Keisha’s boyfriend invites her over when nobody will be home, and almost instantly the lovers are in bed. Will they use a condom? The answer can be life changing, but the moment of decision is just plain awkward. An interactive DVD slows down that moment, allowing viewers to choose different scenarios, and pauses the action at key points so viewers can mentally rehearse the interaction along with Keisha.
This HIV prevention tool is one of 20 computer-mediated interventions that, in aggregate, were recently shown to work as well as human counselors. The field of health education “is kind of at a crossroads right now,” says Seth Noar, a professor of health communication at the University of Kentucky who led the study. “We’ve developed all these [effective] programs, but we’ve done a terrible job getting them into practice.” Even interventions proven to increase condom use and to reduce sexually transmitted disease rates rarely make it out the lab door. “Why do we keep developing these human interventions, when in most cases they can’t be disseminated—oftentimes for reasons as simple as cost?” asks Noar. “Let’s have computers do a lot of this counseling.”
Noar and his colleagues analyzed all the existing studies that test high-tech behavioral interventions to help prevent the spread of HIV by “developing people’s skills, improving their attitudes about condom use, and increasing their knowledge about STDs and HIV,” says Noar. By 2009 there were 20 such trials, the first published in 1997. “Really, the most surprising part was that the effects are quite similar to those that have been found in human-delivered interventions.” For example, teenage girls who struggled along with Keisha on the condom question were two and a half times more likely to be sexually abstinent for three months after participating in the interactive program, and less than half as likely to report an STD six months after the computer-mediated intervention, than a control group who didn’t follow Keisha’s story.
“This is the first synthesis that shows we can use technologies like the Internet to successfully intervene and facilitate healthy sexual behavior,” says Sheana Bull, a professor of community and behavioral health at the Colorado School of Public Health. It reveals enormous potential, since computer-based programs combine some of the strengths of personal interactions with the broad sweep of mass media campaigns. “You can reach large numbers of people in a pretty efficient way, but also you can tailor content at an individual level,” says Noar.
Bull is currently experimenting with Facebook and text messaging to reach at-risk populations, but she doesn’t think computer-mediated interventions are a panacea. “I would caution anyone to avoid using the computer to replace effective face-to-face communication and health promotion,” says Bull. “It’s not going to have the same ability to evoke empathy or clear understanding of an individual’s problem or circumstances. But it can still be a very good tool for providing clear, consistent, standardized information.”
Seth M. Noar, Larson B. Pierce, and Hulda G. Black, “Can Computer-Mediated Interventions Change Theoretical Mediators of Safer Sex? A Meta-Analysis,” Human Communication Research, 36, 2010.
Read more stories by Jessica Ruvinsky.