Feasibility study of the Home-based Exercises for Responsible Sex (HERS) intervention to promote correct and consistent condom use among young women

有什么问题吗？在过去的10年里，英格兰的性传播感染(STI)率增加了约50%，每年新增约50万例。除了感染本身的直接影响之外，性传播感染可能会产生严重的后果，性传播感染的健康、社会和经济成本是巨大的；目前国民保健系统每年的治疗费用估计为6.2亿GB。卫生部已将降低性传播感染比率作为改善性健康的首要任务，并已将年轻的异性恋者视为“高危”群体。英国公共卫生组织发起了一项推广使用避孕套的活动。为什么我们需要做一些事情？男用避孕套的正确和始终如一地使用可以防止性传播感染；然而，有许多问题阻碍了人们使用或正确使用它们，例如消极的态度，性快感降低，以及合适性和手感问题。当避孕套从头到尾都不使用时，对性传播感染的保护也会降低，这是使用避孕套时遇到问题或表示不喜欢避孕套的夫妇更常见的报告。许多健康促进方案试图通过提高男性的知识和避孕套使用技能，以及最近在使用避孕套和润滑剂时促进快感和乐趣，来增加避孕套的使用量。然而，女性也报告了对避孕套的问题和不满，如不适、阴道摩擦和感觉减弱。女性也经常给她们的男性伴侣戴避孕套，并报告戴上避孕套时出现的错误和问题，这可能会导致勃起功能丧失。教育女性和男性如何提高他们愉快的避孕套使用体验可能是一项重要的公共卫生战略，但到目前为止，很少有干预措施专注于这种方法。我们要做什么？我们希望开发和测试一个安全套推广计划，供英国16-25岁的年轻女性使用。该方案从培训课程开始，以建立妇女的信心和与愉快地使用避孕套和润滑剂有关的技能。然后我们会发放“避孕套工具包”(内含不同的避孕套和润滑剂)，并要求妇女在家中自己和她们的性伴侣通过完成各种作业练习来试用工具包中的内容。当他们尝试每一种避孕套和润滑剂时，他们被要求考虑自己的乐趣以及他们最喜欢的是哪一种。然后，女性对她们使用的避孕套和润滑剂进行评分。这项计划的目的是改善妇女使用避孕套和润滑剂的经验，以及改善她们在愉快和安全的性行为中使用避孕套和润滑剂的能力。为确保我们制定一项为年轻女性所接受并会奏效的计划，我们将与年轻女性和健康促进专业人员进行面谈，以了解她们的意见，并协助我们制定新计划的组成部分。然后，我们将邀请当地政府委托汉普郡的生殖泌尿系统(GUG)和外展服务机构参与并帮助招募50名16-25岁的年轻女性，她们因不与新伴侣和临时伴侣使用避孕套而面临性传播疾病的风险，以测试该项目。我们将衡量：我们想知道年轻女性是否喜欢该项目的不同部分，以及是否可能从口香糖和外展环境中为我们的研究招募人员。我们还在测试是否有可能进行一项更大规模的试验，以确定该方案是否能够改变妇女的态度以及避孕套和润滑剂的使用，并估计实施这一方案所需的成本、时间、资源、样本量、结果衡量标准等。在计划结束时，我们将询问妇女对这项研究的意见以及我们要求她们做的事情。这项工作将增加为年轻女性制定有效的避孕套推广计划的可能性，并将评估是否有理由和适当的更大规模的试验。

What is the problem? Rates of sexually transmitted infections (STIs) in England have increased by around 50% over the last 10 years, with about half a million new cases occurring every year. STIs can have serious consequences beyond the immediate impact of the infection itself and the health, social, and economic costs of STIs are huge; the current estimated cost of treatment to the NHS is £620 million per year. The Department of Health has identified the need to reduce STI rates as a priority for improving sexual health and have recognised young heterosexuals as target 'at-risk' groups. Public Health England have launched a campaign to promote condom use.Why do we need to do something? Male condoms can be protective against STIs when used correctly and consistently; however, there are many issues which stop people using them or using them properly, such as negative attitudes, reduced sexual pleasure, and problems with 'fit and feel'. The protection condoms provide against STIs is also reduced when they are not used from the start to the finish of sex, which is more commonly reported by couples who experience problems whilst using condoms or who express a dislike of them. Many health promotion programmes have tried to increase condom use by focusing on improving men's knowledge and condom use skills, and more recently on promoting pleasure and fun when using condoms and lubricants. However, women also report problems and dissatisfaction with condoms, such as discomfort, vaginal friction, and reduced sensation. Women also often apply condoms to their male partners and report errors and problems when putting them on which can result in erection loss. Educating women as well as men about ways to enhance their pleasurable condom use experience is likely to be an important public health strategy, yet very few interventions to date have focused on this approach.What are we going to do? We want to develop and test a condom promotion programme for use among young women aged 16-25 in the UK. The programme starts with a training session to build women's confidence and skills related to pleasurable condom and lubricant use. We will then give out "condom kits" (containing different condoms and lubricants) and ask women to try out the contents of the kit at home by themselves and with their sexual partners by completing various homework exercises. As they try out each condom and lubricant they are asked to think about their own pleasure and which they like best. Women then rate the condoms and lubricants they use. The aim of the programme is for women to improve their experiences with condoms and lubricants and their ability to use them as part of pleasurable and safe sexual activity.To ensure that we develop a programme which is acceptable to young women and which will work we will be interviewing young women and health promotion professionals to find out their views and assist us in developing the components of the new programme. We will then invite local authority commissioned genito-urinary medicine (GUM) and outreach services in Hampshire to take part and help recruit 50 young women aged 16-25, who are at risk of STIs through the non-use of condoms with new and casual partners, to test out the programme.What we will measure: We want to know if young women like the different components of the programme and if it is possible to recruit for our study from GUM and outreach settings. We are also testing whether it is possible to do a larger trial to see if the programme can change women's attitudes and use of condoms and lubricants, and to estimate the costs, time, resources, sample sizes, outcome measures etc. needed to carry this out. At the end of the programme we will ask women for their views about the study and what we asked them to do.This work will increase the likelihood of developing an effective condom promotion programme for young women, and will assess whether a larger trial is justified and appropriate.