Safer Sex Intervention (SSI)

Program Overview

Developer(s)

Lydia A. Shrier, M.D., M.P.H.

Program Summary

Safer Sex Intervention (SSI) is an individual intervention intended to reduce STIs and improve condom use among female adolescents and young adults at high-risk for contracting an STI. The program is delivered one-on-one through a 30- to 50-minute session with a health educator, with three 10- to 30-minute follow-up sessions over the following six months.

Target Population

The program was designed for sexually active females ages 12 to 23 who have been diagnosed with an STI. It was evaluated with sexually active African American females who were 14 to 19 years old, and sought treatment for STIs at an adolescent health clinic.

Program Setting

The program is designed for and was tested in health clinics.

Contact and Availability Information

For curriculum, materials, and pricing information, please contact:

Sociometrics Corporation
1580 W. El Camino Real, Suite 8
Mountain View, CA 94040
Ph: 650-949-3282
Email: socio@socio.com
Website: https://www.socio.com/products/pasha-safer-sex-intervention

For training and support, please contact:

Dr. Lydia Shrier
Boston Children's Hospital
333 Longwood Avenue, 5th Floor
Boston, Massachusetts 02115
Ph:  617-355-8306
Email: Lydia.shrier@childrens.harvard.edu 

Sample of curriculum available for review prior to purchase: No

Adaptation guidelines or kit available: Yes

Languages available: English

Program Components

Program Objectives

The intervention's primary objective is to reduce risky sexual behaviors and reduce HIV and other STI infections by increasing participants' knowledge of condoms, HIV and STIs, pregnancy, and abstinence.  

Program Content

SSI draws upon Social Cognitive Theory, the Transtheoretical Model of Behavior Change, and motivational interviewing models. The sessions are designed to be conducted at the time of an STI diagnosis or treatment, when the participant is most likely to be thinking about her diagnosis relative to sexual risk behaviors.

There are two SSI curricula - Precontemplation Stage and Contemplation Stage. The Precontemplation version focuses on risk perception, motivation, education, and skills building. The Contemplation version focuses on education, skills, self-efficacy, and self-esteem. The participant self-assesses her level of risk using a Wheel of Change assessment, which helps the facilitator determine which curriculum to deliver.

Although the education sessions are tailored based on the participant's feedback and stated priorities, all consist of discussion on the consequences of sexual risk behaviors and methods for preventing pregnancy and STIs such as secondary abstinence and consistent condom use. The sessions teach condom use and negotiation skills.

After the initial session, there are three booster sessions to:

  • Reassess the participant's risk level
  • Discuss sexual history
  • Review the video
  • Review program materials

Participants are given condoms, a condom key chain, a Proud Pete booklet, and written materials.

Program Methods

The program is delivered through individual education sessions that incorporate discussion, role play (in the Contemplation curriculum, optional in the Precontemplation curriculum), condom demonstration, and video.

Implementation Requirements and Guidance

Program Structure and Timeline

The initial session lasts between 30 and 50 minutes, including viewing a 7-minute video. The initial session is followed by three 10- to 30-minute individual booster sessions at a health clinic. The three booster sessions are held at one, three, and six months after the initial session. Booster sessions typically coincide with the participant's clinical treatment schedule. All sessions are individual.

Staffing

Sessions are conducted by a female health educator who is trained in motivational interviewing techniques.

Program Materials and Resources

The following program materials are available through the distributor:

  • Safer Sex Intervention User's Guide
  • Safer Sex Intervention Curriculum Manual
  • Private Lives, HIV and STI Education DVD
  • Photocopy Masters: Handouts and Booster Session
  • Proud Pete Flipbook
  • Condom Keychains
  • Each of the following six brochures:  STD Facts,
    Birth Control Choices, Condoms: How to Use Them, 101 Ways of Saying No, 101 Ways of Making Love without Doin' It, and Safer Sex: Talking with Your Partner.
  • Fidelity toolkit
  • Set of Original Evaluation Instruments
  • Prevention Minimum Evaluation Data Set (PMEDS)
  • Local Evaluator Consultant Network Directory

While a free sample curriculum is not available, providers may purchase an automatic digital download of the user’s guide to review program components, core competencies for facilitators, and scientific evidence of effectiveness. If providers decide to purchase the program, the price of the download is deducted.

Additional Needs for Implementation

The program requires a video/DVD player, male and female anatomical models, condoms, personal lubricants, and a private space for sessions.

