Helmich Day 1 130 pm

Evidence Based Approaches in Training: Preventing Teen Pregnancy, STDs, & HIV: 

Evidence Based Approaches in Training: Preventing Teen Pregnancy, STDs, andamp; HIV Joan Helmich October 2006

Goals: 

Goals Review the research on group interventions for preventing teen pregnancy, STDs, HIV Discuss implications for implementation in training programs

What research? What science?: 

What research? What science? Research about what works in group interventions – sex education School based Community based Includes some youth development programs

Definitions: 

Definitions Science-based approaches Science-based programs Promising programs

Review of the Research: 

Review of the Research Impact of Sex and HIV Education Programs on Sexual Behaviors of Youth in Developing and Developed Countries Summarizes evaluations of 83 programs Funded by USAID Douglas Kirby, B. A. Laris, Lori Rolleri

Goals of Programs: 

Goals of Programs Decrease adolescent sexual risk behaviors Decrease unintended pregnancy Decrease STD including HIV/AIDS

Study Criteria – the programs…: 

Study Criteria – the programs… Targeted youth up to age 25 Curriculum-based with structured activities Group education, not one-on-one Implemented in schools or community Implemented anywhere in the world

Study Criteria – the studies…: 

Study Criteria – the studies… Experimental or quasi-experimental design Sample size of 100 or larger Measured impact on initiation of sex for at least 6 months Measured other behaviors for at least 3 months Were published in 1990 or later

Effects on Sexual Behaviors: 

Effects on Sexual Behaviors

Effects on Protective Behaviors: 

Effects on Protective Behaviors

Results: 

Results 65% had positive impact on andgt;1 behaviors 33% had positive impact on andgt;2 behaviors 7% had a negative impact Some had positive impact for 2-3 years

Conclusions about impact of Sex/HIV education programs: 

Conclusions about impact of Sex/HIV education programs About two-thirds were effective at changing behavior About one-third were not

Conclusions, cont’d.: 

Conclusions, cont’d. Do not increase sexual activity Some sex/HIV education programs: Delay initiation of intercourse Reduce number of sexual partners or Increase use of condoms/contraception Some do all three

Conclusions, cont’d.: 

Conclusions, cont’d. Emphases upon abstinence, fewer partners and condoms / contraception are compatible, not conflicting

Conclusions, cont’d.: 

Conclusions, cont’d. Effective with multiple groups: Low andamp; middle income youth Urban andamp; rural Male andamp; female Different age groups Sexually experienced and inexperienced All major ethnic groups Advantaged and disadvantaged communities

Conclusions, cont’d.: 

Conclusions, cont’d. Programs may be especially effective with high risk youth in disadvantaged communities.

Characteristics of Effective Curricula: 

Characteristics of Effective Curricula What do the most effective curricula have in common?

Characteristics of Effective Curricula: 

Characteristics of Effective Curricula 17 characteristics in three broad categories: Process of development Curriculum characteristics Implementation

Category 1:Characteristics Describing the Process of Development: 

Category 1: Characteristics Describing the Process of Development

Category 1: Process of Development: 

Category 1: Process of Development 1. Multiple people brought different skills to design of curriculum – expertise in: Adolescent sexual behavior Educational theory Curriculum design Experience teaching youth about sex Cultural knowledge Evaluation expertise

Category 1: Process of Development: 

Category 1: Process of Development 2. Used logic model approach: Specified health goals – prevention of HIV, STD, and/or pregnancy Specified behaviors that cause or prevent HIV, STD or pregnancy Identified sexual risk and protective factors affecting those behaviors Designed activities to affect those factors

Part of a sample logic model:: 

Part of a sample logic model:

Behaviors: preventing pregnancy, HIV, STDs*: 

Behaviors: preventing pregnancy, HIV, STDs* Delay onset of sexual intercourse Increase the use of contraception, including condoms and emergency contraception Decrease the frequency of sex Decrease the number of sexual partners Increase screening and treatment of STDs/HIV Male circumcision * Kirby, et al.

