Skip to main content

Advertisement

SpringerLink
Log in

Factors Underlying the Success of Behavioral HIV-Prevention Interventions for Adolescents: A Meta-Review

  • Substantive Review
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

The purpose of this meta-review was to identify characteristics of successful HIV prevention interventions for adolescents based on quantitative (i.e., meta-analyses) and qualitative reviews published to date, and to inform intervention utilization and future development. To that end, we were guided by principles of triangulation. Searches of seven electronic bibliographic databases yielded five meta-analyses and six qualitative reviews that satisfied the selection criteria. Reviews were subjected to careful content analysis. All reviews reported that behavioral interventions had positive outcomes on at least one of the following outcomes: HIV-related knowledge, subjective cognitions and beliefs enabling safer sex, abstinence, delaying next sexual intercourse, decreasing number of sexual partners, and actual condom use. Four categories, suggesting factors more prominently linked to intervention success, emerged: behavior change techniques (e.g., cognitive-behavior and motivation enhancement skills training); recipient characteristics (e.g., age, vulnerability to contracting STIs/HIV); prominent design features (e.g., use of theory, formative research); and socio-ecological features (e.g., supportive school environment). Future interventions would benefit from conducting preliminary formative research in order to enable optimal implementation of all these factors.

Resumen

El propósito de este meta-análisis fue identificar las características de las intervenciones de prevención del VIH con éxito para adolescentes basado en cuantitativos (es decir, los meta-análisis) y comentarios cualitativos publicados hasta la fecha, y que informe a la utilización de la intervención y el desarrollo futuro. Para ello, nos hemos guiado por los principios de la triangulación. Búsquedas de siete bases de datos bibliográficas electrónicas produjeron cinco meta-análisis y seis revisiones cualitativas que cumplieran los criterios de selección. Las críticas fueron sometidas a análisis de contenido con cuidado. Todas las opiniones informaron que las intervenciones conductuales tuvieron resultados positivos en al menos uno de los siguientes resultados: el conocimiento, las cogniciones y creencias subjetivas relacionadas con el VIH que permiten el sexo seguro, la abstinencia, el retraso a la próxima relación sexual, disminuyendo el número de parejas sexuales y el uso real del condón. Emergieron cuatro categorías que sugieren factores sobresalientes relacionados a la intervención exitosa: técnicas de cambios de comportamiento (por ejemplo, formación de habilidades, cognitivas—de comportamiento y de mejora de la motivación); características del participante (por ejemplo, la edad, la vulnerabilidad a contraer ITS/VIH); características de diseño importantes (por ejemplo, el uso de la teoría, la investigación formativa); y las características socio-ecológicos (por ejemplo, el medio ambiente escolar de apoyo). Futuras intervenciones se beneficiaran de llevar a cabo investigaciones formativas preliminares para poder implementar óptimamente todos estos factores.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

(*Asterisked citations were included in the sample of reviews.)

  1. WHO. World Health Statistics 2013. In: World Health Organization. WHO, Geneva, 2013.

  2. UNAIDS. Global report: UNAIDS report on the global AIDS epidemic 2013. In: Joint United Nations Programme on HIV/AIDS. UNAIDS, Geneva; 2013.

  3. Aghaizu A, Brown A, Nardone A, Gill O, Delpech V. HIV in the United Kingdom 2013 report: data to end 2012. London: Public Health England; 2013.

    Google Scholar 

  4. Stamataki P, Papazafiropoulou A, Elefsiniotis I, Giannakopoulou M, Brokalaki H, Apostolopoulou E, et al. Prevalence of HPV infection among Greek women attending a gynecological outpatient clinic. BMC Infect Dis. 2010;10(1):27.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cartagena RG, Veugelers PJ, Kipp W, Magigav K, Laing LM. Effectiveness of an HIV prevention program for secondary school students in Mongolia. J Adolesc Health. 2006;39(6):92e9–e16.

  6. Kiene SM, Barta WD. A brief individualized computer-delivered sexual risk reduction intervention increases HIV/AIDS preventive behavior. J Adolesc Health. 2006;39(3):404–10.