Fidelity

SSI has a fidelity toolkit/checklist, and tools for monitoring program implementation. These may be accessed on the Sociometrics website: https://www.socio.com/products/pasha-safer-sex-intervention

Training and Staff Support

Staff Training:

Training is not required, but is highly recommended. Training lasts two to three days and is provided through consultation with the developer. Providers interested in formalized training should contact Dr. Shrier (Email: Lydia.shrier@childrens.harvard.edu)  .

Technical Assistance and Ongoing Support:

Sociometrics provides telephone technical support on implementation and evaluation for one year with purchase of the program materials.

Allowable Adaptations

The developer has noted several allowable adaptations:

  1. Updating or customizing statistics and facts about youth sexual behavior, pregnancy risk, STIs, and the effectiveness of condoms and other contraception in order to keep the program up-to-date and accurate.
  2. Using different information in materials or brochures that is more up-to-date or relevant for a particular community's population, as long as the new material covers the same information and delivers the same messages.
  3. Adding or replacing incentives/giveaways, such as pens, condoms, bracelets, or Post-it pads, particularly with the clinic's contact information or with messages such as "use protection" or "it's never too late to abstain."
  4. Providing additional resources, such as referrals to other clinics or educational activities or a list of places to get condoms, as long as they are consistent with the intervention's messages and/or promote other clinic sessions.

Implementation Readiness Assessment

The review team conducted an independent assessment of the program’s readiness for implementation. This assessment is based on the team’s review of available program materials and documents. The team also requested input from program developers and distributors about the availability of implementation materials and resources.

On the basis of this assessment, the team calculated an implementation readiness score comprised of three component scores: (1) curriculum and materials, (2) training and staff support, and (3) fidelity monitoring tools and resources. The component scores are combined into a total score, which ranges from 0 to 8, with higher scores indicating the programs most ready to implement.

Curriculum and Materials

Has defined curriculum with lesson plans and/or activities?Yes
Has defined core or required components?Yes
Has facilitator’s guide or instructions?Yes
Component Score3/3

Training and Staff Support

Formal pre-implementation training (by qualified trainers) available?Yes
Supplemental training or ongoing technical support available?Yes
Component Score2/2

Fidelity Monitoring Tools and Resources

Has defined logic model?No
Defines fidelity guidelines and benchmarks?Yes
Offers monitoring and evaluation tools?Yes
Component Score2/3

Total Implementation Readiness Score

7/8

Reviewed Studies

CitationHigh-Quality Randomized TrialModerate-Quality Randomized TrialModerate-Quality Quasi-experimentLow Study RatingDid Not Meet Eligibility Criteria

Shrier et al. 2001

 Yes   

Abt Associates 2015b

Kelsey et al. 2016e

Kelsey et al. 2016f

Yes    

The Policy & Research Group 2015b

Yes    

Notes

Some study entries may include more than one citation because each citation examines a different follow-up period from the same study sample, or because each citation examines a different set of outcome measures on the same study sample.

Study Characteristics

CitationSettingMajority Age GroupMajority Racial/Ethnic GroupGenderSample Size

Shrier et al. 2001

Health clinic14 to 17African AmericanFemale123

Abt Associates 2015b

Kelsey et al. 2016e

Kelsey et al. 2016f

Health clinic14 to 17African AmericanFemale1,809

The Policy & Research Group 2015b

Health clinic14 to 17African AmericanFemale319

Notes

Some study entries may include more than one citation because each citation examines a different follow-up period from the same study sample, or because each citation examines a different set of outcome measures on the same study sample.

Information on study characteristics is available only for studies that received a high or moderate rating. Read the description of the review process for more information on how these programs are identified.

Study Findings

Citation Sexual Activity Number of Sexual Partners Contraceptive Use STIs or HIV Pregnancy

Shrier et al. 2001

Uniformly positive impacts across the outcomes examined in this domain Uniformly null impacts across the outcomes examined in this domain

Abt Associates 2015b

Kelsey et al. 2016e

Kelsey et al. 2016f

A mix of positive, null, and/or adverse impacts across the outcomes examined in this domain A mix of positive, null, and/or adverse impacts across the outcomes examined in this domain A mix of positive, null, and/or adverse impacts across the outcomes examined in this domain Uniformly null impacts across the outcomes examined in this domain Uniformly null impacts across the outcomes examined in this domain

The Policy & Research Group 2015b

Uniformly null impacts across the outcomes examined in this domain Uniformly null impacts across the outcomes examined in this domain
CitationDetails

Shrier et al. 2001

The program’s evidence of effectiveness was first established in a randomized controlled trial involving young women recruitment from the adolescent health clinic of an urban children’s hospital. The sample was limited to women younger than 24 who were seeking treatment for cervicitis or pelvic inflammatory disease. Study participants were randomly assigned to either a treatment group that received the intervention or a control group that received the usual clinic services. Surveys were administered immediately before the program started (baseline) and again one, three, six, and 12 months after study enrollment.

