The Promise of Multimedia Technology for STI/HIV Prevention

Background:  Multimedia interventions, which include the use of computer technology, graphics, videos, and interactive games and narratives, have demonstrated impressive results in the fields of education and psychology.   In the field of sexually transmitted infection (STI) and HIV prevention intervention research, there is increasing excitement about the use of multimedia technology (MT): however, there has been limited discussion of how and why MT may improve STI/HIV prevention.    Existing theoretical work has begun to describe the process and benefits of multimedia learning regarding increased knowledge, skill building, and memory of content.    Because HIV prevention entails complex learning processes, and there is a dearth of evidence-based interventions that have been widely disseminated, it is important to better understand the potential for MT to enhance STI/HIV prevention efforts.

Method:  The purpose of this paper is to describe the mechanisms through which multimedia technology may work to improve the delivery and uptake of intervention material.  We synthesize the extant literature and build on current theories of multimedia learning to develop two conceptual frameworks describing how multimedia technology may improve intervention delivery by 1-Increasing standardization and fidelity to the intervention material and 2-Improving the participant’s ability to learn by improving attention, cognition, emotional engagement, skills-building, and engagement with sensitive material.  In addition, we explicate the mechanisms in these frameworks by describing how a non-multimedia behavioral HIV prevention intervention, Project WORTH, was adapted into a MT format for women involved in the criminal justice system and provide examples of how MT activities can more effectively target key mediators of behavioral change in this intervention.  

Results: Examples of how multimedia technology improves intervention delivery include: Sequential, step-by-step activity menus; easy to retrieve facilitator notes; built in electronic process measures; infrastructure for standardization of core content; and use of electronic feedback in tracking individual progress.  We suggest the following influences of MT interventions on participant learning: 1-Novelty improves participant’s attention; 2-Visual and verbal formats improve cognition; 3-Individualization, narrativity, and interactivity improve emotional engagement; 4-Scaffolding improves skills-building; and 5-Confidentiality improves delivery of sensitive information.  In turn, these improvements will affect the following mediators: knowledge, perceived risk, skills, problem solving, self-efficacy, service utilization, and social supports, ultimately affecting outcomes of condom use and STI/HIV.  Several WORTH multimedia components will be demonstrated to illustrate these mechanisms.

Conclusions:  Multimedia technology may improve participant learning in the context of STI/HIV prevention interventions in a number of ways.  A current efficacy study of Multimedia WORTH is the first known study to compare a MT HIV prevention to its non-MT counterpart; this type of research is needed to test the hypothesized mechanisms from our conceptual frameworks.  The standardization benefits gained from MT interventions, in addition to reduced facilitator training requirements, may be key factors in the more effective dissemination of HIV prevention interventions to high-risk target populations.   MT interventions may be particularly beneficial among those with low levels of intervention content knowledge and younger people; these factors are particularly relevant for current groups at high risk for acquiring or transmitting HIV.