    Article  PubMed  Google Scholar 

  7. *Johnson BT, Scott-Sheldon LJ, Huedo-Medina TB, Carey MP. Interventions to reduce sexual risk for human immunodeficiency virus in adolescents: a meta-analysis of trials, 1985–2008. Arch Pediatr Adolesc Med. 2011;165(1):77–84.

  8. *Shepherd J, Kavanagh J, Picot J, Cooper K, Harden A, Barnett-Page et al. The effectiveness and cost-effectiveness of behavioural interventions for the prevention of sexually transmitted infections in young people aged 13–19: a systematic review and economic evaluation. Health Technol Assess. 2010;14:1–23.

  9. Picot J, Shepherd J, Kavanagh J, Cooper K, Harden A, Barnett-Page E, et al. Behavioural interventions for the prevention of sexually transmitted infections in young people aged 13–19 years: a systematic review. Health Educ Res. 2012;27(3):495–512.

    Article  PubMed  Google Scholar 

  10. Poobalan AS, Pitchforth E, Imamura M, Tucker JS, Philip K, Spratt J, et al. Characteristics of effective interventions in improving young people’s sexual health: a review of reviews. Sex Educ. 2009;9(3):319–36.

    Article  Google Scholar 

  11. Michie S, Abraham C. Interventions to change health behaviours: evidence-based or evidence-inspired? Psychol Health. 2004;19(1):29–49.

    Article  Google Scholar 

  12. Huedo-Medina TB, Ballester E, Johnson BT. Research syntheses related to childhood and adolescent sexuality: a critical review. In: Handbook of child and adolescent sexuality: developmental and forensic psychology [internet]. Amsterdam: Elsevier; 2013.

  13. Francis K. Autism interventions: a critical update. Dev Med Child Neurol. 2005;47(7):493–9.

    Article  PubMed  CAS  Google Scholar 

  14. Foster RL. Addressing epistemologic and practical issues in multimethod research: a procedure for conceptual triangulation. ANS Adv Nurs Sci. 1997;20:1–12.

    Article  PubMed  CAS  Google Scholar 

  15. Uman LS. Systematic reviews and meta-analyses. J Can Acad Child Adolesc Psychiatr. 2011;20(1):57–9.

    Google Scholar 

  16. *Levin KD. Preventing sexually transmitted HIV infection in adolescents: predicting condom use behaviors and reducing risk. Syracuse University: Syracuse; 2002.

  17. Johnson BT, Carey MP, Marsh KL, Levin KD, Scott-Sheldon LJ. Interventions to reduce sexual risk for the human immunodeficiency virus in adolescents, 1985-2000: a research synthesis. Arch Pediatr Adolesc Med. 2003;157(4):381–8.

    Article  PubMed  Google Scholar 

  18. Sacks D. Canadian Paediatric Society Adolescent Health Committee. Age limits and adolescents. Paediatr Child Health. 2003;8(9):577.

    Google Scholar 

  19. WHO. Young people’s health—a challenge for society report of a study group on young people and health for all by the year 2000. World Health Organization: Geneva;1986.

  20. *Mullen PD, Ramírez G, Strouse D, Hedges LV, Sogolow E. Meta-analysis of the effects of behavioral HIV prevention interventions on the sexual risk behavior of sexually experienced adolescents in controlled studies in the United States. J Acquir Immune Defic Syndr. 2002;30 Suppl 1:S94–S105.

  21. Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107–15.

    Article  PubMed  Google Scholar 

  22. Duncan DF. Content analysis in health education research: an introduction to purposes and methods. Health Educ. 1989;20(7):27–31.

    PubMed  CAS  Google Scholar 

  23. Dey I. Qualitative data analysis. A user-friendly guide for social scientists. London and New York.: Routledge; 1993.

    Book  Google Scholar 

  24. Burnard P. Teaching the analysis of textual data: an experiential approach. Nurse Educ Today. 1996;16(4):278–81.

    Article  PubMed  CAS  Google Scholar 

  25. Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol. 1991;44(11):1271–8.

