Risk Reduction Motivation Research Articles

Diabetes misconceptions, seriousness, motivation, self-efficacy and stigma: A cross-sectional comparison of eight Australian diabetes communication campaign videos.

This study examines potential intended (attitudes, motivation and self-efficacy) and unintended (stigmatisation of diabetes) consequences of past Australian National Diabetes Week campaign videos. Further, outcomes are compared by the extent to which participants perceived their allocated video as stigmatising diabetes. In this cross-sectional, ten-arm study, participants (adults with or without diabetes; 1:2 ratio) were randomly allocated to view one of eight archival diabetes campaign videos (intervention), or either an active or passive control group. Post-exposure, study-specific scales measured diabetes Misconceptions and Seriousness, General and Diabetes Risk-Reduction Motivation and Self-efficacy, and perceptions of video Stigmatisation of diabetes. Scores were compared by condition (intervention vs. control) and by campaign Stigma (highest vs. lowest tertile score), separately by cohort (with or without diabetes). The sample included n = 1023 without diabetes; and n = 510 with diabetes (79% type 2 diabetes). No significant differences in outcomes were observed between conditions (intervention vs. control), with one exception: a modest effect on General Self-efficacy among those without diabetes only. Those perceiving high campaign Stigma (15%), relative to low Stigma (60%), reported significantly greater diabetes Misconceptions, lower perceived Seriousness and (among those without diabetes only) lower General Motivation but higher Diabetes Risk Reduction Motivation. Though limited to a single-exposure, we found little meaningful positive influence of past diabetes campaign videos on diabetes attitudes, behavioural intentions or self-efficacy. Further, campaign videos were perceived as stigmatising by a minority-a potential harmful impact. This novel study has implications for the design, implementation and evaluation of future diabetes campaigns.

648-P: Perceptions of Diabetes and Stigma—A Quasi-Experimental, Cross-Sectional Evaluation of Australian Diabetes Campaign Videos

Aim: To examine the potential negative and positive impacts of, and reaction to, eight Australian National Diabetes Week campaign videos (originally broadcast between 2005 and 2015) among adults with and without diabetes. Method: Cross-sectional, quasi-experimental, 10-arm online study. A general population sample (n=1023, aged 41±14 years, 60% women) and a diabetes population sample (n=510, aged 52±12 years, 49% women, 78% type 2 diabetes) were recruited via an Australian research panel. Participants were randomly exposed to one of eight diabetes campaign videos (intervention) or allocated to one of two control groups (active or passive). Post-exposure, study-specific scales measured diabetes Misconceptions and Seriousness, General and Diabetes Risk-Reduction Motivation and Self-efficacy, and perceptions of video Stigmatization of diabetes. Scores were compared by condition (intervention vs. control), and by campaign Stigma (high vs. low), separately by cohort (general and diabetes). Results: Exposure to diabetes campaigns had no significant impact on diabetes perceptions, relative to control, with one exception: a modest effect on General Self-efficacy among the general cohort only (p=0.015; d=-0.19). Those perceiving high campaign Stigma (15%), relative to low Stigma (60%), reported significantly greater diabetes Misconceptions (general: d=1.5; diabetes: d=-1.9) and lower Seriousness (d=0.5; d=0.3), as well as lower General Motivation (d=0.2) but higher Diabetes Risk Reduction Motivation (d=0.3) for the general cohort only. Conclusion: Single exposure to diabetes campaign videos had seemingly little positive impact on public perceptions. The minority, who perceive them as stigmatising, have greater misconceptions about diabetes, and perceive diabetes as less serious. This novel study has implications for the design and evaluation of future diabetes campaign videos globally. Disclosure E.Holmes-truscott: Research Support; Sanofi, AstraZeneca. J.Hateley-browne: None. E.M.Charalambakis: None. A.D.Ventura: None. A.G.Glenister: None. R.Scibilia: Advisory Panel; Ascensia Diabetes Care, Eli Lilly and Company, Roche Diagnostics, Employee; Diabetes Australia, Speaker's Bureau; diaTribe. J.Speight: Research Support; Sanofi, Medtronic, Abbott Diabetes, Lilly, Novo Nordisk A/S, Speaker's Bureau; Sanofi. Funding Diabetes Victoria

Diaries for observation or intervention of health behaviors: factors that predict reactivity in a sexual diary study of men who have sex with men.

Behavioral diaries for observation of health-related behaviors assume absence of reactivity (i.e., change in behavior resulting from observation), while self-monitoring diaries maximize reactivity for behavior change. Little is known about when and for whom behavioral diary studies become self-monitoring interventions. This study evaluated the moderating effects of social cognitive variables on reactivity in sexual risk behavior and risk appraisals in a diary study of men who have sex with men (MSM). One hundred forty-three MSM completed weekly online sexual diaries for 3months. Analyses were conducted with hierarchical linear modeling. There was no evidence of reactivity for the sample as a whole. Social cognitive variables (e.g., risk reduction motivation, condom use intentions, and social norms) moderated reactivity in study outcomes. For example, more highly motivated MSM experienced declines in serodiscordant unprotected anal intercourse over time. Effectiveness of behavioral self-monitoring strategies may vary depending on social cognitive domains.

