• By Dartington SRU
  • Posted on Friday 16th March, 2012

Research and practice: In bed but not connecting

Around three-quarters of teen HIV/AIDS diagnoses in the US are among African-Americans, although they represent less than 20% of the teenage population. And when it comes to improving these shocking statistics, practice and research have failed to learn from each other.This is the argument made by researchers from the US’s Centers for Disease Control and Prevention (CDC). Neither side escapes unbruised from a new review. Researchers have identified that HIV risk behaviors among African-American adolescents are related to several constructs – but popular interventions don’t address them. On the other hand, practitioners routinely use several different constructs – but researchers haven’t assessed their importance.The need is urgent. African-American teens are at much higher risk for risky sexual behavior than their peers. In 2007, data from 34 US states established that 72% of HIV/AIDS diagnoses for 13-19 year-olds were among African-Americans, although they accounted for only 17% of the general population in the same age range. And so the need for coordinated effort is urgent, too. The CDC team, led by Lisa Romero, looked at research studies and at evidence-based programs used in practice. They wanted to see whether insights from research had been incorporated into practice, and whether successful interventions had led to new avenues for research. The gap between research and practice is sadly large, they found – but, more optimistically, argue that these discrepancies show that much more can be done to reduce the HIV/AIDS infection rate among African-American teens.Sexual risk behavior: the research viewRomero and colleagues first analyzed 54 research studies to identify the elements in the research literature that were most likely to reduce HIV/AIDS in African-American adolescents.They found that Environmental Conditions and Perceived Norms were two of the most important constructs influencing the risky sexual behavior that leads to high HIV/AIDS infection rates among African-American youths. Environmental Conditions encompasses the potential sexual situations in which teens find themselves, parental involvement and communication, family structure, and other social factors such as family or neighborhood poverty. Perceived Norms relates to family norms, peers’ sexual behaviors, and peers’ delinquency and drug or alcohol use. The authors concluded that family and community are particularly strong influences on African-American adolescents’ behaviors. Many of these factors are difficult to change through typical interventions, but the findings indicate that it may be useful to target parental involvement. Targeting sexual health: the content of practiceThe team next analyzed the content of seven evidence-based programs used in practice. They found the main elements were Knowledge, Self-efficacy, and Skills. Knowledge activities provide information about forms of contraception, HIV/AIDS, and other sexual health matters. Self-efficacy deals with issues of abstinence, safer sex, and effective communication. Skills comprise anything that teaches adolescents how to act on their newly acquired knowledge and self-efficacy, such as how to use a condom or where to access sexual health services. While the research emphasized the importance of community, peer, and family influences on African-American adolescents, the interventions focused more on individual approaches. Strengthening feedback between research and practiceThe discrepancy between research and practice worked in both directions, the CDC team concluded. Research had not investigated the importance of Knowledge, Self-efficacy, and Skills that played a major part in the proven interventions. Practice had not addressed the findings from research about the importance of Environmental Conditions and Perceived Norms. This gap between research and practice illustrates a clear route for improvement in the field of prevention science. Strengthening feedback mechanisms between research and practice could also have implications for “scale” and “implementation fidelity,” two hot topics in the world of prevention science. If programs are firmly grounded in research and tailored for target populations before implementation, there might be less need for practitioners to amend programs and higher levels of fidelity could more easily be preserved – increasing their effectiveness at scale.***********Reference:Romero, L.M., Galbraith, J.S., Wilson-Williams, L., & Gloppen, K.M. (2010). HIV Prevention Among African American Youth: How Well Have Evidence-Based Interventions Addressed Key Theoretical Constructs? Aids and Behavior, 15, 976-991.

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