Sexually transmitted diseases (STDs) are a major public health problem, particularly in Jefferson County, Alabama, the proposed study site. Previous research has led to the identification of three client-level behavioral factors that impede STD prevention and control. The primary goals of the proposed 5-year project are to pilot-test, revise and expand, and evaluate via a randomized controlled design a computer-tailored interactive, multimedia intervention targeting these behaviors associated with primary and secondary prevention and control of STDs. The recently completed intervention has been designed to 1) promote patient telephoning to obtain STD test results, 2) decrease the interval between screening and initiation of therapy for patients who test positive; and, 3) facilitate stage of change progression toward consistent condom use. Phase I will consist of a one year pilot study followed by a year of intervention revision and expansion. The pilot study will involve recruitment of approximately 660 predominantly African American Jefferson Country Health Department (JCHD) STD Clinic patient s who will interact with the existing intervention. Approximately 15% (n=100) of these subjects will participate in one-on-one follow up interviews designed to solicit specific feedback regarding their reactions to the intervention. Data collected in the Phase I study will inform intervention revisions. Phase II will consist of a randomized controlled trial (N=1670; STD clinic patients) in which the revised intervention will be contrasted with a control (i.e., """"""""usual care"""""""") condition. Three and six month follow up assessments will be conducted with a random subsample of 500 individuals to determine STD status and current condom use. It is hypothesized that, con contrast to the group of patients who obtain """"""""usual care,"""""""" interaction with the automated, individually tailored intervention will result in; 1) a higher percentage of patients who telephone the Clinic for test results; 2) a briefer median time between initial screening and initiation of therapy for those patients testing positive for untreated gonorrhea or chlamydia; and, 3) evidence of greater positive movement through the stages of change for condom use. Successful completion of the proposed project will result in the availability of a readily transferable behavioral intervention targeting STD prevention and control that will be disseminable at a public health level and will have the potential for significant population level impact at relatively low cost.
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