The evaluation of a video-based health education strategy to improve sexually transmitted disease partner notification in South Africa

was acceptable to patients and clinic staff
increased patients&rsquo understanding of the motivation for partner notification
improved patient self efficacy in notifying partners
and increased the number of partners presenting at the STD clinics in the district.

Methods:

The research setting was a busy public health clinic in a rural district in KwaZulu Natal, South Africa. A before/after quantitative study design was used to measure the effect of the health education intervention by comparing measures collected from a pre-intervention (control) phase and an intervention phase. A qualitative evaluation assessed whether the intervention accurately portrayed the intended educational messages and whether unintended messages were also portrayed.

Results:

150 Index patients (55% female) were interviewed in the control phase, and 185 index patients (64% female) in the intervention phase. The age (mean 25 years), education level, and number of contact cards received did not differ across phases. During the intervention phase, 99.5% of patients saw the video, and 98% reported that they found it gave useful advice about partner notification.

There were no significant improvements in knowledge about partner notification among patients in the intervention phase. For example, 78% in the control phase and 86% in the intervention phase correctly answered a question about the role of partner treatment in preventing re-infection (p=0.09). There were improvements on several measures of self-efficacy about notifying casual partners. For example, index patients in the intervention phase, when compared with those in the pre-intervention phase, believed that a greater proportion of their casual partners would see the importance of seeking treatment, as a result of their notification interaction. The rate of contact cards returned per index patient was 0.27 in the intervention phase, compared with 0.20 in the control phase (95% CI for the rate difference: -0.05, 0.17). The qualitative research found that clinic staff and patients accepted the intervention enthusiastically, identified with the characters portrayed, and responded positively to the partner notification messages. However, a fundamental problem with the video was that patients received confused messages about the relation between HIV/AIDS and other STDs. This has potentially negative consequences for partner notification.

Conclusion:

This type of intervention provides a cost-effective model for health education in primary care clinics in developing countries. The next phase of research needs to involve the development of a video that addresses the problems identified in the qualitative research, and the evaluation of its effects on partner referral using a randomised controlled trial.