understanding the choices we make
DESCRIPTION
Craig Lewis (QAHC) outlines the steps in producing a motivational interviewing inspired workook for HIV negative gay men and discusses the process and outcomes. This presentation was given at the AFAO HIV Educators' Conference 2008.TRANSCRIPT
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Craig Lewis
Campaigns & Resource coordinator
Steps in producing a motivational interviewing inspired workbook for HIV negative gay men
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Outline:
• Background - Why this booklet?
• Process
• Use
• Content
• Evaluation
• Challenges
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Background:
• High rates & frequency of HIV testing among gay men – need to identify HIV HP interventions to support clinicians.
• QAHC commissioned a review of opportunities for HP interventions with gay men at time of HIV testing.
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Review results:
• Mostly focused on intensive prevention counselling – shown to be effective
• Brief counselling effective in short term
• Many effective interventions involved Motivational interviewing
• THT ‘The heat of the moment’ booklet effective
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But...
• Intensive counselling is expensive – GPs and sexual health clinics don’t have the staff, time, expertise or money to implement
• Differing skills of brief intervention counselling with clinicians
• Decided on adaptation of ‘The Heat of the Moment’
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Why MI booklet? What is MI?
• Works with clients to get them to realise the differences between actual and desired behaviour
• Focuses on where client is at• Clients reflect on their risk behaviour and
future behaviour• Relatively low cost intervention,
especially compared to counselling
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Process
• QAHC engaged consultant experienced in MI techniques to develop & focus test booklet based on THT ‘The Heat of the Moment’ booklet
• Consultant drafted copy
• Copy reviewed/input given by QAHC
• QAHC in-house GD produced mock up
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Focus testing
• Target group– Questionnaires– Focus group in Brisbane (7 guys)– Individual phone interviews in regional
areas (6 guys)
• Health Workers– Questionnaires (17 agreed, 3 returned
questionnaire)
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Process continued
• Changes made to booklet
• Booklet printed & distributed– Distributed to sexual health clinics & high
gay men caseload GPs for use during pretest discussion
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Use
• Clinician gives booklet to client as part of pretest discussion
• Clinicians asked to provide brief explanation of content
• Client asked to write responses in booklet
• Client encouraged to discuss responses in post test discussion
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Use cont...
• Reinforces commitment to change by– Process of client writing – Thinking deeply about issues– Writing increases commitment and
likelihood of change
• Gives clinicians more to discuss in post test
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Evaluation plan
• Evaluate for: Acceptability, Accessibility & Effectiveness– Sexual health workers recruit participants
who have completed the booklet– QAHC staff contact clients to administer
qualitative evaluation survey– QAHC staff analyse data, making
recommendations for changes as required
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Challenges
• Recruiting adequate gay men & clinicians for focus testing
• Handing out at pre or post test?– THT evaluation & focus testing conflicted
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Acknowledgments
• Troy Hakala – former QAHC staff
• Aldo Spina & David Fowler consultancy – review of HP opportunities at the time of HIV testing
• Kerri Allwood, Allwood & Associates – development of the booklet
• Focus testing participants