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

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

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• INTRODUCTION (BC-1)

INTRODUCTION (BC-1)

Historically, STD prevention programs have been based on a biomedical model that focused on secondary prevention by treating infected individuals. More recently, STD prevention programs have been encouraged to support more interventions that effect changes in behavior. Many behavioral interventions proven to change behaviors that pose risks to health, including sexual behavior, are highly effective. An advantage of behavioral interventions is that they are capable of preventing all STDs, while biomedical interventions are specific only for certain STDs. If behavioral interventions could be widely implemented along with biomedical approaches, they are likely to have a substantial effect on the prevention of STDs (IOM, 1997).

This chapter presents a menu of options for program managers who are seeking ways to implement community and individual behavior change interventions. These options should be tailored to the individual program based on an analysis of local risk issues. Program managers should build partnerships with behavioral scientists to accomplish this task.

The Institute of Medicine's report, "The Hidden Epidemic: Confronting Sexually Transmitted Diseases" indicates that there is little information related to behavior change interventions and STDs. (IOM, 1997) An NIH consensus panel recommended that "intervention and behavioral research be given the highest priority and coordinated with biomedical research; a paradigm shift to develop models that are domain-specific with regard to sexuality and recognition that risk behavior is embedded within personal, interpersonal, and situational contexts; research on individual differences in human sexuality that takes into account cognitive, affective, cultural, and neurophysiological variables; studies on the direct effects of intoxicants on self-regulatory mechanisms; and studies regarding maintenance of behavior change" (NIH, 1997).

In addition, the Institute of Medicine report identified a number of STD interventions that could be accurately evaluated if psychosocial and behavioral data were available:

• reduce individual risk behaviors in populations with high prevalence of STDs;
• promote safer sex practices and such protective methods as condom use to reduce the likelihood of the acquisition of an STD;
• inform the public, especially adolescents and young adults, to be aware of and to recognize symptoms of STDs;
• motivate prompt attempts to get medical treatment for symptoms and suspected exposure to STDs or if engaged in risky behavior, to get tested; and
• ensure access to medical care for those with STDs. The last three activities are limited by the absence of any currently available comprehensive data collection system for STD that would enable assessment or tracking of attitudes or knowledge, behaviors that produce or mitigate STD acquisition, or factors related to seeking health care and access to treatment.

Existing data and surveillance systems (e.g., Behavioral Risk Factor Surveillance System, Youth Risk Behavioral Surveillance System, National Health Interview Survey, National Health and Nutrition Examination Survey, National Survey of Family Growth, National Household Survey of Drug Abuse, General Social Survey) are currently inadequate for a behavioral surveillance system for sexually transmitted diseases. These surveys would require major revision of questionnaires to accommodate STD related question domains, e.g. sex partner characteristics, symptom recognition, decisions concerning medical treatment, and major sampling design revisions to obtain information for monitoring high-risk populations.

There also is a need for information at the community level for monitoring risk behaviors in local populations, planning and measuring community awareness of prevention activities, assessing access to medical care and other related issues, and providing baseline information for evaluating unanticipated secular changes in the community.

Once a target population is identified, it is important to determine the type of intervention to be implemented. The three primary goals of individual- and community-focused interventions are to prevent exposure to STDs; to prevent the acquisition of disease if exposed; and to prevent transmission of infection to others if infected. Comprehensive public health efforts for behavior change should be in place that (1) help individuals develop and maintain STD prevention behaviors (both safe sexual behaviors and timely seeking of treatment), and (2) enable communities to support STD prevention efforts (IOM, 1997).

While there have not been rigorous assessments of many behavioral interventions for STDs, there is reason to believe that they could have a substantial effect on the risk of acquiring and spreading STDs if there were the resources and the national will to implement some of these programs more widely (IOM, 1997). The literature on the effectiveness of HIV prevention programs is applicable for developing other effective STD prevention programs. Based on the National Institutes of Health Consensus Development Conference Statement "Interventions to Prevention HIV Risk Behaviors", the following conclusions were drawn (NIH, 1997): Behavioral interventions to reduce risk are effective and should be implemented widely; legislative barriers that discourage effective programs aimed at youth, corrections, and IVDUs must be eliminated; and, although sexual abstinence is a desirable objective, programs must include instruction on safer sex behaviors.

STD program managers can accomplish this by developing working partnerships with the behavioral science staff at local universities, STD prevention training centers, AIDS education training centers, or other similar institutions to obtain proper input and guidance for developing, implementing, and evaluating behavioral science interventions. In lieu of this approach, behavioral scientists could be hired to be members of the STD prevention program.

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