Abstract P5-09-03: Healthcare Providers’ Support and Lymphedema Risk Reduction

Abstract Background: A critical issue influencing the impact of lymphedema on breast cancer survivors was whether breast cancer survivors received information from their health care providers. In early 1990's, 90% of breast cancer survivors denied receiving basic information concerning their risk of developing lymphedema and expressed concerns regarding lack of lymphedema education. Now more than 10 years later, greater than 50% of breast cancer survivors have been provided with lymphedema information. Despite this improvement, breast cancer survivors still feel frustrated by their healthcare providers’ inability to provide information on lymphedema and risk reduction. Purpose: The purpose of this study was to explore the effects of survivors’ perceived healthcare provider support on lymphedema risk reduction in terms of survivors’ risk-reduction commitment, perceived competence and motivation, cognitive and behavior outcomes. Materials & Methods: Data was collected from 133 breast cancer survivors using a Demographic and Medical Information interview instrument, a Scale for Lymphedema Risk Reduction Commitment, Competence, and Motivation, a Scale for Perceived Support from Healthcare Providers, a Knowledge Test for cognitive outcome, and the Lymphedema Risk Reduction Behavior Checklist for behavior outcome. Data analysis included descriptive statistics, multiple linear regression models, and assessment of moderation and mediation. Model fit was evaluated through the R2 for the overall model and incremental change in R2. Results: While participants reported higher positive caring, understanding, and encouraging patient-provider relationship, perceptions of having necessary information regarding lymphedema and risk reduction were lower. Survivors with higher positive cognitive outcome scored significantly higher in perceived competence (r=0.48; P<0.000), motivation (r=0.21; p=0.02), and reported more risk reduction behaviors being practiced (r=0.29; P<0.000). A model was created and evaluated with final model fit indices suggested a good fit to the sample data (X2[(3, N=133)= 3.94 (p= .268); CFI = .99; RMSEA= .05 (0 to .16); AIC = 29.94; X2(diff)= .181, p = .913). This model substantiates the importance of provider support which is directly associated with participants’ reported commitment, perceived competence and motivation, and with risk-reduction behavior. Behavior outcome was a direct function of cognitive outcome, provider support, and motivation, and indirectly influenced by levels of competence. Discussions: Cognitive outcome was a significant predictor for survivors’ perceived competence, motivation, and behavior outcome. Feeling well supported by healthcare providers did not assist in the gaining or retention of cognitive outcome. Yet, feeling well supported by healthcare providers did increase survivors’ motivation, a significant predictor for behavior outcome. Clinical Implications: Healthcare providers should be trained and encouraged to increase patients’ perceptions of provider support. In turn, this will help promote competence and motivation, resulting in a positive impact on behavior outcome. Implementation of a lymphedema risk reduction program to increased patients’ cognitive outcome impacts positively on patients’ perceived competence, motivation and behavior outcome. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-09-03.

Telephone-Administered Motivational Interviewing to Reduce Risky Sexual Behavior in HIV-Infected Rural Persons: A Pilot Randomized Clinical Trial

Although several studies have characterized patterns and predictors of continued risky sexual behavior in HIV-infected rural persons, far less research has evaluated interventions to reduce risky sex in this group. This pilot randomized clinical trial compared 2 brief telephone-administered interventions designed to reduce continued risky sexual behaviors in HIV-infected rural persons. Participants were 79 HIV-infected rural persons who reported 1 or more occasions of unprotected anal, vaginal, or oral sex in the past 2 months. Participants were recruited through AIDS service organizations in rural areas of 27 states and assigned randomly to either a 2-session, motivational interviewing plus skills-building intervention (i.e., integrated intervention; n = 48) or a 2-session, skills-building only comparison intervention (n = 31). Participants completed self-report measures of sexual behaviors and factors related to risky sex at preintervention and 2-month follow-up. Before enrolling into the intervention, 37% of participants had 2 or more sexual partners in the past 2 months, 29% had sex with 1 or more partners without knowing their partners' HIV serostatus, and almost one-third of participants located sex partners in high-risk environments (e.g., public parks, roadside rest areas). A 2 x 2 repeated measures multivariate analyses of variance found that integrated intervention participants reported greater increases in risk-reduction motivation and greater increases in condom-protected vaginal and oral intercourse occasions at follow-up compared to skills-building only participants. Brief telephone-administered interventions that integrate motivational interviewing with skills-building show potential to reduce risky sexual behaviors in HIV-infected rural persons. Additional and large-scale evaluations of this intervention approach appear warranted.

