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Title: Rachel Jones, PhD, RN


1
Reducing Urban Womens HIV Sex Risk Soap
Opera Videos on Cell Phones
  • Rachel Jones, PhD, RN
  • Rutgers, College of Nursing
  • Newark, NJ

2
Purposes
  • To synthesize findings of pilot studies on
    handheld computers
  • audio computer assisted self interview (ACASI)
  • decision support programming (NLMG08LM008349)
  • content analysis of focus groups as basis to soap
    opera video stories evaluated in a randomized
    controlled trial pilot study (NINR RO3 NR009349)
  • To describe a randomized controlled trial to
    evaluate the effect of an intervention consisting
    of 12 weekly soap opera videos streamed to cell
    phones on young urban womens HIV sex risk
    behavior
  • (NINR R01NR010860)

3
(No Transcript)
4
Background
  • Previous studies by the P.I. conducted among
    young women the urban Northeast (N887) indicated
  • Women engaged in unprotected sex with their male
    partners, even though they felt low trust and
    perceived their partner engaged in a HIV risk
    behavior.
  • Unprotected sex with partners perceived to engage
    in risk behaviors related to sexual pressure-
    defined as gender stereotypical expectations to
    have sex

5
  • Focus groups were held for more in-depth
    understanding of quantitative findings
  • The original pilot video A story about Toni,
    Mike, and Valerie as well as the new series of 12
    segments, are based on the content analysis of
    focus group discussions

6
Focus Group Study
  • Method
  • Data Collection
  • 7 Focus groups in public housing developments,
    day care centers, after
  • school center, job training center in New Jersey
    urban communities City (2 pilot groups were held
    with men)
  • Sample
  • 43 African American and Latina women
  • Content Analysis
  • Cross case analysis, open and axial coding
    following paradigm by Strauss Corbin (1990)
  • HyperResearch to code, categorize, and map
    concepts
  • Content analysis of the focus groups provided the
    basis to story development and scripting
  • NINR RO3 NR009349

7
Sensitizing Theories
  • Sex Script Theory (Simon Gagnon, 1986)
  • Sex scripts provide a repertoire of socially
    shared meanings about sexual behavior
  • Theory of power as knowing participation in
    change (Barrett, 1989)
  • Awareness
  • Choices
  • Feeling free to put choices into action
  • Involvement in change
  • Synthesis The sex script is conceptualized as
    pattern.
  • Conceptualize lower and higher power sex scripts.

  • Jones, R. (2006) Sex Scripts and power A
    framework to explain urban womens HIV sexual
    risk with male partners. Nursing Clinics of North
    America, 41, 425-436.

8
Results the importance of relationship
  • Patterns of Unprotected Sex is a usual practice
    to maintain hope, intimacy, strategic gain, and
    stability with a male partner.
  • In lower power sex scripts the risks of HIV were
    buried under an awareness of oneself as having to
    satisfy a man and accept cheating. What Hes
    Doing for Me, As Long as He Comes Home to Me)
  • Higher power sex scripts involved womens
    awareness of themselves as worthy with diverse
    choices. Characteristic high power themes were
  • Girl Power, Expecting Sex is Not All Right, You
    Dont Own Me)

Jones Oliver (2007). Young urban womens
patterns of unprotected sex with men engaging in
HIV risk behaviors. AIDS and Behavior, 11,
812-821.
9
Higher Power Sex Scripts and Associative Memory
Processing
  • By popularizing higher power sex scripts and
    associating these with lower power sex scripts,
    new health promoting behaviors are more likely to
    be adopted
  • Unprotected sex satisfies several relationship
    promoting needs
  • The health promotion messages are designed to
    satisfy these needs while promoting health.

Stacy, Newcomb, Ames, (2000).
10
Soap Opera and Entertainment-Education
  • A modality that has used the soap opera to
    communicate pro-social messages and behavior
    change
  • Soap operas have the potential to evoke emotions
    and identification
  • (Singhal, Cody,Rogers, Sabido, 2004).

11
  • By grounding the stories in urban womens own
    experiences, via a popular medium of the soap
    opera,
  • Women can identify with the heroines
    emotionally charged process of change, as they
    transform their behavior through a new awareness
    of their value as women, of their choices, and
    their potential.
  • Messages about reducing HIV sexual risk are
    designed to fulfill familiar relationship needs.

