Research That Matters (January 17 - 20, 2008)

Background & Purpose: As the only current female-controlled barrier method for pregnancy, HIV and other sexually transmitted infection (STI) prevention, the female condom is a unique tool for women. Yet, it is vastly underused due to prohibitive cost, limited accessibility, and initial difficulty with use. Much has been written about attitudes and use related to the female condom; however, there is very little published work on skill level related to the female condom. This paper examines the effect of hands-on female condom skill training, in addition to comprehensive safer sex skill building, on female condom use skill level. Data were collected as part of a randomized control trial funded by the National Institute on Drug Abuse Clinical Trials Network conducted during 2004-2006.

Methods: Data were collected at 12 community-based drug treatment sites across the country. 515 women completed a baseline assessment and were randomized in cohorts to a 1-session or 5-session HIV prevention intervention. The 5-session intervention included a hands-on female condom practice session. Session 1 of both interventions included female condom information only. Women were re-assessed at 3-months post treatment. Female condom use skill was assessed by a trained interviewer who observed the participant place a female condom on a table-top pelvic model. OLS regression was used to examine the impact of female condom skill training on female condom use skill at the 3-month follow up assessment controlling for baseline demographic variables (age, race/ethnicity, and education), intention to use the female condom, attitudes towards the female condom, female condom skill (baseline) and use, and male condom skill and use.

Results: 341 women completed the 3-month follow up and were included in the analysis. The overall model was significant (F(16, 238)=5.53, p <.001), accounting for 27.1% of the variability in female condom skill score. Findings indicated that increases in female condom skill were related to level of treatment attendance. Women who attended all five sessions of the experimental condition (t=3.62, p<.001) or less than five sessions but including the female condom skill practice session (t=2.64, p=.01) had significantly higher skill level scores than women who did not attend any sessions. Additionally, male condom skill (t=3.20, p=.002) and higher educational attainment (t=2.07, p=.04) were also positively associated with female condom skill.

Conclusions & Implications: These findings suggest that female condom skill can be enhanced by hands-on practice with the female condom. Since women's facility with male condoms may contribute to their female condom skill, hands-on practice of both is preferred. Further research is needed to understand the impact of education on female condom use skill, including whether it acts as a proxy variable for socioeconomic status, literacy levels, or receptiveness to intervention style and content. In as much as female condoms present a unique opportunity for women to protect themselves from HIV/STIs and unplanned pregnancy, it is essential that providers integrate female condom messages and practice into services for women.