Introduction
Methods
Program Selection
Program | Ethnicity | Gender | Ages | Settings | Format | Sessions | Theory |
---|---|---|---|---|---|---|---|
Be Proud! Be Responsible! (BPBR) | African-American | Males | 13–18 | Multiple urban | Small group | 6 @ 50-min, weekly | Social cognitive (Bandura 1986) |
Reasoned action/planned behavior (Ajzen 1991) | |||||||
Becoming a Responsible Teen (BART) | African-American | Separate groups | 14–18 | Community-based urban | Small group | 8 @ 1.5–2 h, weekly | Social learning (Bandura 1977) |
Self-efficacy (Bandura 1986) | |||||||
Focus on Kids (FOK) | African-American | Separate groups | 9–15 | Friendship networks urban | Small group | 7 @ 1.5 h, weekly 1 one-day retreat | Protection motivation (Rogers 1983) |
Safer Choices (SC) | Multiethnic | Mixed groups | 14–17 | Schools urban and suburban | Classroom | 20 @ 45-min | Social cognitive (Bandura 1986) |
Social influences and school change | |||||||
Street Smart (SS) | Multiethnic | Mixed groups | 11–18 | Community-based urban | Small group | 8 @ 1.5–2 h 1 individual follow-up 1 community visit | Social learning (Bandura 1977) |
Coding and Category Development
Initially there were separate principles for “be a health advocate” and “protect your friends and partners”. Those were lumped together and initially given the name “Be socially responsible”. However, that wording did not seem easily accessible to adolescents, so the principle was reworded to “Act to help others protect themselves”.
Results
Principle | How the principle is demonstrated (outcome goals) | Program | Examples of how principle is embedded in program activities |
---|---|---|---|
1. Believe in your own worth and your right to a happy future | Know your values Have personal goals for desirable future Value yourself & your self-preservation Be able to resist peer pressure | BPBR | Participants role play how to explain condom use in terms of self-respect and self-protection |
BART | Teaches the concept of “Kujichagulia”—believe in self and do those things that strengthen and protect the self
| ||
FOK | Activities to define and rank their values | ||
SC | Participants identify their own values and experience that saying “no” is empowering | ||
SS | Visualization activity to clarify future goals; then write postcards to themselves from 3 years in the future | ||
2. Distinguish fact from myth (operate from head, not gut) | Know facts of HIV transmission Know how to gather information Make judgments using objective facts | BPBR | Facilitators teach the facts of HIV transmission. Participants learn to objectively assess their own vulnerability |
BART | Video and guest speaker teach that judgments of risk based on people’s appearances are not reliable | ||
FOK | Facilitators challenge “false feelings of safety”. Participants make phone calls to gather information | ||
SC | Participants learn how to recognize inaccurate information about HIV/STDs | ||
SS | “You can never tell” game teaches that appearances cannot be trusted in deciding if someone is infected | ||
3. Evaluate options & consequences | Be able to identify probable consequences in risky situations Recognize when options with short term pleasure may cause long term harm | BPBR | Participants assess their options regarding sexual behavior using accurate knowledge and their personal values |
BART | Video with characters making different choices teaches problem solving skills. Participants brainstorm to evaluate potential solutions | ||
FOK | Participants learn to evaluate different options of HIV prevention in terms of consequences | ||
SC | Participants learn how to appraise consequences of actions Recognize that HIV is irreversible and that not having sex is an option | ||
SS | Participants learn concept of ‘rationalization’ and how to counter it with reasoning. Learn tool of cost-benefit analysis and how to practice it | ||
4. Commit to change | Acknowledge personal vulnerability Decide to change unsafe behaviors Make verbal commitment to others | BPBR | Game that simulates HIV transmission dramatizes the negative consequences of staying the same and refusing to engage in safe sex habits |
BART | Game using traffic light helps participants determine their acceptable level of risk; RED: what I will not do, YELLOW: what I might do, GREEN: what I will do | ||
FOK | Participants learn that a decision is followed by commitment to implement it through action | ||
SC | Game and video of teens with HIV personalizes risk; “What can I do?” worksheet with space for private personal commitment | ||
SS | Ask participants to write goal cards. End of session homework, homework report at beginning of session | ||
