Project Connect
Social Work Professor Teams with New Media Center to Better Inform New York Couples About HIV
Paper or Internet? A five-year study led by Dr. Susan Witte, associate professor at Columbia's School of Social Work, is testing the effectiveness of disseminating an Internet-based HIV-prevention program at community-based HIV services organizations across New York State.
Dr. Witte's study compares the effectiveness of dissemination of the original, paper-based version of Connect, a couple-based HIV prevention program, to the effectiveness of Multimedia Connect, the Internet-based version. The two programs are distributed by random assignment to 80 agencies. Forty will use the paper version and 40 will use the Internet.
Despite two decades of research by behavioral scientists demonstrating that theory-based programs can produce reductions in rates of unprotected sex and increases in condom use, little is known about how best to improve the availability and use of scientifically proven prevention approaches. The study seeks to close the gap between research discovery and program delivery to achieve more impact in HIV risk reduction efforts in the U.S.
Eleven of these programs are located in Harlem. An additional 50 organizations are located in the five boroughs of New York City. Each agency receives free training in the use of the program plus technical assistance. Self-reports of participating staff at each agency are collected pre-training and at six, 12 and 18 month intervals post-training. The number of times each staff member actually uses the program with a couple at an agency is the measureable outcome.
The program was developed in collaboration with the Columbia Center for New Media, Teaching and Learning using games, videos and other interactive features to create an updated version of Project Connect, a successful program that aims to prevent HIV transmission among couples.
The goal of Multimedia Connect is to improve the teaching and learning experience for both HIV service providers and participants, expand the range of providers who can implement the program and ensure that the program is executed more consistently and effectively. If the study, funded by the National Institute of Mental Health (NIMH) - now in its third year - finds that community-based organizations are more likely to use Multimedia Connect than the original, paper-based version of Connect, Multimedia Connect may provide a model for the prevention and treatment of other health, mental health and human services-related issues.
Project Connect, in its traditional form, was designed and tested by Professor Nabila El-Bassel, Dr. Louisa Gilbert and Dr. Witte, senior researchers at the School of Social Work's Social Intervention Group. Drs. El-Bassel and Gilbert are co-directors of SIG; Dr. Witte is Associate Director.
With funding from NIMH, a clinical trial of Connect conducted between 1997 and 2002 demonstrated significant decreases in the number of unprotected sexual acts, as well as significant increases in the rates of condom use, among the 217 participating couples.
One of the first couples-based HIV-prevention programs, Project Connect resulted from a shift in perspective on how to stall the spread of AIDS. Previous intervention programs designed to prevent HIV infection encouraged participants-usually women-to think of themselves as individuals protecting themselves from disease, whereas the emphasis in Connect shifted toward both members of a couple working to support and keep each other safe.
"Until we include women's male partners in sexual risk reduction efforts," Dr. Witte said, "we're not going to be able to reduce the spread of the epidemic among women."
Once Witte and her colleagues had demonstrated that Connect was effective at reducing unprotected sex, they realized a number of major obstacles were keeping the program from being put to widespread use.
First, the materials used to implement the program — a lengthy, bound script with ancillary materials and posters — were bulky and hard to transport easily. Second, effective use of the materials demanded the skills of trained social workers, who are not always available at community health and service organizations.
"It's one thing to demonstratethat a program works," said Witte,"and another to get it into the field."Dr. Witte noted that the National Institutes of Health and other key health care funding agencies are clearly indicating a critical need for dissemination and implementation research. "We need mechanisms to ease adoption of new, evidence-based programs into organizations in order to have impact," she said.
With Multimedia Connect, health educators use the Internet-based tool as a road map for completing a series of exercises, including watching videos that support communication and listening skills among couples and other interactive activities that serve as conversation starters. For instance, in one activity couples are asked to work with an interactive diagram of the human body to determine the risk level of specific kinds of sexual contact.
"The visual images break the ice because the couple sees his and her bodies and together they can explore levels of risk," said Dr. Witte. "So the discussion and the experience of learning about risk become less didactic, less abstract and much more interactive and fun for the couple."
Another advantage of translating the Connect program exercises into multimedia tools is the ability to implement them more easily in the social work curriculum. With the traditional model, first- and second-year students could practice certain components of the intervention — the speaker-listener technique, for instance — only in the field.
"As these tools were translated to become Web-based and interactive, we have been integrating them into the classroom," Dr. Witte said. Students exposed to the interactive model in the classroom are likely to use the tools with clients after completing their Master of Social Work, she said. "We believe that integrating these components both in research and into the classroom serves the students, clients and the profession best."
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Screenshots from Multimedia Connect |
