Christine Galavotti

Validation of measures of condom and other contraceptive use among women at high risk for HIV infection and unintended pregnancy

This study assessed the applicability of the transtheoretical model of behavior change (J.O. Prochaska & C.C. DiClemente, 1983, 1984) to the measurement of contraceptive use among 296 women at high risk for HIV infection and transmission. Structural equation modeling suggested that a measure of general contraceptive use could be used to assess use of oral contraceptives and hormonal implants but that measurement of condom use required separate assessments for main and other partners. Self-efficacy (SE) and decisional balance scales were internally consistent for general contraceptive use, for condom use with main partners, and for condom use with other partners. Consistent with research on other health behaviors, SE scores rose significantly across stages, from precontemplation to maintenance, and a shift in decisional balance was observed for 2 of 3 behaviors. This measurement strategy may enhance the ability to evaluate prevention programs for women at risk.

Weight-Management Interventions for Pregnant or Postpartum Women

BACKGROUND A review of randomized controlled trials of weight-management interventions for pregnant or postpartum women was conducted to assess whether effective weight-management interventions exist for this population. METHODS The MEDLINE, EMBASE, PsycINFO, Sociological Abstracts, and CINAHL databases were searched, as well as the reference lists of relevant publications. English-language articles published between January 1985 and August 2007 that used a randomized controlled trial study design and incorporated a weight-related outcome measure were reviewed. All potentially relevant articles were reviewed separately, and final selections were based on consensus reached through discussion. RESULTS Three studies met the inclusion criteria, one conducted among pregnant women and two among postpartum women. The interventions addressed modifications in diet and exercise and included individual or group-counseling sessions combined with written and telephone correspondence or food and exercise diaries. In two studies, the weight-related outcome was significantly better in the intervention group than in the control group. The third study found a significant interaction between weight category and intervention group. In all studies, the refusal or attrition rates were high. CONCLUSIONS While these studies indicate that interventions can help pregnant and postpartum women manage their weight, many questions remain unanswered. Several research gaps for weight-management interventions in this important population have been identified.

A conceptual model of women's condom use intentions: Integrating intrapersonal and relationship factors.

Abstract We developed and tested a multifaceted model of condom use intentions with cross-sectional data from 435 heterosexual women at risk for HIV/STIs. In addition to traditional intrapersonal variables drawn from established models of HIV prevention (e.g. attitudes, norms, self-efficacy), the present study examined the role of relationship factors and dynamics (i.e. relationship commitment, duration, condom use and pregnancy prevention decision-making) in shaping condom use intentions. In some cases, relationship variables were directly associated with condom use intentions. In other cases their effects on condom use intentions were mediated by intrapersonal constructs. The final model accounted for 66% of the variance in condom use intentions and confirmed the importance of integrating intrapersonal variables and relationship characteristics and dynamics in understanding womens intentions to use condoms. These results offer important insights for the design of interventions directed at promoting condom use among young women at risk for HIV/STIs and underscore the need to design prevention programs that address relationship characteristics and dynamics.

Psychosocial factors associated with the stages of change for condom use among women at risk for HIV and STDs: implications for intervention development.

This study examined the prevalence of consistent condom use among inner-city women at risk for HIV, measured the distribution of these women across the stages of change for condom use, determined psychosocial factors associated with the stages, and suggested intervention strategies based on the results. The 5-city sample of women aged 15-34 years consisted predominantly of African Americans. Only 18% reported consistent condom use with main partners and 45% with other partners. Logistic regressions compared women in each stage of change with those in higher stages for each partner type. Results indicated that women who practice or intend to practice consistent condom use were more likely to talk with others about condoms, acknowledge the advantages of condoms, have higher self-efficacy for condom use, and indicate that people important to them favored condom use. Intervention approaches are suggested for women in different stages of change for condom use.

Modeling and Reinforcement to Combat HIV: The MARCH Approach to Behavior Change

Theory and research suggest that behavioral interventions to prevent HIV/AIDS may be most effective when they are personalized and affectively compelling, when they provide models of desired behaviors, and when they are linked to social and cultural narratives. Effective strategies must also take into account the opportunities and obstacles present in the local environment. The Modeling and Reinforcement to Combat HIV (MARCH) projects combine key aspects of individual behavior change with efforts to change social norms. There are 2 main components to the program: entertainment as a vehicle for education (longrunning serialized dramas on radio or television portray role models evolving toward the adoption of positive behaviors) and interpersonal reinforcement at the community level (support from friends, family members, and others can help people initiate behavior changes; support through changes in social norms is necessary for behavioral effects to be sustained over time). Both media and interpersonal intervention activities should be linked to existing resources in the community and, wherever possible, provide increased access to preventive services, supplies, and other supporting elements.

