Julia V Bailey*, University College London, London, United Kingdom Track: Research Presentation Topic: Youth and Digital Learning Presentation Type: Oral presentation Submission Type: Single Presentation Building: MaRS Centre, 101 College Street, Toronto, Canada Room: CR3 Date: 2009-09-18 01:30 PM – 03:00 PM Last modified: 2009-08-13

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Background: Sexual health is a major public health challenge, and face-to-face interventions have had mixed success. Computer-based technology such as the Internet offers a different route for the delivery of sexual health interventions, and has advantages such as convenience, the capacity for individual tailoring, interactivity and multi-media features. There is therefore huge potential for health promotion via new technologies: we present the results of a Cochrane systematic review of interactive computer-based interventions (ICBIs) for sexual health.

Objective: To determine the effectiveness of interactive computer-based interventions for sexual health promotion.

Methods: We searched electronic bibliographic databases; grey literature;
trials registers; reference lists of published studies; and contacted authors. Databases were searched from their start date to end November 2007. The search strategy comprised three overlapping concepts: 1) Randomized Controlled Trial study design AND 2) Computer/Internet-based applications AND 3) Sexual health.

Two review authors screened abstracts and all candidate studies to determine eligibility, apply quality criteria, and extract data from included studies. Authors of included RCTs were contacted for missing data. Results of RCTs were pooled using random-effects model with standardized mean differences (SMDs) for continuous outcomes and odds ratios for binary outcomes. Heterogeneity was assessed using the I-squared statistic.

Results: We identified 15 randomized controlled trials of ICBIs conducted in a variety of settings with a variety of populations, with interventions focusing mainly on the prevention of sexually transmitted infections including HIV. The total number of participants for which outcome data were available was 3917.

1) ICBI vs. minimal intervention: Meta-analyses showed a moderate effect on sexual health knowledge, with an SMD of 0.68 (95% CI 0.32, 1.04); a small effect on self-efficacy (SMD 0.11, 95% CI 0.02, 0.20); a small effect on safer-sex intentions (SMD 0.16, 95% CI 0.05, 0.27); and no significant effect on sexual behaviour measured as a dichotomous outcome (odds ratio 1.23, 95% CI 0.84, 1.80). There were insufficient data for analysis of biological outcomes.

2) ICBI vs. non-computerized, face-to-face sexual health education: Meta-analysis of the two studies with available data on sexual health knowledge showed a small effect (SMD 0.36, 95% CI 0.13, 0.58). There were insufficient data for analysis of other outcomes.

Conclusions: Interactive computer-based interventions for sexual health promotion are feasible in a variety of settings and with a variety of populations. ICBIs are effective tools for learning about sexual health, with meta-analyses showing gains in knowledge. ICBIs also show promising but small effects on self-efficacy and intention. High quality trials which have the power to detect changes in behaviour and biological outcomes are needed. Studies could also embrace a wider definition of sexual health to include emotional, mental and social well-being in relation to sexuality and not just physical health.