    Article  PubMed  CAS  Google Scholar 

  26. Oxman AD, Guyatt GH, Singer J, Goldsmith CH, Hutchison BG, Milner RA, et al. Agreement among reviewers of review articles. J Clin Epidemiol. 1991;44(1):91–8.

    Article  PubMed  CAS  Google Scholar 

  27. Kelly KD, Travers A, Dorgan M, Slater L, Rowe BH. Evaluating the quality of systematic reviews in the emergency medicine literature. Ann Emerg Med. 2001;38(5):518–26.

    Article  PubMed  CAS  Google Scholar 

  28. *Yamada J, DiCenso A. Feldman et al. Systematic review of the effectiveness of primary prevention programs to prevent sexually transmitted diseases in adolescents. In: The effective public health practice project for the public health branch Ontario ministry of health. 1999.

  29. *Juárez O, Díez E. Prevención del SIDA en adolescentes escolarizados: una revisión sistemática de la efectividad de las intervenciones. Gac Sanit. 1999;13(2):150–162.

  30. Michie S, Johnston M. Theories and techniques of behaviour change: developing a cumulative science of behaviour change. Health Psychol Rev. 2012;6(1):1–6.

    Article  Google Scholar 

  31. *Morrison-Beedy D, Nelson LE. HIV prevention interventions in adolescent girls: what is the state of the science? Worldviews Evid Based Nurs. 2004;1(3):165–75.

  32. *Pedlow CT, Carey M. Developmentally appropriate sexual risk reduction interventions for adolescents: rationale, review of interventions, and recommendations for research and practice. Ann Behav Med. 2004;27(3):172–84.

  33. *Kim N, Stanton B, Li X, Dickersin K, Galbraith J. Effectiveness of the 40 adolescent AIDS-risk reduction interventions: a quantitative review. J Adolesc Health. 1997;20(3):204–15.

  34. Bandura A. Self-efficacy mechanism in human agency. Am Psychol. 1982;37(2):122–47.

    Article  Google Scholar 

  35. Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs: Prentice-Hall; 1986.

    Google Scholar 

  36. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179–211.

    Article  Google Scholar 

  37. Fishbein M, Azjen I. Belief, attitude, intention, and behavior. Boston: Addison-Wesley; 1975.

    Google Scholar 

  38. Rosenstock IM. The health belief model and preventive health behavior. Health Educ Behav. 1974;2(4):354–86.

    Google Scholar 

  39. Fisher JD. Possible effects of reference group-based social influence on AIDS-risk behavior and AIDS-prevention. Am Psychol. 1988;43(11):914–20.

    Article  PubMed  CAS  Google Scholar 

  40. Fisher JD, Fisher WA. Changing AIDS-risk behavior. Psychol Bull. 1992;111(3):455–74.

    Article  PubMed  CAS  Google Scholar 

  41. Prentice-Dunn S, Rogers RW. Protection motivation theory and preventive health: beyond the health belief model. Health Educ Res. 1986;1(3):153–61.

    Article  Google Scholar 

  42. Festinger L. A theory of cognitive dissonance. Stanford: Stanford University Press; 1957.

    Google Scholar 

  43. *Pedlow CT, Carey M. P. HIV sexual risk-reduction interventions for youth: a review and methodological critique of randomized controlled trials. Behav Modif. 2003;26:135–90.

  44. *Paul-Ebhohimhen V, Poobalan A, van Teijlingen E. A systematic review of school based sexual health interventions to prevent STI/HIV in sub-Saharan Africa. BMC Public Health. 2008;8(1):4.

  45. Prestwich A, Sniehotta FF, Whittington C, Dombrowski SU, Rogers L, Michie S. Does theory influence the effectiveness of health behavior interventions? Meta-analysis. Health Psychol. 2013. doi: 10.1037/a0032853.

  46. Kirby D. The impact of abstinence and comprehensive sex and STD/HIV education programs on adolescent sexual behavior. Sex Res Soc Policy. 2008;5(3):18–27.

