Role model stories send integrated prevention messages to minority youth.

The concept of using role model stories to provide teens with integrated information on preventing pregnancies, STDs, and HIV was developed by the Family Health Council (FHC) of Pittsburgh, PA, and the Family Planning Council (FPC) of Philadelphia, PA, to reach minority youth in our respective cities. It is part of a national project funded by the Centers for Disease Control and Prevention (CDC) in Atlanta, GA, to develop integrated programs that organizations can replicate.

The idea of using such stories actually began as part of a multi-site FHC program in Pittsburgh designed to help females understand how to remain HIV negative. It was expanded to provide teens--both female and male--with information on preventing the spread of HIV and STDs. Eventually, it was used to provide young female teens with information about pregnancy prevention in clinic waiting areas and in small group discussions and counseling sessions. The integration of the role model messages was both practical and logical.

Drawn from experiences of African American and Latino youth, these stories are based on interviews with young people about their personal decisions to change risky sexual behaviors and develop safer sexual practices. They are accompanied by related facts and data. They incorporate the language of the storytellers and refer to culturally specific mores and norms. (See stories and artwork accompanying this article.)

After the stories are developed and written, they are printed and distributed one-on-one by young peer educators trained by FHC and FPC to minority youth in targeted communities throughout our cities in an effort to help them grasp the importance of making safer sex decisions. The stories are based on the trans-theoretical model developed by James 0. Prochaska and Carlo C. DiClemente popularly known as the stages of change. (1)

DEVELOPMENT AND ADAPTATION

We regularly take a number of specific steps to make certain that role model stories are culturally appropriate and reality-based so that minority youth will relate to them and subsequently make healthy sexuality-related decisions. These steps include:

* Writing the stories based on the stages of change

* Developing appropriate sidebars or information boxes that correspond to the stories

* Developing appropriate artwork

* Reviewing stories with teens and experts (discussion groups and focus groups)

* Making changes based on recommendations

* Submitting the stories for review and approval by a Community Review Board

Overall, effective role model stories communicate messages to teens because they are personal, engaging, and realistic. They also target individuals according to age, gender, culture, ethnicity, and environment. In addition, they have a basis in behavioral theory and use tested principles related to message development and delivery. (2)

We must, therefore, pay careful attention when matching stories to groups. Effective stories are those that connect with the teens themselves.

MESSAGE INTEGRATION

FHC integrated prevention messages in its role model stories by using two distinct strategies.

First, we made certain that the messages addressed multiple teen-related issues focusing on pregnancy, STDs, and HIV. For example, one story focused on a teen who suffered a miscarriage and subsequently decided to use condoms rather that face future unintended pregnancies. Another story focused on a teen who received word from a clinic that he had contracted an STD from unprotected sexual intercourse. He decided to always use condoms to avoid future STDs.

Examples of outcomes (behavior changes) for these individuals included:

* They decided to get information about birth control and condoms

* They started using condoms

* They started talking to their parent(s) about pregnancy, STDs, and HIV

* Their parents initiated conversation about sexual health with them

* They decided to remain abstinent

* They talked to their partner about using condoms

* They talked to their partner about remaining abstinent

* They decided to use birth control to prevent repeat pregnancy

Second, we integrated messages by adding facts about preventing either pregnancies, STDs, or HIV in the form of "sidebars" or information boxes. The information corresponded to the theme of the story and integrated teen pregnancy and STD information.

For example, the story about the teen who had a miscarriage included a sidebar with additional information on condoms (such as the fact that they decrease the risk of getting pregnant as well as getting an STD, including HIV) and a sidebar on how to use a condom.

Similarly, the story about the teen who contracted an STD included a sidebar on ways to reduce the risk of STDs along with information stating that individuals should use a condom even when using another form of birth control such as the pill or Depo-Provera.

We have developed sidebars to incorporate information about:

* Ways to talk to a partner about avoiding STD and pregnancy risks

* True and false questions about pregnancy, STDs, and HIV

* Information about specific STDs, including HIV

* Tips for parents on how to talk to a teen about sexual health

When teens tell us their stories, they often have one concern or problem as their main focus (such as a teen who discovered she was pregnant). A sidebar would, therefore, integrate related information on protection not only from pregnancy but also from STDs and HIV.

USE OF STORIES

FHC and FPC first developed and used role model stories as part of a successful federally--funded, multi-site, female-centered, HIV prevention project as a basis for street outreach, one-on-one discussions, and community mobilization. (3)

Subsequently we used them for teen-focused, state-funded programs for HIV and STD prevention. We also used them in health clinic waiting areas as a focus for small group discussions and counseling sessions, and as a marketing tool.

