Using Relational Agents to Promote Exercise and Sun Protection: Assessment of Participants' Experiences With Two Interventions.

BACKGROUND: Relational agents (RAs) are electronic computational figures designed to engage participants in the change process. A recent study, Project RAISE, tested the effectiveness of RAs, combined with existing computer-based interventions to increase regular exercise and sun protection behaviors. Results showed these interventions can be effective but need further development. OBJECTIVE: The purpose of this study was to examine participants' experiences using RAs to increase participant engagement and promote behavior change . METHODS: A qualitative approach was primarily utilized. A 25-question interview guide assessed different components of participants' experiences with the intervention, including motivation, engagement, satisfaction or dissatisfaction, quality of their interaction with the RA, and behavior change. Quantitative assessment of satisfaction was based on a scale of 1 to 10, with 1 representing least satisfied and 10 representing most satisfied. A summative analytic approach was used to assess individuals' qualitative responses. A single analysis of variance (ANOVA) examined levels of satisfaction by gender. RESULTS: Of the original 1354 participants enrolled in Project RAISE, 490 of 1354 (36%) were assigned to the RA group. A sample of 216 out of 490 (44%) participants assigned to the RA group completed the interventions, and follow-up assessments were contacted to participate in the semistructured interview. A total of 34 out of 216 (16%) completed the interview. Participants were motivated by, and satisfied with, the intervention. Participants viewed the RA as supportive, informative, caring, and reported positive behavior change in both exercise and sun protection. Some participants (15/34, 44%) noted the RA was less judgmental and less "overbearing" compared with a human counselor; other participants (12/34, 35%) said that the interaction was sometimes repetitive or overly general. The majority of participants (22/34, 65%) viewed the RA as an important contributor to their behavior change for exercise, sun protection, or both. Levels of satisfaction ranged between 7 and 10. There were no gender differences noted in levels of satisfaction (P=.51). CONCLUSIONS: RAs provide an innovative and attractive platform to increase exercise and sun protection behaviors and potentially other health behaviors.

Associations of Sexual Victimization, Depression, and Sexual Assertiveness with Unprotected Sex: A Test of the Multifaceted Model of HIV Risk Across Gender.

This study examined whether the Multifaceted Model of HIV Risk (MMOHR) would predict unprotected sex based on predictors including gender, childhood sexual abuse (CSA), sexual victimization (SV), depression, and sexual assertiveness for condom use. A community-based sample of 473 heterosexually active men and women, aged 18-46 years completed survey measures of model variables. Gender predicted several variables significantly. A separate model for women demonstrated excellent fit, while the model for men demonstrated reasonable fit. Multiple sample model testing supported the use of MMOHR in both men and women, while simultaneously highlighting areas of gender difference. Prevention interventions should focus on sexual assertiveness, especially for CSA and SV survivors, as well as targeting depression, especially among men.

Tailored intervention to increase dual-contraceptive method use: a randomized trial to reduce unintended pregnancies and sexually transmitted infections.

OBJECTIVE: The objective of the study was to determine whether a transtheoretical model-tailored expert system intervention increases dual-method contraceptive use, compared with a nontailored educational intervention. STUDY DESIGN: We performed a randomized clinical trial of 542 women at high risk for sexually transmitted infections (STIs) and unintended pregnancy. The intervention group received computer-based tailored feedback using a multimedia program. The control group received general contraceptive information and nontailored advice. RESULTS: Participants in the intervention group were more likely to report use of dual contraceptive methods during follow-up (adjusted hazard rate ratio 1.70, 95% confidence interval 1.09, 2.66), compared with controls. However, there were no differences in the rates of incident STI or unintended pregnancy between the 2 groups. CONCLUSIONS: The computer-based transtheoretical model-tailored intervention resulted in a 70% increase in reported dual-method contraceptive use in a group of women at high risk for STIs and unintended pregnancy. Inconsistent use of dual methods may explain the lack of effect on unintended pregnancy rates and incident STIs.

Design of a stage-matched intervention trial to increase dual method contraceptive use (Project PROTECT).

This manuscript describes the randomized clinical trial titled Stage-Matched Intervention to Increase Dual Method Use or Project PROTECT. Project PROTECT compared two approaches to promote the use of dual methods of contraception among high-risk women. The intervention arm received tailored individualized feedback based on the Transtheoretical Model of Behavior Change using a computer-based multimedia program. The control arm received general information on contraception. The primary outcomes of this trial were 1) self-reported use of dual methods of contraception and 2) the biological outcomes of an unintended pregnancy or an incident or recurrent sexually transmitted disease. In this report, we describe the significance and background of the problem, the specific aims of the study, study organization, patient selection, randomization, outcome variables, data collection, procedures used for follow-up and testing, primary and secondary outcomes, and statistical analyses. We also describe participant characteristics and procedures used to assure patient safety and trial monitoring.

Applying the transtheoretical model to ethnically diverse women at risk for HIV.

The purpose of this study is to compare the reliability and predictability of transtheoretical model (TTM) constructs when applied to minority and White women at risk for HIV. Participants consisted of 332 women, including Blacks, Asians, Hispanics, Native Americans, other non-Whites, and Whites. The results supported the reliability and validity of the TTM variables for minority women as well as for White women. Hierarchical multiple regressions demonstrated that TTM variables were able to predict over and above demographic variables. Structural equation models indicate strong support for a mediational model in which the pros and cons predict condom stage of change and unprotected sex though the mediation of self-efficacy. This study provides strong support for TTM scales applied to minority as well as White women at risk for HIV. The authors discuss how these variables might be incorporated into interventions aimed at increasing condom use in minority women.

Sexual assertiveness in heterosexually active men: a test of three samples.

Heterosexually active men have great potential to increase condom use rates during sexual encounters. However, this potential cannot be realized if men are not assertive with their partners regarding condom use. This study reports on the examination of condom-specific sexual assertiveness (SA) in three independent samples of heterosexually active men. In so doing, a reliable and brief four-item measure of SA was developed from a measure previously used with women. Across all three samples, those with higher SA were significantly more likely to be further along the condom stages of change, and significantly less likely to have engaged in unprotected sex. Results suggest that SA is a meaningful construct for men and that increasing SA in men may result in subsequent increases in safer sexual behaviors.