Sexually Transmitted Diseases  >  Program Guidelines  >  Community and Individual Behavior Change Interventions

Program Operations Guidelines for STD Prevention
Community and Individual Behavior Change Interventions

Previous Page

Table of Contents

Next Page

Section on this page:

• Framework for Planning Interventions

Framework for Planning Interventions (Office of Technology Assessment, 1995)

Paramount to the implementation of an intervention, the program manager should carefully consider the desired outcome of the intervention and should clearly articulate a measurable outcome during the development of the strategy. In addition, for a program manager to develop an appropriate intervention that is successful in the context of a high-risk population, five important questions should be asked: When do you implement an intervention? Who is being targeted? What is the proposed intervention? Where is the intervention being delivered? How is the intervention being delivered? In addition, the program manager also must assess what resources or programs already exist in a community to address some needs of the identified high-risk population. If resources or programs exist, then STD prevention programs should partner with existing programs to plan interventions. If not, then an appropriate intervention should be designed, implemented, and evaluated with the full participation of the community who will be receiving this intervention. The questions follow:

1. When do you implement an intervention?

An intervention should be considered when it becomes clear that ongoing risk behaviors are substantially contributing to enhanced disease transmission in a particular environment or sociogeographic context. Timing of the intervention will necessarily depend on morbidity as well as social, economic, and political factors which affect the feasibility of intervention implementation.

2. Who is being targeted?

• Demographic Characteristics: Describe demographic characteristics of the target group(s), such as age, race, gender, in-school versus out-of school, homeless, mentally ill, sex workers, inmates, parolees, immigrants.
• Geographic: Describe the section or neighborhood of the city where the target group(s) resides or hangs out.
• General Risk Behaviors and Stage of Behavior Change: Describe the general risk behaviors of the target group(s) such as sexual behaviors, drug use behaviors, access to care, and the group's readiness for behavior change. Information collected from behavioral surveillance systems is critical in identifying the target population as noted in the previous section.

3. What is the proposed intervention?

• Level: Describe whether the intervention will be delivered at the individual, couple, small group, street or community level, or to the general public. Ideally, there should be a comprehensive mix of individual, group, and community level interventions.
• Behavioral Objectives: Describe what risk behaviors the intervention expects to change and the direction of this change (e.g, increased use of condoms with casual partners, decrease in the number of partners, etc.)
• Factors Expected to Affect Risk Behavior(s): Describe theoretical factors that will need to be addressed to accomplish the behavioral objectives of the intervention, such as addressing the target group's intentions, skills, self-efficacy, supportive community and peer norms, barriers, and expected outcomes.
• Services, Material, and Information: Describe the services, materials and other information that will be delivered in the interventions such as testing, case management, peer outreach, skills training, condoms, or informative pamphlets.

4. Where is the intervention being delivered?

• Institutional: Describe whether the intervention will be delivered in school, corrections facilities, hospital, clinic, physicians office, emergency room, or other institutional setting.
• Street: Describe whether the intervention will be delivered in the streets or corner of a street in a high drug use area, a crack house, park areas, or other informal settings where high-risk behaviors are taking place.
• Community: Describe whether the intervention will be delivered in a community-based organization, store front, mobile van, bar, or other community setting.

5. How is the intervention being delivered?

• Persons Delivering the Intervention: Describe whether the intervention will be delivered by peers, community volunteers, clinicians and other health professionals, outreach workers, counselors, or other types of individuals.
• Visibility of the Target Group: Describe how the target group(s) for the intervention will learn about its services, such as through various types of media in the community, through formal or informal outreach on the street, or through related agencies.
• Frequency and Duration: Describe whether the frequency of the intervention will be one-time only, periodic, seasonal, or continuing, and whether the duration of the intervention will be in hours, days, weeks, and/or years.
• Scale and Significance: Describe how many members of the target group(s) will be reached by the intervention and, if possible, whether this size is sufficient to make a measurable contribution influencing morbidity.
• Contextual Factors: Describe any contextual factors that will influence how the intervention is delivered, such as the type or level of drug use, gang or domestic violence, the physiologic or mental state of the group, and competing needs for food, shelter, health care, employment, and protection from violence.
• Extent of Coordination: Describe the extent of coordination between the intervention and the services of other agencies in the area and what the effect of other prevention interventions or services will be on the implementation of the proposed intervention.

The utility of addressing these key features in advance is important in a number of ways. First, it allows prevention planners to communicate more clearly the types of priority interventions that they are recommending to service providers, and it helps providers to design interventions more clearly and to implement them as planned. Thinking through the details also helps providers apply behavioral and social science research and theory in designing specific interventions. Making decisions about the key features and describing the program in this way also can be strategically useful if a program intends to seek support or to continue to get support from outside funders and the community. Finally, a systematic description encourages a thorough implementation of the intervention, allows for the replication of the intervention for other groups or communities, and provides a structure to design and carry out process and outcome evaluations. For an example of the planning framework, see Appendix BC-A.

There is compelling evidence to suggest that properly designed mass media campaigns can have beneficial effects on health behaviors (IOM, 1997). The challenge in developing strong prevention messages includes the content of the controversial topics of sexual behavior and drug use, the need for such messages to be specific and sustained, and the resources to develop and sustain such initiatives. These initiatives should also be coupled with and supportive of specific individual, group, and community level interventions in the program area. Mass media messages supporting safer sexual behavior are increasing but not as commonplace as may be necessary. Changes in social norms regarding safer sexual behaviors will be difficult to achieve unless the content of programming in mass media supports such behaviors. Many mass media outlets refuse to allow STD-related public service announcements or condom advertisements despite the support of most Americans (Office of Technology Assessment, 1995). Television has also failed to incorporate safer sex messages into programming where sexual activity is commonplace.

Physicians and other health care providers also are generally seen by the public as reliable sources of prevention information; they could play a major role in delivering prevention counseling but lack information and prevention training about STDs and AIDS. Discomfort in taking sexual history, incorrect assumptions about high risk behaviors, and lack of prevention training in effective counseling methods may deter providers from providing appropriate counseling. Other barriers may include insufficient time for visits, limited or non-existent reimbursement for prevention counseling, lack of access to the provider, or seeing providers in a setting not conducive to providing prevention messages (Office of Technology Assessment, 1995). Another barrier may be the lack of comfort of the patient to share private sexual or drug use behavior, particularly if such behavior is stigmatized by society or illegal.

Previous Page

Table of Contents

Next Page