Clinic waiting room video reduces new STDs
As you move through your busy day at the clinic, how are you providing important sexually transmitted disease (STD) prevention messages to your patients? If caseload and budgetary restrictions are impeding your intentions, take a look at using a brief waiting room video intervention to complement your efforts.
Public health officials have developed "Safe in the City," a 23-minute video depicting heterosexual, gay, and bisexual characters of several races, as a simple, practical intervention to reduce STDs. In a study funded by the Centers for Disease Control and Prevention and conducted in three publicly funded STD clinic waiting rooms in Denver, Long Beach, CA, and San Francisco, the intervention was associated with a nearly 10% reduction in new STDs.1
The clinic-based video is a major advance in STD and HIV prevention, says Jeffrey Klausner, MD, MPH, deputy health officer and director of STD Prevention and Control Services at the San Francisco Department of Public Health and associate clinical professor of medicine at University of California, San Francisco. About 19 million incident cases of sexually transmitted infections occur in the United States annually.2
"Through the simple showing of a professionally developed educational video on condom use, sexual health, and partner communication in waiting rooms, patients had fewer new STDs," says Klausner, a co-author of the research paper. "Given the high rates of STDs in the United States, there is an urgent need to implement this simple and highly effective intervention."
Because of its unique study design, in which all visitors to the study's participating STD clinics were evaluated on the outcomes of the intervention, the results of the study can be generalized to other STD clinics and similar clinical settings, observes Cornelis Rietmeijer, MD, PhD, director of the STD Control Program at the Denver Public Health Department. Rietmeijer served as a co-author of the research paper.
Making it 'safe'
Clinic waiting rooms provide an often overlooked opportunity for delivering prevention information in high-risk populations. Waiting room interventions can deliver a dose of prevention to clinic patients at a teachable moment, when they are waiting to see a health provider and thinking about their health risks. In previous studies of STD clinic patients, brief video-based interventions, typically combined with individual or small-group counseling, have been associated with reductions in risky sexual behavior and new infections.3-6 However, the complexity and expense of administering those behavioral interventions might present barriers to adoption and implementation.1
To develop the "Safe in the City" video, staff from the three targeted clinics worked collaboratively with filmmaker Jesse Moss of New York City. The video is designed to model a variety of condom negotiation skills with heterosexual, gay, and bisexual characters of several races.
"Since the video was going to be the entire intervention, it really did have to look good," comments Lee Warner, PhD, MPH, an epidemiologist at the CDC's Division of HIV/AIDS Prevention and a study co-author. "We needed to impart public health messages, but in an entertaining manner."
The video includes the following three storylines told in a "soap-opera" style; as well as two informative animations that demonstrate the variety of condom types and their correct usage:
Story 1: Paul is getting more serious with Jasmine, but he "slips" and has a sexual encounter with Teresa. Teresa gets diagnosed with an STD, and Paul has to tell Jasmine about it.
Story 2: Teresa meets Luis, who is a friend of Ruben. Ruben encourages Luis to ask Teresa out. Teresa is serious about using condoms with Luis after her STD scare with Paul. As a result, Luis has to make a frantic late-night run to the store to buy condoms.
Story 3: Ruben is bisexual. His girlfriend Christina knows nothing about his interest in men. Ruben and Tim have a casual sex encounter after meeting in a bar. Several days later, Christina observes that Ruben has difficulty urinating, which leads her to believe he has an STD. She insists on a visit to the STD clinic.
Is it effective?
To examine "Safe in the City's" effectiveness, researchers developed a controlled trial among 38,635 patients attending the three STD clinics during December 2003 to August 2005. The video was shown on alternate months. The control group was composed of patients in the waiting rooms during the nonvideo month who received standard clinic services, such as patient education print materials.
The primary endpoint of the study was time to diagnosis of incident laboratory-confirmed infections (gonorrhea, chlamydia, trichomoniasis, syphilis, and HIV), as identified through review of medical records and county STD surveillance registries. During 14.8 months (average) of follow-up, 2,042 patients (5.3%) were diagnosed with incident STD (4.9%, intervention condition; 5.7%, control condition). In survival analysis, patients assigned to the intervention condition had significantly fewer STDs compared with the control condition [hazard ratio (HR), 0.91; 95% confidence interval (CI), 0.84 to 0.99)].
Showing this brief video in STD clinic waiting rooms reduced new infections nearly 10% overall in three clinics, says Warner. Researchers believe this simple, low-intensity intervention might be appropriate for adoption by other STD clinics, as well as family planning clinics, he notes.
References
- Warner L, Klausner JD, Rietmeijer CA, et al. Effect of a brief video intervention on incident infection among patients attending sexually transmitted disease clinics. PLoS Med 2008; 5:e135.
- Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases among American youth: Incidence and prevalence estimates, 2000. Perspect Sex Reprod Health 2004; 36:6-10.
- O'Donnell L, San Doval A, Duran R, et al. The effectiveness of video-based interventions in promoting condom acquisition among STD clinic patients. Sex Transm Dis 1995; 22:97-103.
- Solomon MZ, DeJong W. The impact of a clinic-based educational videotape on knowledge and treatment behavior of men with gonorrhea. Sex Transm Dis 1988; 15:127-132.
- O'Donnell CR, O'Donnell L, San Doval A, et al. Reductions in STD infections subsequent to an STD clinic visit: using video-based patient education to supplement provider interactions. Sex Transm Dis 1998; 25:161-168.
- Cohen DA, MacKinnon DP, Dent C, et al. Group counseling at STD clinics to promote use of condoms. Public Health Rep 1992; 107:727-731.
Resources
- To learn more about the Safe in the City program and preview the video, visit its web site, www.safeinthecity.org.
- To order a free intervention kit, which includes a programmable DVD, posters, and a user's guide, go to the Centers for Disease Control and Prevention's (CDC's) Diffusion of Effective Behavioral Interventions web site, www.effectiveinterventions.org. On the left side of the page, click on "Safe in the City." STD clinics will receive first priority for kit shipment. Due to limited supply, the CDC provides one kit per agency. To obtain more information about the program, call (800) 462-9521 or e-mail [email protected].
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