Increasing condom use in STI clinic clients: Promoting the formation of Implementation Intentions to overcome the discrepancy between motivation and action.

The number of people who contract a sexually transmitted infection (STI) in the
Netherlands and other high-income countries has increased over the last decade.
New behavioural interventions are required to contribute to the prevention of
STI, in particular in so-called high risk groups, including men who have sex
with men (MSM), young people and migrants. Current intervention approaches are
known to be successful in promoting motivation and protective behaviour, but it
has also been shown that the potential efficacy of prevention is limited
because good intentions frequently do not result in protective behaviour. This
study tests the efficacy of a brief intervention component that promotes the
translation of intentions into behaviour and that provides an add-on to
preventive counselling of clients seeking STI-treatment. The intervention that
will be evaluated consists of the formation of implementation intentions, an
approach that has proven to be highly effective in decreasing the
intention-behaviour gap in multiple health behaviour domains, including
smoking, diet and exercise, but that has not been tested with respect to
protective sexual behaviours. Implementation intentions are specific plans that
complement behavioural intentions, such as the plan to use condoms more
consistently, by specifying when and where condoms will be used. If it can be
shown that this method successfully promotes condom use, as is expected, this
would provide clinicians and nurses with a potent, innovative and
easy-to-implement tool to strengthen current behavioural prevention of STI in
health care settings. In addition, the intervention can potentially be used by
other STI prevention professionals in a range of settings, including community
outreach.

To assess whether a self-administered intervention to promote the formation of
Implementation Intentions successfully promotes the use of condoms in both
lower and higher risk clients of an STI clinic and reduces the well-known
discrepancy between intentions and behaviour with respect to condom use.

The study is conceived as a randomized controlled trial, with a 2 (lower risk
vs. higher risk clients) x 2 (experimental vs. control intervention) design.

The intervention is self-administered and will be conducted on a designated
stand-alone personal computer placed in a private space of the clinic. After
providing informed consent and adequate explanation by the researcher
overseeing the study, participants will start the computer program designed for
the study and intervention and first of all answer a series of questions to
assess demographic characteristics, sexual behaviours, evaluations of condom
use, and intention to use condoms. Half of the participants will then be
randomly routed to the experimental intervention, while the other half is
routed to a control intervention. In the experimental intervention participants
a series of questions is presented that guides participants through the process
of forming an Implementation Intention with respect to condom use.
These questions will identify for which of the four main domains of condom
related behaviours (i.e., getting condoms, carrying condoms, talking to a
partner about using condoms, and using the condom; Sheeran, Abraham & Orbell,
1999) they want to get some advice and form a plan which will help them to
actually use condoms. Subsequently, these questions will result in the
formulation of an *If-then* plan or resolution that is characteristic of
Implementation Intentions (e.g., *If I have sex with a new partner, I will
bring up the issue of condom before starting to make out*). The participants
will accomplish this by specifying what, were, when and how (they can choose
which of these four factors they use in their plan). In the control
intervention participants will be asked to think about situations in which they
tend to engage in unsafe sex.

The study consists of answering a series of questions prompted by a tailored
computer program. The only burden attached to this experiment is the investment
of 30 minutes of time required for participation. This includes approximately
10 minutes related to providing informed consent, 15 minutes for the
intervention, and 5 minutes to complete an online follow-up questionnaire. No
other burdens or (health) risks are expected.