The study found that six months after the intervention ended, adolescents in the intervention group were significantly less likely to report having had another sexual partner (in addition to their main partner) in the previous six months. The study found no statistically significant program impacts on having another sexual partner or on condom use at their last sexual encounter at the time of the one-month follow-up survey.

Findings from the 3-month and 12-month follow-ups were not considered for the review because they did not meet the review evidence standards. Specifically, both the 3- and 12-month follow-ups had a high rate of sample attrition, and the study did not establish baseline equivalence for the remaining sample members.

The study also examined program impacts on four measures of condom use (frequency and consistency of use with main partner, and frequency and consistency of use with another partner, in the past six months). Findings for these outcomes were not considered for the review because they did not meet the review evidence standards. Specifically, findings were reported only for subgroups defined by sexual activity at follow-up.

Abt Associates 2015b

Kelsey et al. 2016e

Kelsey et al. 2016f

A subsequent study conducted by a separate group of researchers evaluated the program when implemented on a broader scale and with a more broadly-defined target population. The study used a randomized controlled trial involving young women recruited from 37 clinics across three states (Florida, Minnesota, and Tennessee). The study focused on young women who were sexually active or about to become sexually active. Participants were randomly assigned to either a treatment group that received the intervention or to a control group that received the standard clinic services. Data were collected immediately before random assignment (baseline) and again nine and 18 months after study enrollment.

The study found that nine months after enrolling in the study, adolescents in the treatment group were significantly less likely to report having had sexual intercourse without birth control in the previous 90 days. The study also found that among the subgroup of adolescents who were sexually inexperienced at baseline, those in the treatment group were significantly less likely to report having had sex or having had more than one lifetime sexual partner. These program effects did not persist 18 months after enrollment in the study. In particular, the study found no evidence of statistically significant program impacts, for the full sample and for any of the subgroups of youth defined by sexual experience at baseline, on rates of sexual activity or sexual activity without birth control in the last 90 days, or on having had more than one lifetime sexual partner.

At the 18-month follow-up, the study also found no evidence of statistically significant program impacts on becoming pregnant or being diagnosed with a STI in the last 12 months for either the full sample or the subsample of youth who were sexually inexperienced at baseline. At both the 9- and 18-month follow-ups, the study found no statistically significant program impacts on the percentage of participants who reported having had sex without a condom in the past 90 days.

The study also examined program impacts on measures of knowledge of pregnancy risk and STI risk, attitudes toward protection, attitudes toward risky sexual behavior, motivation to delay childbearing, condom negotiation and refusal skills, and intentions to engage in sexual risky behavior. Findings for these outcomes were not considered for the review because they fell outside the scope of the review.

The Policy & Research Group 2015b

A separate recent study by another group of researchers evaluated the program with a randomized controlled trial that involved 319 young women who sought treatment in five health clinics in New Orleans, LA. The young women participating in the study were randomly assigned to either a treatment group that received the Safer Sex intervention or to a control group that received the Female Sexual Health intervention, which is an individual-level, information only sex education intervention that aims to increase participants’ knowledge about STIs that was designed specifically for this study. The study administered surveys before the start of the program (baseline), and again six months after the end of the program (about 12 months after the baseline).

Six months after the program ended, the study found no evidence of statistically significant program impacts on the number of times in the past three months the study participants reported having had sex. The study also found no statistically significant program impacts on the proportion of times in the past three months that the young women in the study’s sample had sex without using a condom or without using any type of contraceptives.

Notes

Some study entries may include more than one citation because each citation examines a different follow-up period from the same study sample, or because each citation examines a different set of outcome measures on the same study sample. A blank cell indicates the study did not examine any outcome measures within the particular outcome domain or the findings for the outcome measures within that domain did not meet the review evidence standards.

Information on evidence of effectiveness is available only for studies that received a high or moderate rating. Read the description of the review process for more information on how these programs are identified.