Applying a transtheoretical behavioral change model to HIV/STD and pregnancy prevention in adolescent clinics.
OBJECTIVE
To evaluate the application of a transtheoretical model (TTM) of behavioral change to adolescent reproductive health counseling.


METHODS
Family planning counselors in Boston Metro school-based and community health centers used a TTM for pregnancy and human immunodeficiency virus/sexually transmitted disease (HIV/STD) prevention. Data were collected from September 2000 through December 2001. Bivariate analyses using chi-square statistics and multivariate analyses using logistic regression were performed to identify the differences between stage of change (SOC) groups and the predictive variables for SOC movement.


RESULTS
Data on 539 sexually experienced clients were examined. Site, client's gender, race, proximity of sexual activity, sexual partner status, level of partner support, and target behavior were significantly associated with initial SOC for both pregnancy and disease prevention (p < .01). For clients meeting stage movement analysis criteria (n = 86 for pregnancy prevention; 128 for disease prevention), there was suggestive evidence that older ones were more likely to move forward for both pregnancy and disease prevention (p = .08 and p = .07, respectively) between their first and second visits. For disease prevention, those initially in the precontemplation/contemplation stages were more likely than those in the action/maintenance stages to be forward movers (odds ratio = 3.89, p = .06). Counselors/supervisors reported that the TTM helped structure an integrated message and increased client engagement.


CONCLUSIONS
Efforts to prevent teen pregnancy and HIV/STDs should acknowledge the roles of partner support and age in SOC. Adolescents in preparation may need specific skill-building for behavioral change. Overall, TTM represents a promising approach to promoting integrated pregnancy and disease prevention in family planning counseling.
Hacker
Karen
K
Institute for Community Health, Cambridge, Massachusetts 02139, USA. kfhacker@challiance.org
Brown
Elizabeth
E
Cabral
Howard
H
Dodds
Denise
D
D000293:Adolescent; D000294:Adolescent Behavior; D016497:Adolescent Health Services; D000328:Adult; D002648:Child; D003625:Data Collection; D003627:Data Interpretation, Statistical; D005006:Ethnicity; D005193:Family Planning Services; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008297:Male; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*