5. Plan ahead and be prepared | Carry a condom Rehearse how to cope with pressure Select safe settings | BPBR | Group instruction on condom use followed by game where 20 different steps in proper condom use have to be put in correct order |
BART | Visualization activity of a successful condom purchase; practice putting condoms on penile models; practice negotiating safe sex in a mirror | ||
FOK | Participants take part in a “condom hunt” activity in which they are encouraged to go to a store and locate condoms for purchase | ||
SC | Role play activities: participants anticipate what partners will say and rehearse responses | ||
SS | Facilitators give $1 reward to everyone carrying a condom (teens who are already sexually active) when they arrive at a session | ||
6. Practice self-control | Develop awareness of emotions Identify triggers to lack of control Examine and modify self-talk | BPBR | Facilitators teach that drugs and alcohol lower inhibitions. Participants review reasons for saying “no” |
BART | Facilitators teach that it is easier to extricate oneself sooner rather than later in the sexual sequence and explain how drugs and alcohol impair judgment | ||
FOK | Participants role play strategies to either refuse engaging in sexual intercourse or assert the necessity of condom use | ||
SC | Facilitators teach delay tactics to break the mood, cool-down a situation and provide time to think or rehearse | ||
SS | Facilitators teach constructive self-talk before, during, and after risky situations. Participants learn to identify feelings that interfere with cool judgment and rate feeling on a thermometer | ||
7. Know pleasurable alternatives to high-risk activities | Know ways of being sexual without intercourse Understand needs that are being met by sex and have safe ways to meet them Have skills to make use of condom enjoyable | BPBR | Facilitators introduce the concept of “outercourse,” pleasurable sexual activities without sexual intercourse |
BART | A video shows people talking about safer sex with partners; Participants role play proposing an alternative to sexual intercourse | ||
FOK | Participants brainstorm on how to experience closeness and show caring without having sexual intercourse | ||
SC | Participants learn to offer alternate activities to maintain caring relationship when refusing sexual intercourse | ||
SS | Participants create a list of safe sex activities that they can keep in mind when faced with high-risk sexual expectations of others | ||
8. Negotiate verbally, not nonverbally | Know what you want and how to say it Be able to say it with conviction Be able to send relationship enhancing messages | BPBR | Participants learn how to say “no”, share feelings, and ease tension, to show that you still want to be in a close relationship |
BART | Role play assertive communication skills | ||
FOK | Exercises illustrate how to send clear, assertive messages and check out others’ meaning | ||
SC | Activities with scripted and semi-scripted role plays for refusal skills and condom negotiation skills. Practice refusing “pressure lines” | ||
SS | Facilitators teach use of “I statements” to assert values and personal health goals and give participants the opportunity to practice sounding firm and stern | ||
9. Choose to limit your own freedom | Create your own set of rules that benefit you and protect your health Set limits on present gratification in order to attain future goals | BPBR | Participants develop ground rules and are praised for creating their own rules |
BART | Game gets each person to create own rules for sexual behavior | ||
FOK | Activity demonstrates that conscious decision making gives control over their future | ||
SC | Participants imagine and verbalize how future goals would change if they were infected | ||
SS | Activity demonstrates how to choose behavior based on results rather than on rules imposed from outside | ||
10. Act to help others protect themselves | Value the health and safety of others Be able and willing to adopt a health educator role | BPBR | Facilitators instruct participants to notify all sexual partners if they learn they are HIV positive |
BART | Participants are encouraged to ‘spread the word’ after each session and to and to discourage others from taking risks | ||
FOK | Participants take part in projects to deliver HIV prevention messages in their community after finishing the program | ||
SC | Activities show how friends can help friends make good choices | ||
SS | In the final session, participants prepare and videotape a media message to others, incorporating what they’ve learned |