Category 1: Process of Development: 

Category 1: Process of Development 3. Assessed relevant needs and assets of target group Reviewed quantitative data (STD or pregnancy rates, survey data on sexual behavior) Conducted focus groups with youth Interviewed professionals working with youth

Category 1: Process of Development: 

Category 1: Process of Development Designed activities consistent with community values and resources available Pilot-tested the program

Category 2:Characteristics Describing the Curriculum Content: 

Category 2: Characteristics Describing the Curriculum Content

Category 2: Curriculum Content: 

Category 2: Curriculum Content 1. Created a safe social environment for youth to participate Established and enforced class rules Divided class by gender (occasionally)

Category 2: Curriculum Content: 

Category 2: Curriculum Content 2. Focused on clear health goals –prevention of STD/HIV and/or pregnancy Talked about these goals Gave a clear message about these goals

Category 2: Curriculum Content : 

Category 2: Curriculum Content 3. Focused narrowly on specific behaviors leading to these health goals Specified the behaviors (abstinence, condom use) Gave clear messages about behaviors (abstinence is safest approach, condom andamp; contraceptive use if sexually active) Addressed situations that might lead to risk Messages appropriate for age, gender, sexual experience, culture

Category 2: Curriculum Content: 

Category 2: Curriculum Content 4. Addressed multiple risk and protective factors affecting sexual behaviors…

Risk and Protective Factors: 

Risk and Protective Factors For abstinence: Overall knowledge of sexual issues Knowledge about pregnancy, STD and HIV Personal values about sex and abstinence Perception of peer norms about sex Self-efficacy to refuse sex Intention to abstain from sex or restrict sex or partners Communication with parents or other adults about sex, condoms or contraception

Risk and Protective Factors: 

Risk and Protective Factors For condom and contraceptive use: Knowledge of pregnancy, STD, HIV Attitude toward risky sexual behavior and protection Attitudes towards condoms Perceived effectiveness of condoms to prevent STD/HIV Perceptions of barriers to condom use Self-efficacy to obtain condoms Self-efficacy to use condoms Intention to use a condom Communication with parents or other adults about sex, condoms or contraception

Category 2: Curriculum Content: 

Category 2: Curriculum Content 5. Included multiple activities to change each of the targeted risk and protective factors

Including activities to improve three skills: 

Including activities to improve three skills To avoid unwanted sex, unprotected sex To insist on and use condom or contraception To use condoms correctly

Category 2: Curriculum Content: 

Category 2: Curriculum Content 6. Used effective teaching methods Methods were instructionally sound, e.g., role playing to improve skills Actively involved participants Helped them personalize information

Category 2: Curriculum Content: 

Category 2: Curriculum Content 7. Instruction appropriate to culture, developmental age, gender, sexual experience

Category 2: Curriculum Content: 

Category 2: Curriculum Content 8. Covered topics in a logical sequence Basic information Information on behaviors to reduce vulnerability Values, attitudes, social norms about these behaviors Skills needed to perform these behaviors …KAS progression

Category 3:Characteristics Describing the Implementation of the Curriculum: 

Category 3: Characteristics Describing the Implementation of the Curriculum

Category 3: Implementation: 

Category 3: Implementation 1. Selected educators with desired characteristics, and then trained them Important selection criteria: Could relate to youth Experience with health education Comfortable with topic Possibly unimportant selection criteria: Age (adult versus peer) Matched gender or race

Category 3: Implementation: 

Category 3: Implementation 2. Secured support from authorities Note: Were research studies and therefore required approval and support Provide sanction or support for educators

Category 3: Implementation: 

Category 3: Implementation 3. Recruited youth and overcame barriers to involvement Publicized program Obtained parental consent Arranged transportation Assured safety Implemented at convenient times Provided incentives (e.g., food)

Category 3: Implementation: 

Category 3: Implementation 4. Implemented virtually all activities with reasonable fidelity (as designed)

Implications for Training Programs: 

Implications for Training Programs

Integrate the science into…: 

Integrate the science into… Training programs on teen pregnancy prevention Training programs on STD andamp; HIV prevention Training programs on abstinence Training for sexuality educators Training for community workers

Train on the BDI logic model process…: 

Train on the BDI logic model process… For program development For grant writing See Risk and Protective factors

BDI Logic Models: 

BDI Logic Models Health Goal… Behaviors… Determinants… Interventions

Resources: 

Resources www.teenpregnancy.org What Works: Curriculum-Based Programs That Prevent Teen Pregnancy, Kirby Sexual Risk and Protective Factors, Kirby Several PowerPoint presentations www.etr.org/recapp/ BDI Logic Model On-Line Course BDI Logic Models, Kirby

Resources, cont’d.: 

Resources, cont’d. www.advocatesforyouth.org Science and Success: Sex Education and Other Programs That Work to Prevent Teen Pregnancy, HIV andamp; Sexually Transmitted Infections www.healthyteennetwork.org Several publications, PowerPoint presentations

or email…: 

or email… jhelmich@jba-cht.com