By Beth Krane
An interdisciplinary research team from UConn’s Center for Health, Intervention, and Prevention (CHIP) played a significant role in a special issue of the Journal of Acquired Immune Deficiency Syndromes (JAIDS), which was released recently and highlighted at the biannual International AIDS Conference in Melbourne, Australia in July. A press conference took place to promote the special issue at the National Press Club in Washington, DC.
CHIP Principal Investigator (PI) and Professor of Social Psychology Blair T. Johnson and members of his Systematic Health Action Research Program (SHARP) authored or co-authored four of the 13 journal articles focused on health communication and its essential role in HIV prevention and treatment. Johnson also contributed to the project, sponsored by John Hopkins University’s Bloomberg School of Public Health’s Health Communication Capacity Collaborative (HC3), from its formative stages as a member of an expert panel convened by HC3 last year.
“We’re calling attention to when and how the message matters,” Johnson said. “The communication piece of HIV interventions is often taken for granted. The assumption is that the message is always the same – ‘safe sex.’ Although advances in medicine are helping to stem the toll of AIDS in countries that can afford to distribute the medicines, it is clear that enacting safer behavior will always be critical to improving public health.”
The JAIDS supplement highlights the value of communication in changing human behavior, whether through medical or psychosocial interventions, Johnson said. A common theme in the articles his teams authored is that researchers, both of original studies and of meta-analyses, should consider the complexities of their topics in more detail. The authors suggest they do so by looking at the effects of specific elements of content, communicating more precisely about their processes and findings, and examining the influence of multiple social structures on the success of interventions.
“We provide guidance to researchers and reviewers that can help them make research more efficient. Doing so, in turn, should make it easier to replicate their work in other settings and to translate it into practice,” said Johnson, whose SHARP research team has been funded continuously by the National Institute of Mental Health (NIMH) for the past 19 years.
“Ultimately, public health research should clean up tremendously and people’s health should improve as a result.”
All of the articles in the JAIDS special issue are open-access.
1. Effectiveness of Mass Media Interventions on HIV Prevention 1986 – 2013: A Meta-Analysis
This article presents the first global meta-analysis of the effectiveness of mass media campaigns for HIV prevention.
Mass media campaigns were significantly associated with increases in condom use and HIV transmission and prevention knowledge, the authors’ review of both published and unpublished reports found. Increases in condom use were greater following longer campaigns and in countries lower on the Human Development Index (HDI), which compares countries based on factors such as life expectancy, education, and income. Increases in transmission knowledge were more significant when there was greater campaign exposure, for more recent campaigns, and in countries lower on the HDI.
One factor that positively impacted condom use was when the campaign messages were carefully tailored to their target populations. Campaigns including both transmission and prevention information also positively affected condom use.
“It is profound to see that mass media campaigns can have such a large effect in countries lowest on the Human Development Index, where the need is greatest. The results are promising because it shows mass media campaigns are an effective way to go to scale – taking interventions to large numbers of people in the places most in need,” said UConn Professor of Communication Sciences Leslie Snyder, a CHIP PI and a co-investigator on Johnson’s SHARP grant. Snyder is co-author of two of the supplement articles.
The differential impact between nations scoring higher and lower on the HDI may be because of reduced “media clutter” in less developed nations and due to differences in HIV incidence rates and perceived risk, Snyder said.
Co-Editor of the special issue is David R. Holtgrave, who is Professor, Department Chair, and Co-Director of the HC3 program. Dr. Holtgrave remarked that this “paper is a very important and careful systematic review… It provides a comprehensive, up-to-date summary of the impact of these interventions and helps us to understand the social factors that set the stage to make such behavior change programs work most effectively.”
2. Effects of Behavioral Intervention Content on HIV Prevention Outcomes: A Meta-Review of Meta-Analyses
Past meta-analyses of HIV prevention interventions have examined the effectiveness of interventions for various target populations and they have examined the success of different modes for delivering the interventions, but surprisingly few have focused on many, if any, dimensions of intervention content, Johnson said.
“The meta-analyses focused more on whether the interventions worked and for whom than why,” he said.
In this meta-analysis of past HIV intervention meta-analyses, Johnson’s team found two intervention content dimensions significantly related to risk reduction: skill provision and motivational enhancement.
Past HIV prevention meta-analyses have not coded behavior change techniques (BCTs), essentially the mechanisms of change, in the intervention. However, a recently developed BCT taxonomy allows more detailed examination of the interacting components of an intervention, he said.
“The taxonomy is a virtual periodic table of the elements that go into making communication-based interventions successful,” the authors note. They exhort researchers to incorporate the taxonomy into both their original studies and their meta-analyses in the future.
3. Enhancing Reporting of Behavior Change Intervention Evaluations
This article addresses four practices contributing to suboptimal reporting of behavior change interventions and encourages researchers to follow recently developed international standards for what information to include in social science journal articles.
The four practices are: 1. Lack of availability of detailed descriptions of interventions and their implementations, 2. Omission of content from active control groups, 3. Lack of availability of detailed process evaluations and 4. Lack of replication to other contexts.
For example, the authors note that “a substantial portion of the science of behavior change is being lost each year” because of lack of attention being paid to supplemental information available in some HIV intervention manuals, which the U.S. Centers for Disease Control and Prevention (CDC) make available through a program to disseminate best evidenced-based interventions, and because social scientists do not make enough efforts to make such materials available to each other apart from formal programs such as the CDCs.
The importance of paying attention to the content active control groups are receiving is stressed in several of the CHIP articles. In this article, the authors estimate the effects of some interventions could be up to two times greater or four times smaller if control group content were given greater attention.
4. Health Behavior Change Models for HIV Preventions and AIDS Care: Practical Recommendations for a Multi-Level Approach
“Despite increasing recent emphasis on the social and structural determinants of HIV-related risk behavior, empirical research and interventions lag behind, partly because of the complexity of social-structural approaches,” the authors of this article note.
This article compares four multi-level approaches. One of these is the Network Individual Resource model, a 2010 publication that resulted from the work of 14 scholars led by Johnson. This model situates behavior in the web of interactions between individuals and their networks, highlighting how the exchange of resources may increase or decrease risk. The model has fared well in empirical tests. Indeed, the finding that mass media campaigns succeed better in poorer nations supports one of the model’s predictions.
He article reviewing multi-level approaches also provides an extensive list of variables associated with behavior and behavior change on the individual-structural spectrum for researchers’ consideration. The authors also discuss challenges associated with designing research to take into account such complexities and they identify starting points for doing so.
Of note, the researchers recommend assembling an interdisciplinary team and recommend the appropriate disciplines to address different levels of the individual-structural spectrum. While encouraging researchers to embrace the complexities of their research topics, the authors also caution them to limit themselves to limit themselves to two such factors in any one research endeavor.
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UConn-affiliated authors of the articles are: Tania B. Huedo-Medina (Allied Health Sciences), Blair T. Johnson (Psychology), Jessica M. LaCroix (Psychology), and Leslie B. Snyder (Communication), all of whom are CHIP affiliated. Other authors with CHIP affiliations include Charles Abraham (Exeter University, UK) and Marijn de Bruin (Aberdeen University, UK). Michelle Kaufman (HC3 program, Johns Hopkins), who completed her Ph.D. work under the supervision of Prof. Seth C. Kalichman at UConn, was lead author on the article reviewing multi-level theories.