WHAT COULD YOU DO?

OVERVIEW

“What Could You Do?” is an interactive video intervention aimed at increasing young women’s ability to make less risky sexual health decisions.  In a random assignment study, young women assigned to receive the “What Could You Do?” intervention were compared with young women assigned to content- and topic-matched control interventions.  Over the course of a six-month follow-up period, no significant differences emerged between the “What Could You Do?” group and the control groups on sexual knowledge or frequency of condom use.  “What Could You Do?” subjects were initially more likely than control subjects to refrain from engaging in sexual intercourse, but this trend was no longer significant at the six-month follow-up.  “What Could You Do?” subjects were, however, significantly less likely than control subjects to report having been diagnosed with an STD at the six-month follow-up.

DESCRIPTION OF PROGRAM

Target population: 14-18 year old females

The “What Could You Do?” interactive video includes four sections: a sexual situations section, a risk-reduction section, a reproductive health section, and an STD section.  The sexual situations section presents viewers with sexual storylines and highlights “choice points” – moments when females can make choices that will lead them toward or away from unsafe sex.  The risk-reduction section provides information on how condoms lower sexual risk and includes instruction on proper condom use.  The reproductive health section discusses reproductive health, STD testing, and recognizing STD symptoms.  The STD section provides specific information on eight common diseases. 

Video content is presented by ethnically diverse adolescent girls engaging in realistic scenarios.  Throughout the video, condom use is presented as a means of achieving positive outcomes (e.g., pleasure and reassurance), not just as a means of avoiding negative outcomes (e.g., suspicion and disease).  The video is interactive in that viewers select which sections to watch and how each section proceeds.  Frequently, during the video, viewers are encouraged to engage in “cognitive rehearsal” – they are presented with a situation, asked to imagine what they would say or do in such a scenario, and provided with time to “practice it in their heads.”

In this study, the “What Could You Do?” intervention was compared with two control interventions: a content-matched control intervention and a topic-matched control intervention.  The content-matched intervention consisted of a “choose your own adventure”-style book that included all the dialogue from the video.  Readers were presented with the same scenarios and cognitive rehearsal prompts as “What Could You Do?” video viewers.  The topic-matched control intervention consisted of 23 commercially available brochures that closely matched the video intervention in content and length.

EVALUATION(S) OF PROGRAM

Evaluated population: 300 females from urban Pittsburgh, Pennsylvania served as the study sample for this investigation.  All subjects were between the ages of 14 and 18 and reported having engaged in heterosexual vaginal sexual activity within the past six months.  75% of subjects were African American; 15% were white; and 10% were of other racial background.

Approach: Subjects were randomly assigned to the treatment group, the content-matched control group, or the topic-matched control group.  During their first clinic visit, subjects spent 30 minutes with only the sexual situations and risk-reduction sections of their intervention.  Subjects returned to the clinic one, three, and six months later, spending 15 minutes with the intervention materials during each visit.  This time could be devoted to reviewing sections they had seen previously or exploring new material.

Subjects completed a sexual knowledge test, filled out a behavior questionnaire, and submitted self-administered STD tests at baseline.  Subjects retook the knowledge test after each follow-up visit, completed the behavior questionnaire at the three- and six-month visits, and submitted a second STD test at the six-month visit.

Results: All subjects showed improvements in sexual knowledge over time; however, there was no significant difference between groups on knowledge scores at any time point. 

Subjects assigned to receive the “What Could You Do?” video intervention were significantly more likely than subjects assigned to the control groups to refrain from having sex between baseline and the three-month follow-up.  The proportion of subjects who refrained from having sex between the three-month and six-month follow-ups was also greater in the “What Could You Do?” group than in the control groups; however, this difference was not significant.

There was no significant difference between groups on condom use at any time point.

At the final visit, subjects assigned to receive the “What Could You Do?” video intervention were significantly less likely than subjects assigned to the control groups to report having been diagnosed with an STD.  STD tests administered at the six-month follow-up reflected the general trend found in self-reports of STD diagnoses; however, significant differences were not found.

SOURCES FOR MORE INFORMATION

Curriculum materials available for purchase at:

www.whatcouldyoudo.org

References:

Downs, J.S., Murray, P.J., de Bruin, W.B., Penrose, J., Palmgren, C., & Fischhoff, B.  (2004).  Interactive video behavioral intervention to reduce adolescent females’ STD risk: a randomized controlled trial.  Social Science & Medicine, 59, 1561-1572.

Program categorized in this guide according to the following:

Evaluated participant ages: 14-18

Program age ranges in the guide: Adolescence, Youth

Program components: Clinic-Based

Measured outcomes: Reproductive Health

Program information last updated on 2/8/07.