title: From questionnaire to conversation: a structural intervention to improve HIV test counseling.
abstract: OBJECTIVE
  We describe the effects of structural intervention to enhance the quality of HIV test counseling interaction with men who have sex with men (MSM) in San Francisco.
  
  
  METHODS
  Audio recordings of 28 rapid HIV test sessions by seven counselors were collected in two phases: before and after implementation of a waiting room intervention prior to the session. The sessions were analyzed using sequence maps to visualize and compare the sequence and distribution of four activities: counseling, information delivery, data collection, and sample collection.
  
  
  RESULTS
  Prior to the intervention, counselors and clients often oriented to data collection about the client's past risk as if it were a survey. In sessions recorded after the intervention, questions about past risk were dispersed throughout the session and embedded within an elaborated discussion of the client's particular life circumstances.
  
  
  CONCLUSIONS
  Direct observation with the aid of sequence maps illuminates the ways that counselors and clients collaboratively orient to various tasks.
  
  
  CONCLUSIONS
  We demonstrated the feasibility of a structural intervention that improved the quality of both counseling and the accuracy of client risk data without requiring additional session time or counselor training.
authors.affiliation: UCSF Center for AIDS Prevention Studies, San Francisco, CA 94105, USA. Nicolas.Sheon@ucsf.edu
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sheon
authors.forename: Seung-Hee
authors.initials: SH
authors.lastname: Lee
authors.forename: Shelley
authors.initials: S
authors.lastname: Facente
mesh_terms: D003142:Communication; D003376:Counseling; D017144:Focus Groups; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology; D006302:Health Services Research / Q000379:methods; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D012495:San Francisco; D011795:Surveys and Questionnaires; D013637:Tape Recording