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Evidence-Based Programs

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Project IMAGE

Overview of the Intervention

Project IMAGE is a cognitive behavioral intervention intended to reduce subsequent sexually transmitted infections (STIs) among ethnic minority adolescent women (ages 14 to 18 years) with a history of sexual or physical abuse and STIs. The program is adapted from the Project SAFE intervention, which is recognized by the Centers for Disease Control and Prevention as an evidence-based behavioral intervention for ethnic minority women. The Project IMAGE adaptation is for use with adolescents with a history of STIs and abuse. The intervention draws on health-promoting elements of African- and Mexican-American culture to help adolescents recognize the risks of STI acquisition and learn strategies to reduce sexual risk behavior.

Intervention Components

Component 1: Workshop Sessions

The intervention includes two workshop sessions. Each session lasts three to four hours and is delivered to small groups of four to eight adolescent females by a trained facilitator. The workshop sessions are conducted using the principles of motivational interviewing and focus on the following topics:

  • Session 1: Awareness and Perception of Risk. This session helps participants recognize the risks of STIs. They receive information on disease transmission and protection methods and strategies.
  • Session 2: Commitment to Change: Strategies to Reduce Risk Behavior. In this session, participants receive information on sex, drugs, STIs, HIV, contraception, and how to prevent infection and unintended pregnancy. They also learn how to make decisions about sex and improve communication skills.
  • Component 2: Support Group Sessions

    About a week after completing the two workshop sessions, participants are invited to attend a series of three to five support group sessions. The weekly one-hour sessions are led by a trained facilitator who uses principles of motivational interviewing to discuss topics such as interpersonal relationships, contraceptive use, and health risk behaviors. The topics and discussion are tailored to the particular needs of each group.

    Component 3: Individual Counseling Sessions

    In addition to participating in the group-based workshops and support group sessions, each program participant may receive two or more individual counseling sessions. These individual sessions are initiated by the participant and conducted by a trained facilitator. Each session focuses on the expressed needs of the participant and may include referral to other services.

    Theoretical Framework

    Study Citation: Champion, J. Dimmitt, & Collins, J. L. (2012). Comparison of a theory-based (AIDS risk reduction model) cognitive behavioral intervention versus enhanced counseling for abused ethnic minority adolescent women on infection with sexually transmitted infection: Results of a randomized controlled trial. International Journal of Nursing Studies, 49(2), 138–150

    Study setting: Community-based health clinic in a metropolitan area of the southwestern United States.

    Study Sample: 409 African- and Mexican-American adolescent women with a history of physical or sexual abuse and sexually transmitted infection

  • Mean age of adolescents was 16.5 years
  • 16% were African American
  • 84% were Mexican American
  • Study Design: Randomized controlled trial. Participants were recruited from a community-based health clinic and screened for HIV/STIs, pregnancy, and history of physical or sexual abuse. Among those participants who were determined to be eligible and agreed to participate, about half were randomly selected for a treatment group that received the Project IMAGE intervention and half were selected for a control group. STI testing was conducted before the intervention (baseline) and during a 12-month follow-up period.

    Study Rating: The study met the review criteria for a moderate study rating. It did not meet the review criteria for a high study rating because the analyses did not control for reported statistically significant baseline differences in risk behaviors between the treatment and control groups.

    Study Findings:

    Six months after the intervention: Adolescents participating in the intervention were significantly less likely to experience any new STI.

    Twelve months after the intervention: Adolescents participating in the intervention were significantly less likely to experience any new STI.

    Ordering and Training Information

    To learn more about Project IMAGE, including ordering and training information visit: http://www.etr.org/ebi/programs/project-image/