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？过去10年来，英格兰的性传播感染（STI）率增加了约50%，每年新增病例约50万例。性传播感染可能会产生严重的后果，超出感染本身的直接影响，性传播感染的健康，社会和经济成本是巨大的;目前估计NHS的治疗费用为每年6.2亿英镑。卫生部已确定有必要将降低性传播感染率作为改善性健康的优先事项，并将年轻异性恋者视为目标“高危”群体。英国公共卫生部已经发起了一场推广使用避孕套的运动。为什么我们需要做些什么？男用避孕套在正确和持续使用时可以预防性传播感染;然而，有许多问题阻止人们使用它们或正确使用它们，例如消极的态度，降低性快感，以及“适合和感觉”的问题。如果从性行为开始到结束都不使用避孕套，避孕套对性传播感染的保护作用也会降低，这在使用避孕套时遇到问题或表示不喜欢避孕套的夫妇中更为常见。许多健康促进方案都试图通过侧重于提高男子的知识和使用安全套的技能来增加安全套的使用，最近还侧重于在使用安全套和润滑剂时促进快乐和乐趣。然而，女性也报告了避孕套的问题和不满，如不适，阴道摩擦和感觉降低。妇女还经常给男性伴侣使用避孕套，并报告在使用避孕套时出现错误和问题，这可能导致勃起功能丧失。教育妇女和男子如何提高他们使用安全套的愉快体验可能是一项重要的公共卫生战略，但迄今为止，很少有干预措施集中在这种方法上。我们希望在英国16-25岁的年轻女性中开发和测试安全套推广计划。该方案首先举办培训班，以建立妇女的信心，并培养她们使用安全套和润滑剂的技能。然后，我们将分发“避孕套包”（含有不同的避孕套和润滑剂），并要求妇女在家中自己或与性伴侣一起完成各种家庭作业练习，试用避孕套包中的内容。当他们试用每一种避孕套和润滑剂时，他们被要求思考他们自己的快乐以及他们最喜欢的。然后，女性对她们使用的避孕套和润滑剂进行评分。该方案的目的是使妇女更好地使用避孕套和润滑剂，并使她们更好地使用避孕套和润滑剂，使其成为愉快和安全的性活动的一部分，为了确保我们制定的方案能够为年轻妇女所接受，并发挥作用，我们将与年轻妇女和促进健康的专业人员进行面谈，以了解她们的意见，并协助我们制定新方案的组成部分。然后，我们将邀请汉普郡地方当局委托的生殖泌尿医学（GUM）和外展服务参与，并帮助招募50名年龄在16-25岁之间的年轻女性，这些女性由于与新的和临时的伴侣不使用避孕套而面临性传播感染的风险，以测试该计划。我们想知道年轻女性是否喜欢该计划的不同组成部分，以及是否有可能从GUM和外展环境中招募我们的研究。我们还在测试是否有可能进行更大规模的试验，以了解该方案是否能够改变妇女的态度以及对避孕套和润滑剂的使用，并估计开展这项工作所需的费用、时间、资源、样本大小、成果措施等。在项目结束时，我们将询问妇女对这项研究的看法以及我们要求她们做的事情，这项工作将增加为年轻妇女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进行更大规模的试验。

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.