    Article  Google Scholar 

  47. Elliott D, Mihalic S. Issues in disseminating and replicating effective prevention programs. Prev Sci. 2004;5(1):47–53.

    Article  PubMed  Google Scholar 

  48. Johnson BT, Redding C, DiClemente RJ, et al. Anetwork-individual-resource model for HIV prevention. AIDS Behav. 2010;14(2):204–21.

    Article  PubMed  Google Scholar 

  49. Johnson R, McCaul K, Klein WP. Risk involvement and risk perception among adolescents and young adults. J Behav Med. 2002;25(1):67–82.

    Article  PubMed  Google Scholar 

  50. Schaalma H, Aarø LE, Flisher AJ, et al. Correlates of intention to use condoms among Sub-Saharan African youth: the applicability of the theory of planned behaviour. Scand J Public Health. 2009;37(2 suppl):87–91.

    Article  PubMed  Google Scholar 

  51. Bryan A, Kagee A, Broaddus M. Condom use among South African adolescents: developing and testing theoretical models of intentions and behavior. AIDS Behav. 2006;10(4):387–97.

    Article  PubMed  Google Scholar 

  52. Protogerou C, Turner-Cobb J. Predictors of non-condom use intentions by university students in Britain and Greece: the impact of attitudes, time perspective, relationship status, and habit. J Child Adolesc Ment Health. 2011;23(2):91–106.

    Article  Google Scholar 

  53. Bryan A, Schindeldecker MS, Aiken LS. Sexual self control and male condom-use outcome beliefs: predicting heterosexual men’s condom-use intentions and behavior. J Appl Soc Psychol. 2001;31(9):1911–38.

    Article  Google Scholar 

  54. Mullins MM, DeLuca JB, Crepaz N, Lyles CM. Reporting quality of search methods in systematic reviews of HIV behavioral interventions (2000–2010): are the searches clearly explained, systematic and reproducible? Res Synth Methods. 2013. doi:10.1002/jrsm.1098.

  55. Cohen J. A power primer. Psychol Bull. 1992;112:155–9.

    Article  PubMed  CAS  Google Scholar 

  56. Corbin G, Strauss A. Basics of qualitative research: techniques and procedures for developing grounded theory. Los Angeles: Sage Publications; 2008.

    Google Scholar 

  57. Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8(1):45.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann BehavMed. 2013;46(1):81–95.

    Article  Google Scholar 

  59. Abraham C, Johnson BT, de Bruin M, Luszczynska A. Enhanced reporting of behavior-change-intervention evaluations. J Acquir Immune Defic Syndr (in press).

  60. Johnson BT, Michie S, Snyder LB. Effects of behavioral intervention content on HIV prevention outcomes: A meta-review of meta-analyses. J Acquir Immune Defic Syndr (in press).

Download references

Acknowledgments

Preparation of this article was supported by US Public Health Service grant 5R01MH058563-14 to Blair T. Johnson the second author. We thank Ruth Fetter for assistance in creating the database for Figure 2 and two anonymous reviewers for their input on prior drafts of this article.

Author information

Authors and Affiliations

  1. Center for Health, Intervention and Prevention, University of Connecticut, Storrs, CT, USA

    Cleo Protogerou

  2. Department of Psychology and Center for Health, Intervention and Prevention, University of Connecticut, Storrs, CT, USA

    Blair T. Johnson

  3. Liverpool Reviews and Implementation Group, Health Services Research, University of Liverpool, Second Floor, Whelan Building, Brownlow Hill, L, L69 36B, UK

    Cleo Protogerou

Authors
  1. Cleo Protogerou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Blair T. Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cleo Protogerou.

Additional information

Cleo Protogerou and Blair T. Johnson contributed equally to this work.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 38 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Protogerou, C., Johnson, B.T. Factors Underlying the Success of Behavioral HIV-Prevention Interventions for Adolescents: A Meta-Review. AIDS Behav 18, 1847–1863 (2014). https://doi.org/10.1007/s10461-014-0807-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-014-0807-y

Keywords

Search

Navigation