DiFranceisco W, Kelly J A, Sikkema K J, Somlai A M, Murphy D A, Stevenson L Y
Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee 53202, USA.
Am J Public Health. 1998 Jul;88(7):1068-73. doi: 10.2105/ajph.88.7.1068.
The purpose of this study was to identify factors predicting program attrition among participants in human immunodeficiency virus (HIV) risk reduction trials.
Participants were gay/bisexual men and severely mentally ill adults recruited to take part in HIV risk reduction small-group interventions. Program completers were compared with participants who were assessed at baseline but then failed to attend any sessions. The health belief model provided a framework for selection of possible predictors of program attrition.
Younger age was associated with early dropout in both samples. Other predictors among gay/bisexual men included involvement in an exclusive sexual relationship, minority ethnicity, injection drug use, and higher perceived severity of AIDS. Severely mentally ill dropouts were less knowledgeable about safer sex methods and more likely to hold positive outcome expectancies for condom use.
Evaluation of intervention effectiveness among vulnerable population segments is threatened if there is selective attrition. Better methods are needed to attract and maintain participation in HIV prevention programs. Alternatively, wider application of "intention to treat" analysis of intervention outcomes is recommended to minimize selection bias due to program dropout.
本研究旨在确定预测参与降低人类免疫缺陷病毒（HIV）风险试验的参与者退出项目的因素。
参与者为招募来参加降低HIV风险小组干预的男同性恋者/双性恋男性以及患有严重精神疾病的成年人。将项目完成者与在基线时接受评估但随后未参加任何课程的参与者进行比较。健康信念模型为选择项目退出的可能预测因素提供了框架。
在两个样本中，年龄较小与早期退出有关。男同性恋者/双性恋男性中的其他预测因素包括处于排他性性关系、少数族裔、注射吸毒以及对艾滋病更高的感知严重性。患有严重精神疾病的退出者对安全性行为方法的了解较少，并且更有可能对使用避孕套持有积极的结果预期。
如果存在选择性退出，那么弱势群体中干预效果的评估将受到威胁。需要更好的方法来吸引并维持对HIV预防项目的参与。或者，建议更广泛地应用对干预结果的“意向性分析”，以尽量减少因项目退出导致的选择偏倚。
