Brief interventions of up to 30 mins that focus on what is normal healthy behaviour and include video or new media, may help reduce sexually transmitted infections in youth under 25. The rates of infections such as HIV and chlamydia fell in some examples. The uptake of testing improved and self-reported risky behaviour reduced in this review of programmes for young people. Another analysis looked at similar short counselling interventions for men who have sex with men.
Effective interventions tended to use videos and new media such as a Facebook page where “expectations for a healthy relationship” could be discussed. Some interventions ran alongside one-to-one counselling. This review is based on a small number of interventions and was unable to pool the size of effects to get an average. So further detailed analysis of the 16 that were proven effective is needed before deciding what should or should not be included in future programmes to prevent these infections.
The focus on media channels that young people use and the emphasis on healthy behaviours rather than providing information on risks only are nevertheless useful pointers.
Why was this study needed?
In England there were 434,456 cases of sexually transmitted infections (STIs) in 2015. People under the age of 25 and men who have sex with men are most at risk.
Infections are spread through unprotected sex and genital contact. Common infections include chlamydia and gonorrhoea. Symptoms vary according to the infection and some people do not experience any at all. Although most can be treated with antibiotics, if left untreated, they can cause long term damage such as infertility.
Health promotion and education play a vital role in tackling this issue, and it is increasingly recognised that changing behaviour is key. An earlier study showed that brief (30 minutes or less), low intensity approaches for those attending clinics could help reduce infections. Shorter sessions may also be relatively cheap to provide and therefore good value if they work.
The review was designed to identify trials that showed what did or did not work. It looked especially at the question of whether shorter or cheaper digital interventions could work as well as longer one-to-one counselling. The main aim was to help researchers design future programmes.
What did this study do?
This systematic review included 33 randomised controlled trials of brief interventions delivered in a range of settings. All ten trials involving men who have sex with men were based in the USA, as were most aimed at people aged 14 to 25. Only three were set in the UK.
The researchers looked at whether elements such as providing information, condom use skills and behavioural skills training (equipping participants with the component skills they need to change behaviour) affected outcomes.
Trials were of fair to good quality but there was considerable variation between interventions so the results could not be pooled. It was not possible for the impact of delivery format to be clearly separated from the content which limits the ability to know which parts of the programmes were linked to success.
What did it find?
A variety of intervention types and content were effective, and the researchers looked to see if there were any common themes amongst these. Six elements were consistently associated with effectiveness, which were providing information, interpersonal training, STI tests and components that presented the arguments about attitudes, social norms and behavioural skills.
For young people:
- Reduction in STIs occurred in 2/7 trials of one-to-one counselling, 1/5 trials of a video and 1/3 trials of an STI home-testing kit.
- STI risk behaviour reduced in 3/6 trials of computer interventions, 3/5 video trials and 1/2 trials using printed materials but 0/7 trials of one to one counselling.
For men who have sex with men:
- No trials reported a reduction in STIs.
- STI risk behaviour decreased in 4/6 trials of online interventions and 2/4 trials of one to one counselling.
What does current guidance say on this issue?
NICE 2007 guidance on Sexually transmitted infections and under-18 conceptions: prevention: guidance (PH3) is aimed at primary care.
It states that risk assessment should be carried out at opportune moments. This could be when someone registers or when seeking contraceptive advice. One to one discussions based upon behaviour change theories are also recommended. These should be brief and last between 15 to 20 minutes and address factors such as risk taking.
What are the implications?
This review highlights the difficulty in trying to reduce STIs, but it may provide some useful pointers for those designing brief interventions in an area lacking robust evidence. For example prioritising the positive messages of normal behaviour rather than providing information on risk. Using a variety of different delivery formats including new media, one-to-one counselling, video presentations, digital offline computer software and online web-based interventions were promising. Notably, the inclusion of STI self-sampling increased STI testing in both groups.
Further research to look at quantifying the effects of the interventions and to focus on STIs in men who have sex with men appears warranted. If designing such programmes here, it is worth bearing in mind that the research reported in this review was often conducted in sexual health clinics and set in the USA.
Citation and Funding
Long L, Abraham C, Paquette R, et al. Brief interventions to prevent sexually transmitted infections suitable for in-service use: A systematic review. Prev Med. 2016;91:364-382.
This project was funded by the National Institute for Health Research Health Technology Assessment programme (project number 12/191/05) and NIHR Leadership in Applied Health Research and Care of the South West Peninsula (PenCLAHRC).
NHS Choices. Sexually transmitted infections. London: Department of Health; 2015.
NICE. Sexually transmitted infections and under-18 conceptions: prevention PH3. London: National Institute for Health and Care Excellence; 2007.
PHE. Sexually transmitted infections and chlamydia screening in England, 2015. London: Public Health England; 2016.
Produced by the University of Southampton and Bazian on behalf of NIHR through the NIHR Dissemination Centre