Differences in HIV-Related Knowledge, Attitudes, and Behavior Among Psychiatric Outpatients with and Without a History of a Sexually Transmitted Infection

SUMMARY HIV infection among the mentally ill is estimated to be at least eight times the prevalence in the general population. Psychiatric patients may also be disproportionately vulnerable to other sexually transmitted infections (STIs), but this has not been well studied. We sought to characterize the prevalence and correlates of STIs in a sample of psychiatric outpatients (N= 464). Over one-third of the sample (38%) reported a lifetime history of one or more STIs. Multivariate analyses showed that, relative to those without an STI history, patients with a lifetime STI history were more knowledgeable about HIV, expressed stronger intentions to use condoms, and perceived themselves to be at greater risk for HIV. However, those with a past STI were also more likely to report sex with multiple partners and reported more frequent unprotected sex in the past 3 months. Treatment for an STI may increase HIV knowledge and risk reduction motivation, but does not necessarily lead to changes in sexual risk behavior among psychiatric patients. Findings highlight the need for STI/ HIV risk reduction interventions in psychiatric settings, particularly for patients with high-risk profiles.

Optimizing a community-friendly HIV risk reduction intervention for injection drug users in treatment: a structural equation modeling approach.

Research on behavioral HIV risk reduction interventions for injection drug users (IDUs) has focused on primary outcomes (e.g., reduced injection drug use, increased condom use) but has not fully examined the respective roles played by intervention components on these primary outcomes. In this paper, we present a structural equation modeling (SEM) approach in which we specify the causal pathways leading from theory-based intervention components to risk reduction outcomes among a sample of primarily IDUs (n = 226) participating in an inner-city community-based methadone maintenance program. Similar pathways were found leading to both drug- and sexual-related risk reduction outcomes. Findings suggest the importance of targeting participants' risk reduction motivation and behavioral skills versus employing more passive informational strategies. Findings also indicate that our intervention may be optimized by focusing more on participants' risk reduction motivation within the sexual-related content and placing equivalent emphasis on participants' risk reduction knowledge, motivation, and behavioral skills within the drug-related content. By quantifying the specific linkage between intervention components and risk reduction outcomes, our SEM findings offer empirical guidance for optimizing this intervention. This strategy may also serve as a useful theory- and data-driven means to inform the refinement of other behavioral interventions.

Patterns of Sexual Risk Behavior Change Among Sexually Transmitted Infection Clinic Patients

Effective interventions to reduce sexually transmitted infection (STI) risk behaviors are most potent in the short term and are not uniformly effective for all people. The present study examined patterns of sexual behavior change among 238 men and 104 women who received risk reduction counseling in a public STI clinic and were followed for 9 months with a 1-year retrospective clinic chart abstraction for newly diagnosed STI. A two-stage, multivariate cluster analysis was performed on four risk behavior difference scores (follow-up - baseline) for 1-month, 3-month, 6-month, and 9-month follow-up frequencies of unprotected vaginal and anal intercourse. Cluster analysis identified three profile subgroups: Subgroup 1 had lower levels of risk behavior at all time points; Subgroup 2 had significant reductions in risk over time; and Subgroup 3 demonstrated significant increases in risk over time. Analyses on variables external to the cluster analysis found that the three profile subgroups differed on numbers of sex partners, substance use, sensation seeking, indicators of risk reduction motivation and behavioral skills, and contracting new STI. STI clinic patients with varying profiles of sexual behavior change were, therefore, differentiated by factors relevant to STI interventions.

Modulators of 'activated motivation': Event-specific condom use by drug injectors who have used condoms to prevent HIV/AIDS

Since sexual transmission of HIV among and from drug injectors is a frequent source of infection, condom use by them is important for prevention. This paper focuses on predictors of condom use at last sex by drug injectors with “activated motivation,” that is, by those who already are trying to use condoms to reduce HIV risk. Principal subjects are 1,240 drug injectors who report activated motivation to use condoms to prevent HIV and who had had sex within 6 months before the interview. Many used condoms at last sexual event with primary partners (65%) and with casual partners (80%). Condom use with primary partners increased over time, and was higher among those who knew they were HIV-positive or who talked about AIDS with sexual partners, but was lower among those who knew they were HIV-negative, who were Black, Hispanic, women, younger, or high school graduates, or who used crack with their partners at the sexual event. Condom use with casual partners was lower among women, older drug injectors, and those who were high on alcohol along with their partners, and tended to be more likely among those who know they are infected. Condom use with both primary and casual partners was greater with partners who did not themselves inject drugs. Programs should urge drug injectors who are trying to use condoms to avoid HIV transmission that having sex while using psychoactive substances may be a barrier to their doing so even if they want to use condoms and have done so in the past. Finally, research should be conducted to determine if persons with activated motivation should receive HIV prevention assistance that is different from that offered those who lack risk-reduction motivation or those who want to reduce their risk behaviors, but have been unable to implement the desired changes.