Reducing HIV Risk in Adult Women with Intellectual Disabilities

描述(申请人提供)：本申请的目的是扩展我们的第一阶段工作，并进一步为患有轻度智力残疾(ID)的成年妇女(智商约为55至75)开发完全互动的多媒体(IMM)计算机艾滋病毒/艾滋病预防课程。在这项第二阶段的申请中，我们将扩大在“降低智障女性感染艾滋病毒风险”计划第一阶段完成的工作。第二阶段的开发将产生一套三个30分钟的IMM程序。这三个项目将侧重于1)基于第一阶段专业访谈的性和性教育项目，涉及性与性、节育、怀孕、更年期和艾滋病毒/艾滋病；2)利用第一阶段开发的内容，我们将使用高清(HD)视频修改我们的原型，并创建一个专注于艾滋病毒/艾滋病事实、知识、检测和避孕套使用的项目；以及3)我们将开发一个围绕性行为的关系谈判项目。关于性和性行为的节目1和关于关系谈判的节目3将包括为绝经前和绝经后的妇女量身定做的信息，因为她们由于没有怀孕风险而很少使用避孕套。三个第二阶段计划的最终用户将是患有轻度智力残疾(ID)的成年妇女(18岁)。利用精通学习(ML)、直接教学(DI)和通用学习设计(UDL)的元素，这三个IMM计划将非常有效地教授患有智障的成年女性。三个第二阶段计划中的每一个都将有一个配套的视频DVD和教师指南，作为第二阶段计划系列的一部分。形成性程序(即顾问小组和电话采访)将被用来在内容、剧本编写和框架方面向扩大的计划提供信息。我们将使用随机治疗对照设计，对80名患有轻度ID的女性、30名服务提供者和30名父母对该计划的可用性、吸引力、功能价值和购买可能性进行评估。这种评估方法将使我们能够确定该计划适用于轻度ID的妇女，有效地教育她们关于艾滋病毒的传播和避免、艾滋病毒检测和避孕套的使用，并使他们在基本的消费者满意度因素上给予高度评价。此外，我们将确认服务提供商认为该计划适合他们的客户，它提供了重要信息，他们会使用它并将其推荐给他们的同事，父母认为该计划和内容对他们的女儿有帮助和重要。该应用程序支持国家精神卫生研究所艾滋病和健康行为研究部，因为其目的是开发和传播一种行为干预措施，以防止艾滋病毒传播，特别是在艾滋病毒感染的高危人群中。此外，它还支持开发课程和计算机软件，为减少艾滋病毒风险提供沟通技能和培训，以及制定减少或改变与艾滋病毒有关的危险行为的方法。 公共卫生相关性：虽然关于智障人士中艾滋病毒/艾滋病流行率的研究仍然很少，但有理由相信，智障妇女中艾滋病毒/艾滋病的流行率与非智障人群中的艾滋病毒/艾滋病流行率相似，甚至更高。疾控中心确定了妇女在抗击艾滋病毒/艾滋病方面面临的独特挑战，其中一些挑战在轻度ID的妇女中放大，原因是知识有限，沟通技能有限，难以与卫生保健专业人员沟通，以及渴望参与亲密关系，同时缺乏一些社会判断和决策技能，这些技能可以帮助她们识别和避免高风险液体和高危性接触。

DESCRIPTION (provided by applicant): The purpose of this application is to expand upon our Phase I work and further develop a fully-interactive multimedia (IMM) computer-based HIV/AIDS prevention curricula for adult women with mild intellectual disabilities (ID) (I.Q. approximately 55 through 75). In this Phase II application, we will expand the work completed in Phase I of the "Reducing HIV Risk in Women with Intellectual Disabilities" program. Phase II development will result in a suite of three 30-minute IMM programs. The three programs will focus on 1) Sex and Sexuality education program based on input from Phase I professional interviews that addresses sex and sexuality, birth control, pregnancy, menopause, and HIV/AIDS, 2) using content developed in Phase I, we will revise our prototype using high-definition (HD) video and create a program focused on HIV/AIDS Facts, Knowledge, Testing and Condom Use, and 3) we will develop a program on Relationship Negotiations around sexual behavior. Program 1 on sex and sexuality, and program 3 on relationship negotiations will include messages tailored for women who are both pre- and postmenopausal as they seldom use condoms due to lack of pregnancy risk. End users of the three Phase II programs will be adult women with mild intellectual disabilities (ID) (age 18 +). Using elements of Mastery-based learning (ML), Direct Instruction (DI), and Universal Design for Learning (UDL), the three IMM programs will be highly effective at teaching adult women with ID. Each of the three Phase II programs will have a companion video DVD and instructor guide developed as part of the Phase II program series. Formative procedures (i.e., advisor groups and telephone interviews) will be used to inform the expanded programs in terms of content, scriptwriting, and framing. We will evaluate the program with 80 women with mild ID using a randomized treatment-control design, and with 30 service providers, and 30 parents for usability, appeal, functional value, and likelihood of purchase. This evaluative approach will allow us to establish that the program is useable by women with mild ID, effective at teaching them about the transmission and avoidance of HIV, HIV testing, and condom use, and that they rate it highly on essential consumer satisfaction factors. In addition, we will confirm that the program is seen by service providers as appropriate for their clients, that it provides vital information and that they would use it and recommend it to their colleagues, and that parents view the program and content as helpful and important for their daughters. This application supports the Division of AIDS and Health Behavior Research, National Institute of Mental Health, as its purpose is to develop and disseminate a behavioral intervention that prevents HIV transmission, especially among populations at high risk for HIV infection. Additionally it supports the development of curricula and computer software that provides communication skills and training for HIV risk reduction, and the development of methods to reduce or change HIV-associated risk behaviors. PUBLIC HEALTH RELEVANCE: While there continues to be little research on the prevalence of HIV/AIDS among people with intellectual disabilities (ID), there is reason to believe that the prevalence of HIV/AIDS in women with ID is similar to, if not greater than, that of the non-ID population. The CDC has identified unique challenges facing women in the fight against HIV/AIDS, and some of these challenges are amplified in women with mild ID, due to limited knowledge, limited communication skills, difficulty communicating with health care professionals, and the desire to be involved in intimate relationships while lacking some of the social judgment and decision-making skills that could help them identify and avoid high-risk fluids and high-risk sexual encounters.