Background:
STI risk assessment and counseling are recommended but not consistently delivered.

Objective:
Develop a computerized counseling tool: ‘CARE' for STIs (Resources Online, Seattle).

Method:
Expert input and evidence based interventions were used to design CARE content. A pilot study to test the beta tool with users (n=43), and to explore staff perceptions (5 focus groups), collected data using observation, in-depth interviews, and focus groups in health care settings in three US cities.

Result:
Patients could use CARE with minimal or no assistance, especially < 25 year olds. Sessions averaged 30.6 minutes. CARE usefulness was rated 8.2 on ascending utility scale of 0 to 10. Usability issues related to tablet computer, navigation controls, question format, and programming errors. Patient-identified strengths were perceived novelty, simplicity, confidentiality, personalization and plan development. Patients reported increased willingness to be honest; lack of judgment when using computer format; and a unique opportunity for self-evaluation. Staff-identified strengths were opportunity for enhanced data collection, handout customization, education standardization, and behavioral priming. Patient-identified limitations included limited flexibility and responses, and lack of personal touch. Staff-identified limitations were selecting users, cost, conflict with patient-provider role, privacy, and time for use.

Conclusion:
CARE was well-received and easily usable by most patients (especially 18-25 year olds). Specific usability issues were addressed by modifying the software. Patient and staff perceptions support the use of CARE as an adjunct to the usual practice in a clinical setting and as a method to expand services. Honesty, reduced time constraints, and lack of judgment associated with CARE appeared to lead to increased self-evaluation which may facilitate behavior change.

Implications:
A computerized tool that offers standardized, individualized STI risk assessment and risk reduction counseling may be an effective way to scale up delivery of risk reduction. A randomized trial to assess behavioral efficacy is now underway.