12
A Story about Toni, Mike and Valerie A soap
opera video to reduce HIV risk in young urban
womenwww.stophiv.newark.rutgers.edu
Jones, R. (2008). Soap opera video on handheld
computers to reduce urban womens HIV risk. AIDS
and Behavior, 12, 876884 Jones Oliver (2007).
Young urban womens patterns of unprotected sex
with men engaging in HIV risk behaviors. AIDS
and Behavior, 11, 812-821.
13
Next step Create video and pilot
  • The feasibility of producing a soap opera video
    to reduce HIV risk
  • Acceptability of the video
  • Potential to produce change in stereotypical
    gender expectations to have sex
  • Acceptability of taking an interview (ACASI) and
    viewing the videos on a small, handheld computer.
  • NINR RO3 NR009349

14
Methods Pilot Study
  • Design
  • Experimental, systematic assignment into groups,
    control, pretest-posttest.
  • Experimental video -43 minutes
  • The control video featured careers in healthcare
    and computers -43 minutes
  • Sample
  • 76 women
  • aged 18 to 29
  • in sexual relationships with men previous 6
    months
  • 85.5 African American 10.5 Latina.
  • Data Collection Sites
  • Public housing in Jersey City, NJ
  • Public STD Clinic in Jersey City, NJ
  • Downtown storefront office in Newark

15
Data Collection ACASI
  • handheld computer Sony Vaio U series, 4 screen,
    1.2 lb, touch screen

16
Hypothesis The difference in pretest-posttest
scores is greater in the experimental group than
control group indicating greater reduction in
stereotypical expectations to engage in
unprotected sex.
  • Results of independent samples t-test supported
    the hypothesis. The change between pretest and
    posttest mean scores differed significantly by
    group, t (57.77) 3.29, p .001
  • According to the value of Cohens d, the
    experimental group scored .72 standard deviations
    lower, on the average, on the posttest than on
    the pretest, a moderate to large effect.
  • Jones, R. (2008). Soap opera video on handheld
    computers to reduce urban womens HIV risk. AIDS
    and Behavior, 12, 876884

17
Acceptability
  • Results also suggested support for viewing the
    video on the handheld computer. Of the sample of
    76
  • 73 felt the screen was large enough to see the
    video clearly
  • Only 2 felt the print was too small to read when
    taking the ACASI
  • All 76 felt their privacy was safeguarded while
    using the handheld computer

18
Conclusions and Implications
  • Video on handheld computers a feasible approach
    in urban women, aged 18 to 29.
  • In order to assess BEHAVIOR change a longitudinal
    study would be needed

19
Next step NLM Feasibility and Acceptability
  • To extend an ACASI to deliver tailored video
    health promotion and to compare handheld,
    laptop, and desktop computers in
  • branching functionality,
  • technical performance/feasibility,
  • and user acceptability of the ACASI/ DSS
    prototype
  • Several versions (with minor variations) of A
    Story about Toni, Mike and Valerie were created
    in order to tailor the video to the category of
    risk.
  • NLMG08 LM008349

20
Development
  • Using ACASI, all the items are both heard over a
    headset and read simultaneously on the screen.
  • The application processes the participants
    answers to the ACASI
  • Executes an algorithm to determine the level of
    HIV sex risk.
  • Depending on the level of HIV sex risk, a
    different version of the video is played.

21
Evaluation Study
  • Cross-sectional design.
  • Sample
  • 181 women, in a relationship with a male partner
    /past 3 months.
  • 18 to 29 (M 22, SD 3.5), 86 African
    American (rest Latina, Caribbean, African)
  • Systematically assigned into each of the three
    treatments
  • Handheld (Sony Vaio tm)
  • Laptop (Toshiba Tablet PC)
  • Desktop (Dell Optiplex tm)
  • Data Collection sites
  • Three different public housing developments,
    public recreation center,
  • downtown storefront, public STD clinic

22
Results Hypothesis Testing
  • As hypothesized
  • There was no statistically significant difference
    between groups on computer acceptability (F (2,
    178) .73, p .48)
  • No difference in experience of watching the 43
    minute near feature length video on a larger
    computer
  • (F (2, 178) 1.71, p .18)

23
Conclusion/Implication
  • Findings support the feasibility and
    acceptability of small handhelds to complete a
    detailed interactive interview and view a full
    length video in young urban women.
  • Handhelds have the advantages of privacy and
    portability
  • Growing popularity of small portable devices to
    run videos suggests a new paradigm to deliver
    health promotion
  • The potential to stream HIV risk reduction videos
    to at-risk young urban women on their own
    personal devices, such as cell phones.

