September 26, 2002
Women living in inner cities in the United States are the fastest growing segment of individuals infected with HIV. There is an urgent demand for development of intervention programs aimed at these target populations. Because there is no vaccine for AIDS, and no cure once HIV is contracted, preventive behavioral interventions should hold the most promise for limiting the spread of the AIDS epidemic.
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.
This research was undertaken between 1995 and 1999 at two clinics (hospital based and free-standing community based) serving lower income populations either on welfare or without medical insurance in a medium-sized Midwestern city. A total of 1,177 women agreed to be initially interviewed. Of these, approximately 80 percent agreed to be assigned to intervention or control conditions. Women were assigned to the HIV prevention, health promotion, or standard care control group in a 2:2:1 ratio. Participants were on average 21.42 years of age; 42 percent were employed, and 77 percent had incomes under $10,000. African-Americans represented 55 percent of the sample, and European-Americans represented 42 percent.
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