Crittenden Kathleen S, Kaponda Chrissie P N, Jere Diana L, McCreary Linda L, Norr Kathleen F
Sociology Department, University of Illinois at Chicago, Chicago, IL 60680, USA.
Kamuzu College of Nursing, University of Malawi, Private Bag 1, Lilongwe, Malawi.
Soc Sci Med. 2015 May;133:136-44. doi: 10.1016/j.socscimed.2015.03.055. Epub 2015 Mar 30.
This paper examines whether a peer group intervention that reduced self-reported risky behaviors for rural adults in Malawi also had impacts on non-participants in the same communities. We randomly assigned two districts to the intervention and control conditions, and conducted surveys at baseline and 18 months post-intervention using unmatched independent random samples of intervention and control communities in 2003-2006. The six-session peer group intervention was offered to same-gender groups by trained volunteers. In this analysis, we divided the post-intervention sample into three exposure groups: 243 participants and 170 non-participants from the intervention district (total n = 415) and 413 control individuals. Controlling for demographics and participation, there were significant favorable diffusion effects on five partially overlapping behavioral outcomes: partner communication, ever used condoms, unprotected sex, recent HIV test, and a community HIV prevention index. Non-participants in the intervention district had more favorable outcomes on these behaviors than survey respondents in the control district. One behavioral outcome, community HIV prevention, showed both participation and diffusion effects. Participating in the intervention had a significant effect on six psychosocial outcomes: HIV knowledge (two measures), hope, condom attitudes, and self-efficacy for community HIV prevention and for safer sex; there were no diffusion effects. This pattern of results suggests that the behavioral changes promoted in the intervention spread to others in the same community, most likely through direct contact between participants and non-participants. These findings support the idea that diffusion of HIV-related behavior changes can occur for peer group interventions in communities, adding to the body of research supporting diffusion of innovations theory as a robust approach to accelerating change. If diffusion occurs, peer group intervention may be more cost-effective than previously realized. Wider implementation of peer group interventions can help meet the global goal of reducing new HIV infections.
本文探讨了一项针对马拉维农村成年人减少自我报告的危险行为的同伴群体干预措施，是否也对同一社区的非参与者产生了影响。我们将两个地区随机分配到干预组和对照组，并在2003 - 2006年使用干预组和对照组社区不匹配的独立随机样本，在基线和干预后18个月进行了调查。由经过培训的志愿者向同性别的群体提供为期六节的同伴群体干预。在本分析中，我们将干预后的样本分为三个暴露组：来自干预地区的243名参与者和170名非参与者（共n = 415）以及413名对照组个体。在控制人口统计学和参与情况后，对五个部分重叠的行为结果产生了显著的有利扩散效应：与伴侣沟通、曾使用避孕套、无保护性行为、近期HIV检测以及社区HIV预防指数。干预地区的非参与者在这些行为上的结果比对照地区的调查受访者更有利。一个行为结果，即社区HIV预防，显示出参与效应和扩散效应。参与干预对六个心理社会结果有显著影响：HIV知识（两项指标）、希望、对避孕套的态度以及社区HIV预防和更安全性行为的自我效能感；没有扩散效应。这种结果模式表明，干预中促进的行为变化传播到了同一社区的其他人，很可能是通过参与者与非参与者之间的直接接触。这些发现支持了这样一种观点，即同伴群体干预在社区中可以发生与HIV相关行为变化的扩散，这为支持创新扩散理论作为加速变革的有力方法的研究增添了内容。如果发生扩散，同伴群体干预可能比之前意识到的更具成本效益。更广泛地实施同伴群体干预有助于实现减少新HIV感染的全球目标。
