The findings and conclusions in these presentations have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.

Tuesday, May 9, 2006
147

Development and Software Usability Testing of an Interactive Computer Counseling Tool to Reduce Sexually Transmitted Infection (STI) Risk

Ann Kurth1, Freya Spielberg2, Sara Mackenzie2, Anneleen Severyn1, C. Kevin Malotte3, J. Dennis Fortenberry4, and Janet St. Lawrence5. (1) BNHS; and Global Health, University of Washington, Box 357266, Seattle, WA, USA, (2) Family Medicine, University of Washington, 325 9th Avenue, Seattle, WA, USA, (3) Community Health and Social Epidemiology (CHASE) Programs, California State University, Long Beach, CA, USA, (4) Section of Adolescent Medicine, Indiana University School of Medicine, 575 N. West Drive, Room 070, Indianapolis, IN, USA, (5) Division of STD, CDC, Atlanta, GA, USA


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.