A Computer-based Approach to Preventing Pregnancy, STD, and HIV in Rural Adolescents

Abstract

A computer- and Internet-based intervention was designed to influence several variables related to the prevention of pregnancy, sexually transmitted diseases (STDs), and human immunodeficiency virus (HIV) in rural adolescents. The intervention was guided by the extended parallel process model and was evaluated using a pretest–post-test control group design with random assignment at the school level. Three hundred and twenty-six tenth-grade males and females enrolled in two rural Appalachian public high schools completed the survey at both points in time. Results indicate the vast majority (88.5%) of students in the experimental school completed at least one activity (M = 3.46 for those doing at least one activity). Further, both the overall program and all but one of the activities were rated positively by participants. Regarding the effects of the intervention, results indicate that students in the experimental school were less likely to initiate sexual activity and had greater general knowledge, greater condom negotiation self-efficacy, more favorable attitudes toward waiting to have sex, and greater situational self-efficacy than in the control school. In tandem, the results suggest that the computer-based programs may be a cost-effective and easily replicable means of providing teens with basic information and skills necessary to prevent pregnancy, STDs, and HIV.

Acknowledgments

This research was funded by National Institute of Mental Health grant R01 MH16876 awarded to the University of Kentucky, Rick S. Zimmerman, principal investigator.

The authors thank the students, parents, teachers, and administrators at the schools where data collection took place. We also thank our research team members (Pamela Cupp and Gary Hansen) and technology staff (Scott Johnson, Carrie Johnson, Shea McCombs, Brian Raney, and Derek Rockhill) for their assistance throughout this project. An earlier version of this article received a Top-Three Paper Award from the Applied Communication Division of the National Communication Association in November 2005.

Notes

¹Though some health professionals are starting to use the term (STIs) sexually transmitted infections, this practice is not well known to the general public, and particularly among rural adolescents. Thus, to avoid confusion, we chose to use the more well-known acronym STD during the intervention (a convention we kept in the article itself to maintain consistency).

²More than 98% of those taking part in this study reported regular access to the internet at home (80.2%), at a friend's home (87.2%), or at school (92.1%). Further, 96% reported regular access to a CD-ROM drive at home (85.7%), at a friend's home (86.1%), or at school (86.9%).

³Originally, a similar hypothesis also was advanced for severity. Pretest data revealed, however, a ceiling effect for the severity items (i.e., on a 7-point scale, mean responses ranged from 6.38 and 6.97 in both the experimental and control schools). Since there was little to no room for improvement, the severity hypotheses were dropped. It is worth noting, however, that there were no significant differences in either the experimental and control schools on any of the severity items during either the pretest or the post-test.

^a In addition to the six main activities, the website also contained buttons linking to (1) a “protect yourself” page with information about refusal skills and delaying tactics, (2) an “inform yourself” page with information about five STDs and teen pregnancy, (3) a “prizes” page with information about the various prizes students could win by participating, and (4) a “report trouble” page where participants could report any technical difficulties they experienced during the intervention.

^b Percent of students in the experimental group who completed an activity.

^c Includes ratings only from those in the experimental group who did the activity.

^d Adapted from Hoyle et al. (2002).

^e Adapted from Barth (1996).

^f Adapted from Donohew et al. (2000).

^g The Choose Your Own Adventure activity and the Refusal Skill activity were actually two parts of the same activity. This percentage indicates the number of students who did both the CD-ROM and Internet portions of the activity. Additional students may have done just the CD-ROM part of the activity, though there was no way to track this information.

⁴We are aware of the heterosexual bias in our initiation of sexual activity item. Although it is unfortunate, time and space limitations prevented us for addressing other important alternatives in the intervention or evaluation.

*p < .05

**p < .01

***p < .001

^a experimental group outperformed the control group

^b control group outperformed the experimental group

‡p = .055

^#analysis includes only individuals who were sexually active by Time 2

⁵Correlation analysis was conducted on the seven continuous variables under investigation. The mean absolute value among the 28 correlations was r = .18 (SD = .14), and nearly 47% of the correlations were insignificant. Further, the vast majority of those that were significant could be described as qualitatively weak at best (i.e., with most in the low to mid .10 s and .20 s, and only two of the 28 correlations reaching the .40 level or above).