Intervensi digital interaktif untuk promosi kesihatan seksual
Abstract
Background
Sexual health promotion is a major public health challenge; there is huge potential for health promotion via technology such as the Internet.
Objectives
To determine effects of interactive computer‐based interventions (ICBI) for sexual health promotion, considering cognitive, behavioural, biological and economic outcomes.
Search methods
We searched more than thirty databases for randomised controlled trials (RCTs) on ICBI and sexual health, including CENTRAL, DARE, MEDLINE, EMBASE, CINAHL, British Nursing Index, and PsycINFO. We also searched reference lists of published studies and contacted authors. All databases were searched from start date to November 2007, with no language restriction.
Selection criteria
RCTs of interactive computer‐based interventions for sexual health promotion, involving participants of any age, gender, sexual orientation, ethnicity or nationality. 'Interactive' was defined as packages that require contributions from users to produce tailored material and feedback that is personally relevant.
Data collection and analysis
Two review authors screened abstracts, applied eligibility and quality criteria and extracted data. Results of RCTs were pooled using a random‐effects model with standardised mean differences (SMDs) for continuous outcomes and odds ratios (ORs) for binary outcomes. We assessed heterogeneity using the I2 statistic. Separate meta‐analyses were conducted by type of comparator: 1) minimal intervention such as usual practice or leaflet, 2) face‐to‐face intervention or 3) a different design of ICBI; and by type of outcome (cognitive, behavioural, biological outcomes).
Main results
We identified 15 RCTs of ICBI conducted in various settings and populations (3917 participants). Comparing ICBI to 'minimal interventions' such as usual practice, meta‐analyses showed statistically significant effects as follows: moderate effect on sexual health knowledge (SMD 0.72, 95% CI 0.27 to 1.18); small effect on safer sex self‐efficacy (SMD 0.17, 95% CI 0.05 to 0.29); small effect on safer‐sex intentions (SMD 0.16, 95% CI 0.02 to 0.30); and also an effect on sexual behaviour (OR 1.75, 95% CI 1.18 to 2.59). Data were insufficient for meta‐analysis of biological outcomes and analysis of cost‐effectiveness.
In comparison with face‐to‐face sexual health interventions, meta‐analysis was only possible for sexual health knowledge, showing that ICBI were more effective (SMD 0.36, 95% CI 0.13 to 0.58). Two further trials reported no difference in knowledge between ICBI and face‐to‐face intervention, but data were not available for pooling. There were insufficient data to analyse other types of outcome.
No studies measured potential harms (apart from reporting any deterioration in measured outcomes).
Authors' conclusions
ICBI are effective tools for learning about sexual health, and they also show positive effects on self‐efficacy, intention and sexual behaviour. More research is needed to establish whether ICBI can impact on biological outcomes, to understand how interventions might work, and whether they are cost‐effective.
Ringkasan bahasa mudah
Program komputer untuk promosi kesihatan seksual
Promosi kesihatan seksual adalah cabaran kesihatan awam yang utama. Terdapat potensi besar untuk promosi kesihatan melalui teknologi seperti Internet, tetapi tidak diketahui sama ada intervensi adalah berkesan. Intervensi interaktif berasaskan komputer menyediakan maklumat, dan juga menawarkan maklum balas peribadi. Kami mencari pangkalan data untuk kajian yang percubaan terkawal secara rawak (RCTs) intervensi berasaskan komputer/internet yang bertujuan untuk meningkatkan kesihatan seksual. Kami memasukkan ujian intervensi berasaskan komputer yang disampaikan kepada rakyat pelbagai umur, jantina, orientasi seksual, etnik atau kewarganegaraan. Kajian ini menilai 15 RCT melibatkan 3917 peserta. Hasil kajian menunjukkan bahawa intervensi berasaskan komputer mempunyai kesan yang sederhana dalam meningkatkan pengetahuan rakyat tentang kesihatan seksual berbanding dengan intervensi minima seperti 'amalan biasa' atau risalah. Kami juga mendapati kesan yang kecil ke atas efikasi diri (keyakinan seseorang terhadap keupayaan mereka untuk melakukan tindakan tertentu) seks yang lebih selamat, kesan kecil ke atas niat seks yang selamat, dan juga kesan ke atas kelakuan seksual (seperti penggunaan kondom untuk seksual persetubuhan). Kami mendapati bahawa intervensi berasaskan komputer kelihatan lebih baik daripada intervensi bersemuka untuk meningkatkan pengetahuan kesihatan seksual, tetapi tiada data yang mencukupi untuk menganalisis hasil yang lain. Tiada kajian yang mengukur kemudaratan berpotensi (selain daripada melaporkan kemerosotan dalam hasil). Intervensi berasaskan komputer secara interaktif untuk promosi kesihatan seksual boleh dilaksanakan dalam pelbagai tetapan. Mereka adalah alat yang berkesan untuk belajar tentang kesihatan seksual, dan mereka juga meningkatkan efikasi diri, niat dan tingkah laku seksual, tetapi lebih banyak penyelidikan diperlukan untuk menentukan sama ada intervensi berasaskan komputer dapat mengubah hasil seperti jangkitan seksual dan kehamilan, untuk memahami bagaimana intervensi mungkin berkesan, dan menilai sama ada ia adalah kos efektif.
