Understanding The Choices We Make


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Craig Lewis (QAHC) outlines the steps in producing a motivational interviewing inspired workook for HIV negative gay men and discusses the process and outcomes. This presentation was given at the AFAO HIV Educators' Conference 2008.

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  • Understanding The Choices We Make

    1. 1. Craig Lewis Campaigns & Resource coordinator <ul><li>Steps in producing a motivational interviewing inspired workbook for HIV negative gay men </li></ul>
    2. 2. Outline: <ul><li>Background - Why this booklet? </li></ul><ul><li>Process </li></ul><ul><li>Use </li></ul><ul><li>Content </li></ul><ul><li>Evaluation </li></ul><ul><li>Challenges </li></ul>
    3. 3. Background: <ul><li>High rates & frequency of HIV testing among gay men – need to identify HIV HP interventions to support clinicians. </li></ul><ul><li>QAHC commissioned a review of opportunities for HP interventions with gay men at time of HIV testing. </li></ul>
    4. 4. Review results: <ul><li>Mostly focused on intensive prevention counselling – shown to be effective </li></ul><ul><li>Brief counselling effective in short term </li></ul><ul><li>Many effective interventions involved Motivational interviewing </li></ul><ul><li>THT ‘ The heat of the moment’ booklet effective </li></ul>
    5. 5. But... <ul><li>Intensive counselling is expensive – GPs and sexual health clinics don’t have the staff, time, expertise or money to implement </li></ul><ul><li>Differing skills of brief intervention counselling with clinicians </li></ul><ul><li>Decided on adaptation of ‘The Heat of the Moment’ </li></ul>
    6. 6. Why MI booklet? What is MI? <ul><li>Works with clients to get them to realise the differences between actual and desired behaviour </li></ul><ul><li>Focuses on where client is at </li></ul><ul><li>Clients reflect on their risk behaviour and future behaviour </li></ul><ul><li>Relatively low cost intervention, especially compared to counselling </li></ul>
    7. 7. Process <ul><li>QAHC engaged consultant experienced in MI techniques to develop & focus test booklet based on THT ‘The Heat of the Moment’ booklet </li></ul><ul><li>Consultant drafted copy </li></ul><ul><li>Copy reviewed/input given by QAHC </li></ul><ul><li>QAHC in-house GD produced mock up </li></ul>
    8. 8. Focus testing <ul><li>Target group </li></ul><ul><ul><li>Questionnaires </li></ul></ul><ul><ul><li>Focus group in Brisbane (7 guys) </li></ul></ul><ul><ul><li>Individual phone interviews in regional areas (6 guys) </li></ul></ul><ul><li>Health Workers </li></ul><ul><ul><li>Questionnaires (17 agreed, 3 returned questionnaire) </li></ul></ul>
    9. 9. Process continued <ul><li>Changes made to booklet </li></ul><ul><li>Booklet printed & distributed </li></ul><ul><ul><li>Distributed to sexual health clinics & high gay men caseload GPs for use during pretest discussion </li></ul></ul>
    10. 10. Use <ul><li>Clinician gives booklet to client as part of pretest discussion </li></ul><ul><ul><li>Clinicians asked to provide brief explanation of content </li></ul></ul><ul><li>Client asked to write responses in booklet </li></ul><ul><li>Client encouraged to discuss responses in post test discussion </li></ul>
    11. 11. Use cont... <ul><li>Reinforces commitment to change by </li></ul><ul><ul><li>Process of client writing </li></ul></ul><ul><ul><li>Thinking deeply about issues </li></ul></ul><ul><ul><li>Writing increases commitment and likelihood of change </li></ul></ul><ul><li>Gives clinicians more to discuss in post test </li></ul>
    12. 30. Evaluation plan <ul><li>Evaluate for: Acceptability, Accessibility & Effectiveness </li></ul><ul><ul><li>Sexual health workers recruit participants who have completed the booklet </li></ul></ul><ul><ul><li>QAHC staff contact clients to administer qualitative evaluation survey </li></ul></ul><ul><ul><li>QAHC staff analyse data, making recommendations for changes as required </li></ul></ul>
    13. 31. Challenges <ul><li>Recruiting adequate gay men & clinicians for focus testing </li></ul><ul><li>Handing out at pre or post test? </li></ul><ul><ul><li>THT evaluation & focus testing conflicted </li></ul></ul>
    14. 32. Acknowledgments <ul><li>Troy Hakala – former QAHC staff </li></ul><ul><li>Aldo Spina & David Fowler consultancy – review of HP opportunities at the time of HIV testing </li></ul><ul><li>Kerri Allwood, Allwood & Associates – development of the booklet </li></ul><ul><li>Focus testing participants </li></ul>