PTab: The Future of Evidence-Based Behavioral Intervention Delivery

In 2014, the rate of new cases of HIV infection in the United States was 13.8 per 100,000, but among African Americans, that rate was an astonishing 49.4 per 100,000. Between the years 2010 and 2014, 45% of all new HIV infections, 62% of newly infected women, and 64% of newly infected children aged less than 13 years were African American.¹ To make clearer what these numbers mean, only 13.3% of Americans are African American.² Similarly, Latinos make up only 17.8% of Americans, yet 23% of new HIV infections occur among Latinos.³

How can such disparities be combated? If you are an innovative nursing professor like Dr. Brooke Flinders at Miami University of Ohio, you call Dr. Josefina Card at Sociometrics Corporation. From Sociometrics, Dr. Flinders obtained FOCUS: Preventing Sexually Transmitted Infections and Unwanted Pregnancies among Young Women and incorporated delivery of this program into her nursing curriculum. The FOCUS group behavioral intervention was originally intended for young women in the Marine Corps. Dr. Flinders’ dual aim was to help fight the high rates of sexually transmitted infections and unplanned pregnancies among young women in the community and to teach nursing skills to her students.

Today, some 9 years later, Dr. Flinders’ students have used this intervention to help more than 2,000 women ages 15 to 19 avoid sexually transmitted infections and unplanned pregnancies.⁴

But why did Dr. Flinders call Dr. Card and why did student nurses find FOCUS useful and energizing? Dr. Card is a research scientist trained in social psychology. She established Sociometrics Corporation in 1983 to create research-based products for scientists and practitioners. That began with databases on sexually transmitted infections and unplanned pregnancies. As awareness grew of a new disease called HIV/AIDS, it became obvious that some behaviors that led to HIV infection were the same as those leading to unplanned pregnancy and infections like syphilis or gonorrhea. Developing HIV/AIDS databases was a natural outgrowth of the work Sociometrics was already doing.

From creating and disseminating research databases on sexually transmitted infections, unplanned pregnancies, and HIV/AIDS, Dr. Card and Sociometrics moved to producing, selecting, and disseminating programs and interventions that had been shown to be helpful in preventing and combating these problems. Why do programs like FOCUS, called “evidence-based interventions (EBIs)” work? People can avoid HIV infections through behaviors such as learning a potential sex partner’s HIV status before having sex with that person, using a condom, or refusing to have unsafe sex. But behaviors are actions, not facts. A person may not learn how to perform an action by reading a book or hearing a lecture. Learning an action takes practice.

The main difference between a program like FOCUS and typical instruction is the opportunity to practice a skill with the help of someone who knows that skill well. It’s like learning to play an instrument with a good teacher. The EBI is the “good teacher” and the skills learned are those that can help a person avoid becoming infected with HIV. An EBI provides practice in such behaviors using techniques like modeling, role-playing, and games.

As more of these kinds of programs were developed, tried, and published, a challenge arose. People wanted to use EBIs because they were proven to work, but they are difficult to implement in a different setting. This is especially true when the only information available is a scientific journal article about the EBI. Dr. Card’s first big innovation, funded by the National Institute on Minority Health and Health Disparities (NIMHD), was to work with EBI creators to make packages that could be used by others—“EBIs in a box,” as Dr. Card calls them. An article doesn’t give enough information to replicate an EBI in another place, but these packages gave health practitioner users everything needed to successfully perform the intervention in their own setting.

The next innovation, one enabled by technological advancements, was to make all the materials available electronically. Dr. Card and her team converted the EBIs to PDFs so they could be downloaded by users. This reduced costs and allowed many more people to use them. It also led very naturally to Dr. Card’s next question: “What if, instead of requiring a teacher to deliver the intervention, we programmed a computer to present it? It would be the same curriculum, but there would not need to be a human communicator in front of a roomful of people.”

With funding from NIMHD, Dr. Card and her team were able to show that an EBI tailored for African American women could be shorter, easier to scale up, and just as effective when delivered on a computer. Instead of about 16 hours, class time was reduced to 2 to 3 hours, with no decrease in effectiveness.

The Sociometrics website today contains the next advance in delivering EBIs. HIV prevention and treatment programs for youth, adult, and minority populations are now available for individual and group use. The interventions are broken down by lessons, and available online on a responsive website which makes the content accessible to uses on smartphones and tablets.

“[This] was the start toward putting all these interventions on tablets so they can easily be taken into any clinic, classroom, or other setting,” said Dr. Card.

Dr. Card’s current NIMHD-funded project is to do exactly that, and its purpose is much more than to use the coolest, latest technology. It is a project to create Android apps that allow interventions to be delivered even in rural clinics or church basements where there is no Internet connection. The app, called EBI Premium, will be available before the end of the year. EBI Premium will include all the curriculum materials and prompts for the presenter, as well as handouts, assignments, and quizzes for the students. It will even allow collection of the data needed to measure program effectiveness in the new, local setting. When the Internet is available, those data may be downloaded so they can be analyzed and published.

Sociometrics calls this project “HIV Prevention Tablet for Minority-focused Effective Behavioral Interventions,” or “PTab.”

“Think of PTab as the future of evidence-based behavioral intervention delivery. PTab will make it possible to view the curriculum on a tablet or smartphone so that anybody can carry around a portable teaching cheat sheet. For those who want to see if the curriculum is effective in their local setting, PTab will make collecting and displaying such program evaluation data a turnkey experience,” said Dr. Card.

Dr. Card believes this new use of tablets will revolutionize the delivery of EBIs, with the potential of being adapted to any EBI for any condition or use—not just to prevent HIV infection.

For more information about PTab and its availability, contact socio@socio.com.

References

1. Centers for Disease Control and Prevention (CDC). (2017). Health Disparities in HIV/AIDS, Viral Hepatitis, STDs, and TB: African Americans/Blacks.
2. United States Census Bureau. (2017). Quick Facts.
3. CDC. (2017). Health Disparities in HIV/AIDS, Viral Hepatitis, STDs, and TB: Hispanics/Latinos.
4. Solomon, J. (2018). Sustaining Evidence-Based Programs: A Model Partnership. Sociometrics Newsletter, 1.

Posted May 9, 2018