Intervention
With whom did you have sex? Evaluation of a partner notification training for STI professionals using motivational interviewing

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Abstract

Objective

To enhance partner notification (PN) practices in Dutch STI clinics, a PN training using motivational interviewing as core strategy was offered to STI professionals and evaluated.

Methods

The effectiveness of PN training on professionals’ attitude, self-efficacy, skills and behavior toward PN, was examined using within-subject and between-subject comparison. Before the training and at three months follow-up, a questionnaire was completed by the intervention group (n = 54) and a non-random control group (n = 37).

Results

In the within-subject comparison, positive changes were observed in self-efficacy, skills, and PN behaviors (all p < .05), but not in attitudes toward PN. When we examined differences in change-scores between the intervention and control group, self-efficacy was no longer significant.

Conclusion

The PN training significantly improved PN skills and -behavior, but had no effect on professionals’ attitudes or self-efficacy toward PN. The selection of a convenience control sample seems to offer a more rigorous test of hypotheses than pre–post evaluation only.

Practice implications

The beneficial effect of PN training of STI professionals seems to support a wider roll-out of the training to all STI clinics in the Netherlands, although effects on the number of partners notified and transmissions prevented need to be examined in future research.

Introduction

Yearly more than 100,000 new consultations for STI are registered at the STI clinics in the Netherlands. Fourteen percent of these consultations result in an STI diagnosis [1]. Notifying recent sexual partners of people diagnosed with an STI can promote timely testing, early treatment and reduce further spreading of STI [2]. Thus, partner notification (PN) is an important element in the work of STI clinic professionals. A Dutch pilot study showed that only 41% of the identified sexual partners at risk of men who have sex with men (MSM), diagnosed with an STI are informed about their risks. For partners of heterosexuals this percentage is 72% [3]. It would therefore be relevant to identify interventions that can lead to a higher rate of successful PN and break transmission chains [2]. The objective of the present study was to evaluate such an intervention directed at STI clinic professionals.

Partner notification sounds simple, but in practice health care providers deal with a lack of time due to a full agenda for the STI consultation, and index-clients (i.e. those diagnosed with an STI, hereafter referred to as client) or their partners are not always cooperative or reachable. A popular approach to promote PN is offering clients online communication tools that allow anonymous text or email messages to their sexual partners, which is recently introduced in, for example, the Netherlands and being evaluated [4]. However, literature suggests that case-finding effectiveness of PN (number of newly diagnosed partners among the notified partners) can also improve if professionals are better trained to motivate the client to contact partners, or when the responsibility of contacting partners is taken over by the professional [5], [6]. The reasoning behind PN is that the client has a moral responsibility to inform sexual partners, but in the Netherlands PN is not enforceable by professionals. The role of the professional is therefore to motivate clients and provide them with the confidence required for notifying their sexual partners, or to agree to have them notified by the professional.

Motivational interviewing (MI) is a client-centered approach that focuses on motivating people for a particular behavior and providing them with the confidence to perform that behavior [7], [8]. MI focuses on eliciting people's internal motivation, pacing the change process according to their needs and abilities, and it has been widely applied across a large range of (health) behaviors [9]. It also offers several techniques on how to work when people feel ambivalent about a behavior and show initial resistance to perform a behavior, which is not uncommon in PN consultations. We considered MI particularly useful as the backbone of our PN intervention. As MI is a general approach, we tailored the MI content to the topic of PN, context, and users, based on barriers and facilitators toward PN as reported by STI professionals during elicitation research, and as described in literature [2], [5], [6]. This was integrated in a PN protocol that STI clinic professionals were supposed to deliver.

For the MI-based PN intervention to be effective, it is important that it is delivered accurately to clients. Despite the popularity of MI as a counseling method, a recent review of MI training for health care professionals found only 10 studies examining the effects of such a training on professionals’ performance [10]. Five of these used a post-training assessment without a control group, which is unsuited for evaluating training effects. Of the 5 remaining studies, one used a pre–post design without control group, so that observed changes could also be caused by background trends or mere measurement effects. The four other studies were randomized controlled trials (RCTs). The review revealed that only five studies offer some guidance on the potential effects of MI trainings, which suggests that designing such studies properly is apparently challenging.

The objective of the current study was to evaluate the effects of the MI-based PN training for STI clinic professionals. We expected that the training would enhance professionals’ motivation and confidence toward, and skills in delivering the MI-based partner notification intervention, and ultimately their effectiveness in successful PN.

Section snippets

Design

The newly developed training intervention was offered to STI professionals from five public health clinics (departments on sexual health in Amsterdam, Rotterdam, The Hague, Arnhem and Groningen) by contacting team leaders. We evaluated the effects of the PN training first with a within-subject (pre–post) comparison design, since resources were insufficient for including a sufficiently large number of clinics to allow for a cluster randomized controlled trial. To address some of the limitations

Results

Of the 110 STI professionals (72 in the intervention and 38 in the control clinics) who received the questionnaires, 105 completed the baseline questionnaire (91%). Of those, 91 (87%) also returned the follow-up questionnaire after three months, of whom 54 STI professionals followed the PN training and 37 were controls, whom were included in the analysis. Baseline characteristics of the study population are presented in Table 2. Apart from recruitment regions, the intervention group did not

Discussion

This study evaluated the effects of a newly developed training on partner notification for STI professionals based on motivational interviewing. We examined whether there were effects on attitudes, self-efficacy, skills and behavior of the professionals, in line with the objectives of the training. This was evaluated in a pre–post analysis and through comparison with a non-randomly selected control group that did not receive the training. Significant changes were observed in both analyses. The

Conflicts of interest

The authors declare no conflicts of interest.

Acknowledgements

The authors would like to thank Irene Harmsen (RIVM) for her contribution to the development of the questionnaire and discussions on data analysis. Marianne van der Sande and Birgit van Benthem (RIVM) are acknowledged for critical comments on the manuscript. All STI professionals are thanked for filling in questionnaires.

The study is financed by the ‘AIDS Fonds Netherlands’, grant number: 20090986.

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    1

    See Appendix A for the Partner Notification Group members.

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