September 26, 2002
In the authors' previous and current intervention research, they have based their program on social learning theory. However, rather than emphasizing individual efficacy, they focus on enhancing women's sense of communal effectance: the sense that their efficacy stems from their being members of families and communities that depend on them, that they depend on, and with whom they share intimate, loving ties. The authors' strategy focuses in particular on increasing women's sense of communal effectance to enhance health behavior.
In this study, the authors used two control conditions, including a full intervention control. The full intervention control was an intensive general health promotion intervention yoked to the HIV intervention. The two interventions were matched for communal orientation, emotional intensity, role-plays, use of cognitive rehearsal, and the communication-negotiation skills taught. They differed in that the HIV intervention incorporated the intervention within the context of HIV risk and prevention, whereas the health promotion intervention focused on general health issues (e.g., alcohol and drug use, smoking and exercise). Thus, through this set of comparisons, differences between the HIV prevention and health promotion groups could be attributed to learning negotiation, planning and goal-implementation skills and learning to focus more generally on one's health.
To judge program effectiveness, the authors obtained women's self-reports of safer-sex behavior; used audiotape ratings of communication-negotiation skills recorded in role-plays 6 months after women completed groups; used "condom credit cards" that women could present at area pharmacies; and had women medically tested for STDs.
Women were interviewed with a standard battery of questionnaires 2 weeks before, within 2 weeks after, and 6 to 7 months after the intervention. At follow-up, women were provided referrals to undergo clinical examinations and laboratory evaluations for STDs. Also at follow-up, interviewers audiotaped participants in role-play scenarios to assess their acquisition of communication-negotiation skills.
Women assigned to the three groups reported greater intention to purchase condoms than those who were interviewed but declined to participate in the intervention, and white women were slightly more likely to be in the standard care control condition. In comparison with women who received a yoked health promotion intervention and those who received standard care, those in an HIV prevention condition reported greater and more consistent behavioral change. Those in the general health promotion intervention made more changes than standard care controls, but only to a limited degree.
The findings indicate that the effects on the health promotion participants were limited, consisting of their acquiring the learned communication-negotiation skills and some indication of greater self-reported behavioral change. Both African-American and European-American women and pregnant and non-pregnant women benefited from the intervention. The authors found reduced rates of medically evaluated STDs only among women who reported a previous STD and only in comparison with the health promotion controls. The authors also did not find reductions in women's reports of number of partners.
Journal of Consulting and Clinical Psychology
08.02; Vol. 70, No. 4, P. 950-960; Stevan E. Hobfoll; Anita P. Jackson; Justin Lavin; Robert J. Johnson; Kerstin E. E. Schröder