title: Patient and staff perspectives on the use of a computer counseling tool for HIV and sexually transmitted infection risk reduction.
abstract: OBJECTIVE
  To explore use of an interactive health communication tool--"Computer Assessment and Risk Reduction Education (CARE) for STIs/HIV."
  
  
  METHODS
  This was a mixed method study utilizing participant observation and in-depth interviews with patients (n = 43), and focus groups with staff (5 focus groups, n = 41) from 5 clinics in 3 states (1 Planned Parenthood, 1 Teen, 2 STD, and 1 mobile van clinic). Data were managed using Atlas.ti. Inter-rater reliability of qualitative coding was .90.
  
  
  RESULTS
  Users were 58% nonwhite with mean age 24.7 years (74% < 25). Patients could use CARE with minimal to no assistance. Time for session completion averaged 29.6 minutes. CARE usefulness was rated an average of 8.2 on an ascending utility scale of 0 to 10. Patient themes raised as strengths were novelty, simplicity, confidentiality, personalization, and plan development, increased willingness to be honest, lack of judgment, and a unique opportunity for self-evaluation. Staff themes raised as strengths were enhanced data collection, handout customization, education standardization, behavioral priming, and expansion of services. Patient limitation themes included limited responses and lack of personal touch. Staff limitation themes were selecting users, cost, patient-provider role, privacy, and time for use.
  
  
  CONCLUSIONS
  CARE was well-received and easily usable by most (especially 18-25-year-olds). Patient and staff perceptions support the use of CARE as an adjunct to usual practice and as a method to expand services. Honesty, reduced time constraints, and lack of judgment associated with CARE appeared to enhance self-evaluation, which may prove an important component in moving patients forward in the behavior change process.
authors.affiliation: Department of Family Medicine, University of Washington, Seattle, Washington 98195-4410, USA. saramack@u.washington.edu
authors.forename: Sara L C
authors.initials: SL
authors.lastname: Mackenzie
authors.forename: Ann E
authors.initials: AE
authors.lastname: Kurth
authors.forename: Freya
authors.initials: F
authors.lastname: Spielberg
authors.forename: Anneleen
authors.initials: A
authors.lastname: Severynen
authors.forename: C Kevin
authors.initials: CK
authors.lastname: Malotte
authors.forename: Janet
authors.initials: J
authors.lastname: St Lawrence
authors.forename: J Dennis
authors.initials: JD
authors.lastname: Fortenberry
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D002140:California; D003194:Computer-Assisted Instruction; D003376:Counseling / Q000379:methods*; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D007196:Indiana; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D019370:Observation; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D040242:Risk Reduction Behavior; D012749:Sexually Transmitted Diseases / Q000517:prevention & control / Q000523:psychology; D014861:Washington