prevention messages addressing condom use based on the participant’s responses (Phase III). In Phase IV, Insights, a 12-page magazine of tailored and non-tailored messages, is printed. An intervention packet, containing the Insights magazine, a welcome letter, condoms, a condom carrier, and instructions on how to use condoms is packaged and delivered to participants, by mail or pick-up at the agency, in Phase V. In the final phase (Phase VI), three months after delivery of the intervention packet, participants are contacted to complete a second survey, similar to the first one, and respective data are used to create a booster tri-fold newsletter, Extra Insights, that is delivered to participants. This follow-up newsletter also contains tailored and non-tailored messages that reinforce condom use messages.

Research Results
Two months after delivery of the complete intervention, participants in the intervention group were significantly more likely than the comparison group participants to:

• Use condoms with any partner and with a primary partner
• Carry condoms
• Discuss condoms with male partners
• Have greater self-efficacy to use condoms

For Details on the Research Findings
Scholes D, McBride CM, Grothaus L, Civic D, Ichikawa LE, Fish L J, et al. (2003). A tailored minimal self-help intervention to promote condom use in young women: Results from a randomized trial. AIDS, 17, 1547-1556.

The Intervention

A Package Developed from Science
Replicating Effective Programs (REP) is a CDC-initiated project that supports the translation of evidence-based HIV/AIDS prevention interventions into everyday practice, by working with the original researchers in developing a user-friendly package of materials designed for prevention providers.

Insights is one of the REP interventions and is the product of extensive collaboration among researchers, community-based organizations, and experts in health communication.

The package has been field tested in community-based organizations and a clinic by non-research staff with women 18-29 years of age. Therefore, this intervention package is appropriate to implement with non-monogamous women up to age 29 who are not married, not pregnant and who have sex with men.

Core Elements
Core elements are intervention components that must be maintained without alteration to ensure program effectiveness. The core elements of Insights include:

Content Core Elements

1. Use pre-written, STD/HIV prevention messages that are tailored to the participant’s responses to the health survey. The messages are included in the Insights message library.
2. Include male and female condoms, condom carrier, and illustrated instructions in the Insights Packet.

Pedagogical Core Elements

3. Obtain participant’s risk data via the computer-based Insights health survey.
4. Encourage participants to read and review the intervention materials alone.

Implementation Core Elements

5. Develop recruitment and retention plans to engage eligible participants.
6. Deliver the intervention packet to the participant within 2 to 3 weeks of them completing the health survey and Extra Insights approximately 3 months after delivery of the initial intervention packet.
7. Implement the complete intervention only once with each participant.
8. Obtain specific information from participants about where and how they would like potentially sensitive materials to be delivered.

Package Contents

• Insights Implementation Manual, Monitoring and Evaluation Guide, and Technical Assistance Guide
• Administrative rights to access the Insights website

Timeline for Availability
Development of the REP package was completed and final versions of the REP materials will be available in the future.

For More Information on the Insights Intervention Package
Dr. Delia Scholes at Group Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101. Phone: 206-287-2888. E-mail: scholes.d@ghc.org.

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