“RU@Risk?”: Encouraging STD Testing Behaviors Among At-Risk Young Adults Through a Web-Based Tailored STD Risk Assessment and Test Kit Ordering System

Background Young adults account for nearly half of newly reported STDs each year and are at higher risk of acquiring STDs. Screening is one of the most cost-effective methods for preventing the spread of STDs but research indicates limited uptake among college students. Reasons for poor uptake include: feelings of shame and stigma, concerns about reliability of tests and confidentiality, trust of health care providers, and real time availability of support. Moreover, most interventions delivered within STD clinics, attract individuals who recognize they are at risk or are already vigilant about their own health. This limits access to a large section of the population who are less vigilant or who have limited knowledge about their own risk for STDs, particularly as most infections are asymptomatic. These issues underscore the need for effective, innovative interventions that can be implemented more widely at relatively less cost and that can be used to complement existing prevention programs. Empirical research of this nature is critically important in order for us to be able to design and implement effective web-based tailored approaches for STD prevention. Objective This paper describes the development and evaluation of a web-based tailored STD risk assessment and test kit ordering system on young adults’ acceptance of and uptake of STD screening services. Specifically, we are seeking to test whether 24/7 and private access to tailored feedback and risk assessment online would appeal to asymptomatic at-risk young adults and whether this approach can help bolster intentions to get tested. Methods About 1000 university students were recruited to participate in a randomized controlled trial to compare the effectiveness of a web-based tailored STD risk assessment to a non-tailored educational website on encouraging self-assessments of risk and uptake of screening services. Participants assigned to the treatment group explored a web-based risk assessment system designed to provide feedback tailored to the individual’s level of risk. Tailored risk reduction messages were created by analyzing individual responses to questions related to theory-based determinants of sexual risk taking (e.g., perceived susceptibility for STDs, sexual history, risk behaviors, relationship status, and sexual sensation seeking). Individualized feedback was provided in stages as each part of the risk assessment was completed. The comparison group explored a non-tailored educational website after completing the pretest questionnaire. After exploring the sites, participants completed a posttest questionnaire to measure improvements in knowledge, attitudes and behavioral intentions related to STD testing. All participants were then offered an opportunity to order a free STD screening kit for chlamydia/gonorrhea/trichcomoniasis. Test kit orders were processed through a secure online ordering system built to exchange encrypted HIPAA compliant data files with the Florida Department of Health Bureau of Laboratories, which will process the orders, receive the self-collected specimens for analysis and report positive test results to treatment providers identified by the individual. This provided us with an opportunity to measure actual uptake of screening services. Results: Research in Progress. Analysis of descriptive data and preliminary results related to uptake of STD screening services are anticipated by May 2012. Conclusions: Pending analysis of preliminary data. []