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A multi-component clinic-based intervention to improve young men’s sexual health
Bruce Armstrong, DSW Debra Kalmuss, PhD Molly Franks, MPH Gabrielle Hecker, MPH Pedro Alicea David Bell, MD Center for Community Health & Education Heilbrunn Department of Population & Family Health Columbia University Mailman School of Public Health New York-Presbyterian Hospital
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Young Men’s Health Initiative
Young Men’s Clinic Work in schools Work with CBOs Outreach for YMC On-site SRH education Capacity building
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The Young Men’s Clinic Established 1987
Funding: Office of Family Planning, Ford Foundation, NYS DOH, Medicaid, self-pay Only SRH clinic for men in NY metro area Provides primary care 3 sessions per week 12-35 years old 85% 20+
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Annual Visits to YMC
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YMC Services Medical Social Work Health Education Individual Group
“leaderless” groups assessment, short-term, referrals
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A typical session Varicocele, infertility Hernia Chlamydia Condyloma
Sports physicals Gynecomastia Sexual orientation Circumcision ED Acne HIV testing Looking for work Feeling anxious
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Formative Work Problem (evidence-based) Project Development
Young adult males have inadequate access to SRH care “Teachable moments” are missed when men access care “Down-time” in clinic waiting rooms can be used better Project Development Defining objectives Developing instruments (e.g. “slide”, “wifey”) Developing intervention (length, focus, teaching aides)
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Study Outcomes SRH knowledge SRH attitudes SRH behaviors
SRH attitudes: Health care utilization, Condoms
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Intervention 15 minute waiting room group with health educator
One-one interview with health educator Reinforcement of health messages by medical provider Laminated reminder cards to increase intervention “fidelity”
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Study Design Quasi-experimental pretest-posttest design
Baseline self-administered interview Exit interview 3-month follow-up telephone interview Exit interview is a manipulation check/fidelity and a satisfaction check
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Eligibility 18-30 Ability to understand English-language educational modules No prior visit to YMC in last 2 years
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Sample 174 men enrolled and 157 men completed both rounds of data collection (90% RR) “Attriters” vs. “non-attriters” Attriters older & more likely to be uninsured No difference: educational achievement, employment, race/ethnicity, SRH behaviors
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Sample Characteristics
Sociodemographics Nonwhite Young Uninsured Socioeconomically disadvantaged Sexual behavior in last 3 months Sexual risk behavior Multiple partners Sporadic condom use Sizeable minority
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Measures Satisfaction Knowledge STIs (3) EC (1) Condom pleasure (1)
Attitudes/Beliefs Health Care Utilization (2) Condoms Behaviors Number of partners Drunk, high, “buzzed” before intercourse Condom use with “main” and “casual” partners Satisfaction Clinic Health education intervention Knowledge STIs (3) EC (1) Pleasure-lubrication/condoms (1) Attitudes/Beliefs Health Care Utilization Condoms Behaviors Number of partners Drunk, high, “buzzed” before intercourse Condom use with “main” and “casual” partners Speaking to others about SRH services (2) Satisfaction Clinic Satisfaction, quality of care, intent to return Health education intervention Attention paid, education presentation helpful to men like you, educaitonal information useful
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Analysis Primary Outcome Analysis Dosing Analysis
Paired t-tests comparing respondents at baseline and 3 month follow-up Dosing Analysis Regression analysis with two independent variables; baseline score on the outcome measure and dose
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Knowledge Outcomes Pretest Mean Posttest Mean Sexual Health
2.66 4.33 strong ***P<.001
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Attitudinal Outcomes Pretest Mean Posttest Mean Condom Attitudes 7.95
7.96 Only get hc when sick/hurt 2.94 3.10 Only place can afford hc is ER*** 2.82 3.18 mixed *** P<.001
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Behavioral Outcomes # sex partners*** Buzzed, drunk, high at last sex*
Condom use w/main partner* Condom use w/casual partner*** Main partner uses BC (NS) Monthly TSE*** * p<.05 *** p<.001
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Dosing Analyses Dose had no significant effect on
Knowledge, behavioral outcomes Dose had a significant + effect on Attitudinal outcomes
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Discussion Male health education embedded in clinical settings
Viable Well-received Efficacious Valuable “teachable moments” while men wait Men can be empowered to become “gatekeepers” Staff buy-in essential Need to be sensitive to patient flow issues Service-based research enhances programs Incorporating brief sexual health messaging into men’s clinical visits can impact SRH knowledge, attitudes, behaviors Male patients and program staff need to be on board Men can be empowered to become “gatekeepers” for others Patient flow can be an issue, but… Valuable “teachable moments” created while men wait Men are receptive to health education during clinical visits Formative research to construct instruments & intervention is important Formative work to construct instruments & intervention
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Discussion (cont’d) Limitations No control group Self-report
Absence of control group Convenience sample Self-report Not able to generalize Incorporating brief sexual health messaging into men’s clinical visits can impact SRH knowledge, attitudes, behaviors Male patients and program staff need to be on board Men can be empowered to become “gatekeepers” for others Patient flow can be an issue, but… Valuable “teachable moments” created while men wait Men are receptive to health education during clinical visits Formative research to construct instruments & intervention is important
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