24
www.stophiv.newark.rutgers.edu
  • The 43 minute A Story about Toni, Mike and
    Valerie is available for viewing on the website
  • Emails and requests for the video have been sent
    from public health departments and clinicians
    across the country and international requests
    continue to be received.

(NLMG08 LM008349)
25
Series of Soap Opera Videos on Cell Phones
Research in Progress
  • The purpose is to evaluate whether a series of
    12-weekly data and theory-based urban soap operas
    will promote a reduction in HIV sex risk behavior
    in young urban African American and Latina women.
  • A randomized controlled trial (RCT) with 250
    high-risk women aged 18 to 29, recruited in
    neighborhood settings in Newark and Jersey City,
    will be conducted to test the effect of the
    video-based intervention on HIV sexual risk
    behavior.
  • A control group will receive text messages with
    audio that stress HIV health promotion messages.
  • The series of 12 20-minute videos to the video
    intervention group (n125) and 12-weekly HIV-risk
    reduction text/ audio messages to the control
    group (n125) will be viewed over video-capable
    cell phones so that women may view the videos and
    text messages repeatedly and in privacy.
  • This study is supported with a grant from
    1R01NR010860

26
Currently
  • Creating the technical infrastructure to track
    whenever the video/text messages are accessed on
    the cell phone
  • Series of 12 videos have been filmed and are
    currently being edited by the filmmaker
    preparing for focus group review
  • Evaluating candidate cell phones based on
    criteria including operating system, pixel,
    screen size, cost

27
Filming the current intervention
Production and filming is supported by a grant
from the Healthcare Foundation of New Jersey
28
The stories of 4 women
29
It is expected that as a result of watching the
video series
  • the video intervention group will demonstrate
    greater reductions in unprotected sex from
    baseline to 3 and 6 months than will the control
    group.
  • they will demonstrate lower sexual pressure,
    indicating lower stereotypical expectations to
    engage in unprotected sex.
  • Secondary analyses will determine whether there
    are differences in these results by partner type,
    whether there is a reduction in the number of
    high risk sex partners, and whether choosing to
    watch the videos more frequently will relate to
    further reduction in risk behavior.
  • The program will track when, how often, and for
    how long the videos are viewed.
  • The interviews at 3 and 6 months will be
    conducted using ACASI on desktops stationed at
    the community sites

30
Significance to Youth
  • If the aims of this proposal are achieved, the
    use of the cell phone to view videos could change
    the paradigm of how health promotion is amplified
    between clinic sessions.
  • Potentially hard to reach young urban women who
    may be at risk for HIV, will be able to access
    video-based interventions on their own cell
    phones.
  • The popularity of the cell phone and use of the
    Internet for multimedia offer a new communication
    channel to address health disparities in young
    urban women.

31
Gratefully acknowledge
Filmmaker Alan Roth, digital applications
developer, Bob Nahory, technical project
management, Dave Lurachy and the IT team at
Rutgers Newark, all the actors (including
Tatianna Bosier, Lawrence Covington, Omar Golden,
Yasmine Weaver, Martinique Moore, Vanessa Garcia,
Benu Muhammad) and crew, undergraduate nursing
student RAs, public housing leaders , STD clinic
Director and staff, and especially all the women
who participated in these studies. Gratefully
acknowledge Healthcare Foundation of NJ, NINR and
NLM for their support of this research
  • Rachel Jones, PhD, RN
  • Rutgers, College of Nursing
  • Newark, NJ
  • racjones_at_rutgers.edu
  • www.stophiv.newark.rutgers.edu
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