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Effect of a Brief Video Intervention on Incident Infection among Patients Attending Sexually Transmitted Disease Clinics
  • Published Date:
    Jun 24 2008
  • Source:
    PLoS Med. 2008; 5(6).
Filetype[PDF - 136.24 KB]


Details:
  • Corporate Authors:
    for the Safe in the City Study Group
  • Description:
    Background

    Sexually transmitted disease (STD) prevention remains a public health priority. Simple, practical interventions to reduce STD incidence that can be easily and inexpensively administered in high-volume clinical settings are needed. We evaluated whether a brief video, which contained STD prevention messages targeted to all patients in the waiting room, reduced acquisition of new infections after that clinic visit.

    Methods and Findings

    In a controlled trial among patients attending three publicly funded STD clinics (one in each of three US cities) from December 2003 to August 2005, all patients (n = 38,635) were systematically assigned to either a theory-based 23-min video depicting couples overcoming barriers to safer sexual behaviors, or the standard waiting room environment. Condition assignment alternated every 4 wk and was determined by which condition (intervention or control) was in place in the clinic waiting room during the patient's first visit within the study period. An intent-to-treat analysis was used to compare STD incidence between intervention and control patients. The primary endpoint was time to diagnosis of incident laboratory-confirmed infections (gonorrhea, chlamydia, trichomoniasis, syphilis, and HIV), as identified through review of medical records and county STD surveillance registries. During 14.8 mo (average) of follow-up, 2,042 patients (5.3%) were diagnosed with incident STD (4.9%, intervention condition; 5.7%, control condition). In survival analysis, patients assigned to the intervention condition had significantly fewer STDs compared with the control condition (hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.84 to 0.99).

    Conclusions

    Showing a brief video in STD clinic waiting rooms reduced new infections nearly 10% overall in three clinics. This simple, low-intensity intervention may be appropriate for adoption by clinics that serve similar patient populations.

    Background.

    In the US alone there are 19 million new cases of sexually transmitted diseases (STDs) every year. STDs are infections that pass between people during sexual activity (through semen, vaginal fluids, blood, or skin-to-skin contact). Some STDs are caused by bacteria (for example, chlamydia, gonorrhea, and syphilis). Others are caused by parasites (for example, trichomoniasis) or viruses (for example, herpes simplex virus and HIV). Symptoms vary among STDs but may include sores, unusual lumps and itching in the genital region, pain when urinating, and unusual genital discharge. While symptoms are generally more common in men than women, many STDs cause no symptoms. Untreated STDs are more serious for women and may include pelvic inflammatory disease (PID), ectopic pregnancy, infertility, and chronic pain. Bacterial and parasitic STDs can be cured with various drugs; STDs caused by viruses cannot be cured although they can be treated with antiviral drugs.

    Why Was This Study Done?

    Several interventions have been developed to educate people at risk of infection about risky sexual behavior and to teach them the personal skills needed to avoid unsafe sex (for example, negotiation skills that help them persuade their partner to use a condom). Although these interventions reduce the incidence of STDs, they usually involve several sessions of individual or group counseling and are likely too complex and expensive to implement in busy STD clinics. In this study, the researchers ask whether a short video that contains key STD prevention messages can reduce the acquisition of new infections among patients who watch the video while sitting in the waiting room of an STD clinic (a “teachable moment” when people are likely to be receptive to messages about health risks).

    What Did the Researchers Do and Find?

    The researchers developed a 23-minute soap-opera style video—“Safe in the City”—that contained three interwoven dramas about young people in various types of relationships negotiating safer sexual behavior, and two animation segments about condoms. The researchers showed this video (and displayed related posters) in the waiting rooms of three US publicly funded STD clinics every alternate month over a 20-month period. Nearly 20,000 patients were exposed to this intervention. Another 20,000 “control” patients who attended the clinics in the months when the video was not shown were exposed to a standard waiting room environment in which only leaflets about STDs and condoms were available. The researchers then reviewed medical records and STD surveillance registries to find out how many patients in each group developed laboratory-confirmed STD after their initial clinic visit. Their statistical analyses show that the intervention reduced the number of new STD diagnoses by nearly 10%. The intervention was most effective among patients who had had an STD at their first visit and among men, but did not appear to reduce the chances of women acquiring an STD.

    What Do These Findings Mean?

    These findings suggest that showing a brief, carefully designed video in STD clinic waiting rooms might be a simple, effective way to reduce the incidence of STDs. More research is needed to discover which parts of the video—those that increase knowledge and perception of STD risk, those that promote positive attitudes toward condom use, or those that provide the necessary skills to negotiate safe sexual practices—are the most effective and why the video appeared to be more effective for some groups of patients than others. The intervention also needs to be tested in other types of clinics but if it works as well elsewhere as in the three study clinics, the widespread implementation of this low-cost, low-intensity waiting room intervention could produce a meaningful reduction in the incidence of STDs in the US and elsewhere.

    Additional Information.

    Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0050135.

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