Stage-Based Computer-Delivered Interventions to Increase Condom Use in Young Men

ABSTRACT

Objectives: The aim is to examine whether adopting or increasing condom use can be influenced by psychological treatment targeting both motivational and volitional aspects, when these components are matched to the characteristics of the recipients. Method: In a randomized controlled trial, 159 heterosexual young men (intervention groups, n = 113; control condition, n = 46) were exposed to 2 computer-delivered intervention arms, 1 targeting nonintenders (n = 36; motivational intervention arm) and the other targeting intenders (n = 77; volitional intervention arm). Intention and condom use were assessed through self-report questions at 3 points in time, each 2 weeks apart. Motivational intervention involved screen content requesting decisional balance for condom use and focus on past success to trigger self-efficacy. Volitional intervention encouraged the formation of specific if-then plans, where participants were required to choose and write about the most favourable situations by means of reflection on when, where, and how to carry them out, and of thinking about strategies for obstacles that might hinder condom use. Results: Experimental nonintenders obtained higher levels of condom use intention two weeks and one month later and of reported condom use one month later than control nonintenders. Experimental intenders reported an increase in condom use in comparison with control intenders one month later. Conclusions: At a 30-day follow-up, treatment was shown to have helped nonintenders to first increase their condom use intentions and later condom use, and intenders to improve condom use behavior. A stage-based computer-delivered intervention design including motivational and volitional treatment appears to be suitable for improving condom use motivation as well as behavior after a 1-month period.

KEYWORDS:

• Young adults
• condom use
• stages of change
• health behavior interventions
• computerized intervention

Notes

¹ We are grateful to a reviewer for drawing our attention to the fact that the efficacy of HIV prevention on a population scale would be enhanced by incorporating multiple evidence-based biomedical and behavioral strategies, in addition to condom use. The efficacy of a multimethod approach stems from the use of pre-exposer prophylaxis (PrEP) as an important and recent means of sexual HIV prevention. The use of PrEP, namely the use of daily antiretroviral treatment to protect against infection before exposure, when provided in conjunction with other HIV prevention-services, is a promising approach for preventing HIV infection with a similar magnitude in men and women in heterosexual populations (e.g., Baeten et al., 2012).

² Condom use is a dual method (STI/HIV prevention and contraceptive) and is still one of the most cost-effective approaches to preventing STIs and HIV, although it should not be presented as the only form of effective protection against HIV infection due to the PrEP specified above.