Date Published: June 28, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Elizabeth Baumler, Jill Glassman, Susan Tortolero, Christine Markham, Ross Shegog, Melissa Peskin, Robert Addy, Heather Franks.
A set of mediation analyses were carried out in this study using data from It’s Your Game. . .Keep It Real (IYG), a successful HIV/STI/pregnancy prevention program. The IYG study evaluated a skill and normbased. HIV/STI/pregnancy prevention program that was implemented from 2004 to 2007 among 907 urban low-income middle school youth in Houston, TX, USA. Analyses were carried out to investigate the degree to which a set of proposed psychosocial measures of behavioral knowledge, perceived self-efficacy, behavioral, and normative beliefs, and perceived risky situations, all targeted by the intervention, mediated the intervention’s effectiveness in reducing initiation of sex. The mediation process was assessed by examining the significance and size of the estimated effects from the mediating pathways. The findings from this study provide evidence that the majority of the psychosocial mediators targeted by the IYG intervention are indeed related to the desired behavior and provide evidence that the conceptual theory underlying the targeted psychosocial mediators in the intervention is appropriate. Two of the psychosocial mediators significantly mediated the intervention effect, knowledge of STI signs and symptoms and refusal self-efficacy. This study suggests that the underlying causal mechanisms of action of these interventions are complex and warrant further analyses.
The majority of teen HIV/STI/pregnancy prevention programs are theory-based, targeting psychosocial variables to produce changes in sexual risk-taking behaviors. Guided by established psychosocial theories such as social cognitive theory  and social influence theory [2, 3], these interventions seek to reduce sexual risk-taking behaviors, such as sexual initiation and frequency of sex, first by impacting psychosocial mediating factors, such as attitudes and self-efficacy regarding those behaviors [4–6]. Researchers in the field recognize a critical need for further examination of psychosocial mediating factors to gain insight into the mechanisms of action influencing behavior change for these interventions [4–6] because there are little data available on which psychosocial variables provide the actual mediating causal mechanisms through which HIV/STI/pregnancy prevention interventions change sexual risk-taking behaviors for adolescent populations. In this study a set of mediation analyses was carried out using data from It’s Your Game…Keep It Real (IYG), a successful HIV, STI, and pregnancy prevention program [7, 8] to investigate the degree to which the psychosocial outcomes mediated the intervention effect.
Table 1 shows the alpha reliability statistics for the psychosocial scales tested in the mediation models; Table 2 provides descriptive statistics on the baseline characteristics of the sample. Table 3 provides the estimated standardized a, b, and c′ effects and corresponding standard errors from the multilevel regression models.
The findings from this study provide evidence that the majority of the psychosocial mediators targeted by the IYG intervention are indeed related to the desired behavior and provide evidence that the conceptual theory underlying the targeted psychosocial mediators in the intervention is appropriate. The relationships between the psychosocial mediators and the behavioral outcome, the b effects, indicate that eleven of the thirteen mediators are related to initiation of sex. This provides the strongest evidence that the mediators currently being targeted by the intervention do have the potential to influence the outcome behaviors. Only two of the psychosocial mediators, HIV/STI knowledge and perceived norms about condoms, were not significantly related to the behavior.Glassman et al. (in submission)found similar b path results in their mediation analysis of a similar theory-based HIV/STI pregnancy prevention program, further supporting the theoretical underpinnings of these types of interventions.
Results of this study suggest specific areas for deepening the focus of these types of HIV/STI/pregnancy prevention interventions for this type of middle school population. In addition, the relatively small proportion of intervention effect mediated by each of the psychosocial measures is suggestive that additional mediators not measured in this study may also be driving the intervention’s effect on behavior change. Augmenting existing theories may help bolster intervention effects. Additional mediation analyses are needed that examine different aspects of the underlying mechanisms of interventions for different populations. Different stories are beginning to emerge about mediators for similar theory-based interventions when implemented in different populations (e.g.,Glassman et al., submission pending). As the body of literature in this field begins to grow, interventionists will be better equipped to begin to understand these complex processes and how to tailor intervention curriculum through targeted instruction for different populations to gain maximum risk reduction.