Health Projects

Contributions of this project

Development of the Studies

Meta-analysis: 3000 articles reviewed, 70 included, 200 studies coded and analyzed (2003-2004).
Elicitation research to adapt intervention. We interviewed a sample of 100 participants from the target population to gather qualitative data concerning their beliefs and experiences in the domain of HIV prevention.(2003).
Pilot testing of the protocol and participation measures and consecutive adjustments of the materials (2003-2004).
Pilot testing of the program-introduction manipulations (2004-2005).
Field Studies. 750 participants were interviewed, and exposed to the prevention materials from June 2004 to June 2005.

Findings from the Meta-Analyses

Interventions are more successful at achieving immediate cognitive and motivational change than at achieving immediate behavioral change.
The immediate motivational change decays later in time, whereas behavior change increases over the same period.
Interventions that engage audiences in particular activities like role-playing condom use are more effective than presentations of materials to passive audiences.
Interventions that contain components that are consistent with the theories of reasoned action and planned behavior, self-efficacy models, and the information-motivation and behavioral skills models prove effective, whereas interventions designed to induce fear do not.
Expert intervention facilitators are more effective than lay community members in all cases. When populations are disempowered, expert facilitators are particularly effective and are most effective if they also share the gender and ethnicity of the target audience.
People select to participate in a preventive intervention on the basis of their particular deficiencies. That is, low knowledge individuals stayed more when the intervention is informational, low motivation individuals stayed when the intervention is motivational, and low condom users stayed more when the intervention surround behavioral-skills training.
Disempowered populations are more sensitive than powered ones to instrumental, financial and social incentives offered to increase participation. Thus, women and African’s background people stay more when they are offered incentives, independently of their past sexual behavior. Instead, men and European or Latino background audiences make their decision of participate on the basis of their need to improve a specific behavior: they stay more when they had low condom use in the past, independently of the offered incentives.

Findings from the Field Studies

We found external factors that influence on exposure to or participation in motivational or behavioral interventions. The introduction to or promotion of a preventive program shapes expectations about the nature of the intervention. These expectations play a role in people's decisions to participate in the program or not. Thus, people react differently to interventions that attempt to motivate recipients to participate.The decision to participate in a motivational or behavioral intervention also depends on internal factors, such as the motivation and prior behavior of the target audience. People who contemplate participating in an intervention assess their own needs and examine how useful or threatening the intervention is given these factors.

We also found that prior physical or psychological complaints of the participants have a positive influence on their participation in counseling programs.

It is possible to design intervention contexts that communicate that the intervention will be useful or that it will allow recipients to enact their intentions (confidence). The introductory context of an intervention typically includes descriptions of the content or nature of the programs available to potential targets. These descriptions are provided by practitioners or through informal contacts with the social network. In addition, the title, setting and staff of the program communicate important information on which potential recipients base their participation decisions.

A meta-intervention conveying that participants are free to not change are the ones that attract participants. A meta-intervention that describes the intervention as effective as changing behavior did not differ from an informational meta-intervention or a no-meta-intervention control.

The implications of finding ways to increase participation in HIV-prevention interventions are vast. To date, researchers and practitioners have spent large amounts of resources on testing the effectiveness of sophisticated preventive programs that have the potential to increase condom use among recipients. However, there has been little if any research on ways to increase participation in these programs. To this extent, there is little knowledge on how to promote programs for different populations or how to introduce an HIV-prevention intervention in ways that will be best accepted by the target audience. This project attempts to fill this gap and provide a theoretical and empirical understanding of the mechanisms that underlie decisions to participate in or to avoid a given intervention.