Objectives We compared multiple‐choice and open‐ended responses collected from a web‐based tool designated ‘Case for Change’, which had been developed for assessing and teaching medical students in ...the skills involved in integrating sexual risk assessment and behaviour change discussions into patient‐centred primary care visits.
Methods A total of 111 Year 3 students completed the web‐based tool. A series of videos from one patient encounter illustrated how a clinician uses patient‐centred communication and health behaviour change skills while caring for a patient presenting with a urinary tract infection. Each video clip was followed by a request for students to respond in two ways to the question: ‘What would you do next?’ Firstly, students typed their statements of what they would say to the patient. Secondly, students selected from a multiple‐choice list the statements that most closely resembled their free text entries. These two modes of students’ answers were analysed and compared.
Results When articulating what they would say to the patient in a narrative format, students frequently used doctor‐centred approaches that focused on premature diagnostic questioning or neglected to elicit patient perspectives. Despite the instruction to select a matching statement from the multiple‐choice list, students tended to choose the most exemplary patient‐centred statement, which was contrary to the doctor‐centred approaches reflected in their narrative responses.
Conclusions Open‐ended questions facilitate in‐depth understanding of students’ educational needs, although the scoring of narrative responses is time‐consuming. Multiple‐choice questions allow efficient scoring and individualised feedback associated with question items but do not fully elicit students’ thought processes.
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Previous research links high rates of unprotected anal intercourse (UAI) with men who go to bathhouses; however, the literature provides no prevalence estimates. An exit survey of a probability ...sample was conducted to describe the prevalence of risk activity at the bathhouse.
Data are from a 2-stage probability sample of men exiting a gay bathhouse (n = 400).
During their visit, 91.5% of men had oral sex and 44.2% had anal sex (11.1% reported UAI and 5.5% reported unprotected receptive anal intercourse). In the prior 3 months, 85% reported having anal sex, which was more likely to be unprotected when it occurred in a private home or hotel as opposed to a public setting (P < 0.001). Moreover, having UAI at home was a significant correlate of risk during the bathhouse visit (P < 0.001).
Most men at the bathhouse engaged in oral sex rather than anal sex, and most anal sex included use of condoms. Furthermore, men were more likely to have UAI in a private home than in any public setting. The bathhouse seems to have facilitated condom use when anal sex occurred on-site.
The efficacy of behavioral HIV prevention interventions has been convincingly demonstrated in a large number of randomized controlled phase 3 research outcome trials. Little research attention has ...been directed toward studying the effectiveness of the same interventions when delivered by providers to their own clients or community members, however. This article argues for the need to conduct phase 4 effectiveness trials of HIV prevention interventions that have been found efficacious in the research arena. Such trials can provide important information concerning the impact of interventions when applied in heterogeneous “real-world” circumstances. This article raises design issues and methodologic questions that need to be addressed in the conduct of phase 4 trials of behavioral interventions. These issues include the selection and training of service providers engaged in such trials, maintenance of fidelity to intervention protocol in provider-delivered interventions, determination of intervention core elements versus aspects that require tailoring, selection of relevant phase 4 study outcomes, interpretation of findings indicative of field effectiveness, sustainability, and other aspects of phase 4 trial design.
This article highlights findings from an evaluation that explored the impact of mobile versus clinic-based testing, rapid versus central-lab based testing, incentives for testing, and the use of a ...computer counseling program to guide counseling and automate evaluation in a mobile program reaching people of color at risk for HIV. The program's results show that an increased focus on mobile outreach using rapid testing, incentives and health information technology tools may improve program acceptability, quality, productivity and timeliness of reports. This article describes program design decisions based on continuous quality assessment efforts. It also examines the impact of the Computer Assessment and Risk Reduction Education computer tool on HIV testing rates, staff perception of counseling quality, program productivity, and on the timeliness of evaluation reports. The article concludes with a discussion of implications for programmatic responses to the Centers for Disease Control and Prevention's HIV testing recommendations.
Providers in emergency care settings (ECSs) often face barriers to expanded HIV testing. We undertook formative research to understand the potential utility of a computer tool, "CARE," to facilitate ...rapid HIV testing in ECSs. Computer tool usability and acceptability were assessed among 35 adult patients, and provider focus groups were held, in two ECSs in Washington State and Maryland. The computer tool was usable by patients of varying computer literacy. Patients appreciated the tool's privacy and lack of judgment and their ability to reflect on HIV risks and create risk reduction plans. Staff voiced concerns regarding ECS-based HIV testing generally, including resources for follow-up of newly diagnosed people. Computer-delivered HIV testing support was acceptable and usable among low-literacy populations in two ECSs. Such tools may help circumvent some practical barriers associated with routine HIV testing in busy settings though linkages to care will still be needed.
Although stigma is considered a major barrier to effective response to the HIV/AIDS epidemic, there is a lack of evidence on effective interventions. This media intervention took place among key ...HIV-vulnerable communities in Southern India. Two HIV stigma videos were created using techniques from traditional film production and new media digital storytelling. A series of 16 focus group discussions were held in 4 rural and 4 urban sites in South India, with specific groups for sex workers, men who have sex with men, young married women, and others. Focus groups with viewers of the traditional film (8 focus groups, 80 participants) and viewers of the new media production (8 focus groups, 69 participants) revealed the mechanisms through which storyline, characters, and esthetics influence viewers' attitudes and beliefs about stigma. A comparative pre-/post-survey showed that audiences of both videos significantly improved their stigma scores. We found that a simple illustrated video, produced on a limited budget by amateurs, and a feature film, produced with an ample budget by professionals, elicited similar responses from audiences and similar positive short-term outcomes on stigma.
This study sought to identify factors influencing HIV testing decisions among clients at a sexually transmitted disease clinic, gay men, and injection drug users. Focus group and intensive interview ...data were collected from 100 individuals. The AIDS Risk Reduction Model was adapted to describe factors that affect test decisions. Testing barriers and facilitators were grouped as factors affected by "Individual" beliefs, "System" policies and programs, "Testing" technology, and "Counseling" options. Individual factors (fear of death and change), system factors (anonymous test availability, convenience), and counseling and testing factors (rapid results, counseling alternatives) interact to determine whether an individual does not test ("apprehension") or does test ("action"), and ultimately, tests routinely ("integration"). In conclusion, traditional HIV testing presents barriers to some populations at risk for HIV. These findings suggest several strategies to improve HIV test acceptance: acknowledge fears, address system barriers, utilize available test technologies, and expand counseling options.
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