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QUESTIONS: Do HIV prevention videos increase “condom use self efficacy” and actual condom use in college students? Does being in a steady dating relationship influence the effectiveness of the videos?
Randomised, (unclear allocation concealment) unblinded, controlled trial with 3 months of follow up.
A university in the US.
202 college students (50% men, mean age 20 y, 70% white, 53% in a dating relationship for a mean of 11 mo) were recruited by advertisements and received monetary reimbursement for their participation. Follow up was 98%.
Participants were allocated to watch 1 of 3 HIV prevention videos (lasting 42 min) that provided education on communication skills (to increase comfort and facility with discussing condom use), technical skills (to increase comfort with, familiarity, and hedonistic beliefs about condom use), or a combination of communication and technical skills; or a waiting list control group. Participants watched the video alone.
Main outcome measures
Condom use self efficacy (Condom Use Self-Efficacy Scale scores for each of 7 distinct factors), actual condom use, and relationship context were assessed by questionnaires before the intervention, immediately after the intervention, and at 3 months.
Immediately after the intervention, participants who received the technical skills video had greater self efficacy for eroticising condom use than those who received the communication skills video (mean scores 3.96 v 3.69, p<0.01), but those who received the communication skills video did not differ significantly from those who received the combined skills video (mean scores 3.69 v 3.84, p<0.09). At 3 months, participants who received the technical skills video had greater self efficacy for correct use of condoms than those who received the communication skills video (mean scores 4.19 v 3.99, p<0.03) and greater self efficacy for suggesting condom use without offending one's partner than those who received the communication or combined skills video (mean scores 4.74 v 4.49, p<0.03 or 4.47, p<0.01, respectively). At 3 months, those who received the combined skills video and were not in a relationship had a greater proportion of condom use than those in the other intervention groups who were not in a relationship (p<0.01), and than those who were in a relationship regardless of intervention (p<0.01).
A technical skills HIV prevention video was associated with greater “condom use self efficacy” for college students. Students who received a video that emphasised both technical and communication skills and who were not in a dating relationship had the highest condom use.
Limited research exists on the effectiveness of using videos for HIV prevention among people who are more educated and have lower risks.1, 2 Whether videos confer any advantage over and above other techniques for HIV prevention remains unclear.
This study by Sanderson used a group of paid volunteers who were college students in the US; the study findings may not be generalisable to young people in different circumstances. Participants ranged in age from 17–24 years; because sexual risk taking behaviour may vary among these ages, it might have strengthened the design to adjust for age. The participants were paid US$25 for completing the pre-test, post-test, and 3 month follow up, and this may account for the excellent follow up rate of 98%. Previous research has shown that videos are effective in changing attitudes and knowledge, but not behaviour.1, 2 Sanderson, however, found an improvement in condom use at the 3 month follow up among those who were not in a steady relationship. We do not know whether the improvement in condom use was sustained over the long term. Collection of personal sexual data is dependent on honest self reporting, which is always a challenge in this area of research.
Effective HIV prevention is critical for young people. This research identified the value of using a video as a method of intervention and the importance of including both technical and communication skills as part of its content. Given their low cost and short time commitment, videos are a practical tool. This intervention was only effective for those who were not in a steady dating relationship; being in a steady dating relationship, however, is not synonymous with less risky behaviour. This research has shown that different types of intervention messages are required depending on the current relationship context and that further work is required to identify an effective intervention for those in steady dating relationships.
Source of funding: National Institute of Mental Health.
For correspondence: Dr C A Sanderson, Department of Psychology, Box 2236, Amherst College, Amherst, MA 01002, USA. Fax +1 413 542 2145.
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