Rachel Jones, PhD, RN

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Reducing Urban Womens HIV Sex Risk Soap
Opera Videos on Cell Phones

• Rachel Jones, PhD, RN
• Rutgers, College of Nursing
• Newark, NJ

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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)

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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

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• 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

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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

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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.

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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.
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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).
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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).

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• 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.

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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.
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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

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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

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Data Collection ACASI

• handheld computer Sony Vaio U series, 4 screen,
  1.2 lb, touch screen

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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

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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

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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

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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

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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.

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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

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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)

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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.

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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)
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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

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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

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Filming the current intervention
Production and filming is supported by a grant
from the Healthcare Foundation of New Jersey
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The stories of 4 women
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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

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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.

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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