Efficacy of a motivational behavioral intervention to promote chlamydia and gonorrhea screening in young women: a randomized controlled trial.

BACKGROUND: Seeking screening and treatment for chlamydia (CT) and gonorrhea (GC) by young women is critical to reduction of asymptomatic cervicitis and its complications. OBJECTIVES: To evaluate the efficacy of a client-centered motivational behavioral intervention (MBI), to promote seeking of sexually tranmitted infection (STI) checkups by young women. METHODS: Three hundred seventy-six of 770 eligible sexually active, nonpregnant, English-speaking women (mean age 18.5 years) were recruited from an urban reproductive health clinic and randomized to two groups: intervention plus standard care (MBI) or standard care alone (SC). MBI (two sessions plus booster) was based on the Transtheoretical Model of Change and employed motivational interviewing. Outcome measures monitored for 12 months included: client-initiated clinic visits for STI checkups in response to seven high-risk sexual behaviors by self-report (primary), consistent condom use, number of CT and GC episodes, and movement along the stages of change obtained at baseline and 6- and 12-month follow-up assessments (secondary). Analyses included chi-square, logistic regression, and generalized estimating equations. RESULTS: At baseline, more than 70% endorsed the action stage of change for seeking STI checkups for three of seven high-risk sexual behaviors. No significant differences were noted between the two groups for the primary or secondary outcomes. Across groups, having multiple partners and being pregnant or thinking one might be pregnant were associated with STI checkups. CONCLUSIONS: This is the first known client-centered clinical trial to promote STI screening. Risk-taking and health-seeking behaviors are complex and interrelated with STI and pregnancy concerns. The intervention may have an effect if it is targeted to women in a less medically connected community-based sample.