Specification of a social-cognitive model predicting smoking cessation in a Mexican-American population: a prospective study

The stages-of-change model for smoking cessation was specified using interview and biochemical data from a sample of Mexican—American smokers in south Texas. Factor analysis of items measuring the processes of change for smoking indicated the stability of the structure of these constructs for this population. The scales discriminated among groups of smokers with different intentions toward smoking cessation. Intention to change was predictive of cessation category 1 to 2 years later and mediated the influences of three process-ofchange cognitions on behavior. Number of years of smoking was independently negatively related and age was positively related to cessation category. Our findings for Mexican—Americans showed that the stages and processes of change are generalizable to this population and that they predict cessation behavior prospectively.

Stages of condom use in a high HIV-risk sample

Abstract The goals were to (1) clarify high risk individuals into one of five stages of readiness for consistent condom use based on the Transtheoredcal Model of behavior change (e.g., Prochaska, Norcross and DiClemente, 1994); (2) investigate whether frequency of condom use was different for vaginal vs. anal sex, and for steady vs. other partners; and (3) explore whether condom use was related to several demographic variables. Street interviews were conducted in six major geographic areas across the United States on a diverse sample of 345 individuals engaging in high HIV-risk behaviors. Percentages of individuals found in each of five stages of condom use were: 36% Precontemplators, 15% Contemplators, 7% in Preparation, 7% in Action, and 35% in Maintenance. Individuals used condoms more with other, casual partners than with a steady partner, and slightly more when engaging in anal sex rather than vaginal sex. Condoms were also used more by: men, Caucasians, non-heterosexuals, and those who were not in a...

Navigating the swampy lowland: a framework for evaluating the effect of community mobilisation in female sex workers in Avahan, the India AIDS Initiative

Background Few models of how community mobilisation works have been elaborated in the scientific literature, and evaluation of the impact of these programmes on HIV and other health outcomes is extremely limited. Avahan, the India AIDS Initiative, has been implementing community mobilisation as part of its prevention programming with groups of high-risk individuals across six states since 2005. Purpose To articulate a programme theory and evaluation framework for evaluation of Avahans approach to community mobilisation among female sex workers in four southern states in India. Methods The authors use a goal-based evaluation approach to describe the programme goals and an underlying programme theory that specifies how the programme is expected to work. Using multilevel structural equation modelling with propensity score matching, the evaluation will compare what is observed in the data with the predicted relationships specified by the model. Results The Avahan model of community mobilisation posits that meaningful participation in high-risk group intervention, structural intervention and organisational development activities leads to identification, collectivisation and ownership, which in turn leads to improved programme outcomes. Strong community groups and an enabling environment reinforce social norm and behaviour change outcomes and lead to sustained impact. Discussion Specifying an explicit programme theory can aid in the evaluation of complex interventions, especially when the evaluation design is observational. In addition to articulating Avahans community mobilisation approach in a model that can be tested, we recommend some specific measures and methods that could be used to improve evaluation efforts in the future.

Promoting condom use with main partners: A behavioral intervention trial for women

The Stages of Change (SOC) model was used to implement and evaluate a condom promotion intervention for HIV-positive and at-risk women who were recruited from clinic and community settings in Baltimore and Philadelphia. Participants were assigned to receive standard reproductive health services or enhanced services (standard plus SOC peer advocate intervention). Women who had a main partner at baseline and at a 6-month follow-up were included in the analysis (70 HIV positive, 471 at risk). Compared with the standard group, HIV-positive women in the enhanced group were significantly more likely to have progressed in the SOC model or to have maintained consistent condom use, and less likely to have relapsed or stayed in the precontemplation stage. Among the at-risk women, exposure to the intervention was associated with being at a higher SOC and being less likely to relapse relative to the standard group. The SOC model has promise for use in social and public health service settings that serve women at risk or living with HIV.

Radio role models for the prevention of mother-to-child transmission of HIV and HIV testing among pregnant women in Botswana

Although Botswana supports a program for the prevention of mother-to-child-transmission of HIV (PMTCT), many women initially did not take advantage of the program. Using data from a 2003 survey of 504 pregnant and post-partum women, we assessed associations between exposure to a long-running radio serial drama that encourages use of the PMTCT program and HIV testing during pregnancy. Controlling for demographic, pregnancy and other variables, women who spontaneously named a PMTCT character in the serial drama as their favorite character were nearly twice as likely to test for HIV during pregnancy as those who did not. Additionally, multiparity, knowing a pregnant woman taking AZT, having a partner who tested, higher education and PMTCT knowledge were associated with HIV testing during pregnancy. Identification with characters in the radio serial drama is associated with testing during pregnancy. Coupled with other supporting elements, serial dramas could contribute to HIV prevention, treatment and care initiatives.