We currently use role model stories to conduct street outreach with youth in several inner-city neighborhoods in Pittsburgh. We recruit teens from the intervention neighborhoods to become "peer networkers." We train them in STD, HIM and pregnancy prevention as well as in street outreach strategies.

They eventually participate in two to three hours of outreach per week in their community. We give them gift vouchers in appreciation for their time. When conducting the outreach, the "peer networkers" approach young people, introduce themselves and the project (if appropriate), and offer copies of the role model stories.

They may describe a story and then answer questions related to teen pregnancy, STDs, HIM or condoms. They may also, if needed, refer individuals to health care services. They provide feedback to us through weekly debriefings and teen focus groups.

The distribution of role model stories through street outreach enhances FHC's ability to reach a large number of teens with a format which they like.

EVALUATION

Both FHC and FPC convened focus groups and discussion groups to evaluate the effectiveness of our role model handouts. Findings have indicated the need for realistic, detailed stories that display emotion to draw the reader into the story; the importance of illustrations and bright colors to attract readers' attention; and the relevance of locally appropriate slang to connect the reader.

Organizations interested in adapting role model stories to communicate sexual health messages to teens should keep these findings in mind. Above all, they should remember that the success of the program will depend on the involvement of local teens and experts through discussion and focus groups. Their participation will help to make the stories relevant and meaningful.

In an effort to determine the effectiveness of our role model stories, FHC placed the role model handouts in two of its clinic waiting rooms so clients could read them before or after clinic visits. We included a brief anonymous questionnaire with the handouts and asked the individuals to complete them and return them to a colorful box located in the waiting area.

Findings suggested that teens found the stories and sidebars useful, informative, and realistic. The majority also said they would recommend them to friends, felt the stories could happen to them or someone they knew, and found the sidebar information helpful.

That feedback alone made us realize that we were succeeding in using role model stories to communicate integrated sexual health messages to teens in our community.

Contact information: Jami Stockdale, research associate, Family Health Council, Inc., 960 Pennsylvania Avenue, Suite 600, Pittsburgh, PA 15222. Phone: [phone], extension 149. E-mail: [e-mail]

This article was adapted from an article written by the author for the NOAPPP Network (summer 2002, vol. 22, no. 2, pp. 9-10), a quarterly publication of the National Organization on Adolescent Pregnancy, Parenting, and Prevention (NOAPPP) in Washington, DC.

References

(1.) J. O. Prochaska and C. C. DiClemente, "Stages and Processes of Self-change of Smoking: Toward an Integrative Model of Change," Journal of Consulting and Clinical Psychology, 1983, vol. 51, pp. 390-95; D. M. Grimley, R. J. DiClemente, J. O. Prochaska, and G. E. Prochaska, "Preventing Adolescent Pregnancy, STDs, and HIV: A Promising New Approach," Florida Educator, Spring 1995, pp. 7-15.

(2.) E. W. Maibach and D. Cotton, "Moving People to Behavior Change: A Staged Cognitive Approach to Message Design" in E. Maibach and R. Parrott, editors, Designing Health Messages: Approaches from Communication Theory and Public Health Practice (Thousand Oaks, CA: Sage. 1995), pp. 41-63; K. Witte, "Fishing for Success: Using the Persuasive Health Message Framework to Generate Effective Campaign Messages" in E. Maibach and R. Parrott, editors, Designing Health Messages: Approaches from Communication Theory and Public Health Practice (Newbury Park, CA: Sage, 1995), pp. 145-66; A. B. Bakker, "Persuasive Communication about AIDS Prevention: Need for Cognition Determines the Impact of Message Format," AIDS Education and Prevention, 1999, vol. 11, no. 2, pp. 150-62; W. Witte, "Preventing Teen Pregnancy through Persuasive Communications: Realities, Myths, and Hard-fact Truths," Journal of Community Health, 1997, vol. 22, no. 2, pp. 137-54; L. M. Sagrestano, R. M. Heiss-Wendt, A. N. Mizan, M. J. Kittleson, and P. D. Sarvela, "Sources of HIV-prevention Information for Individuals at High Risk," American Journal of Health Behavior, 2001, vol. 25, no. 6, pp. 545-56.

(3.) M. A. Terry, J. Liebman, B. Person, L. Bond, C. Dillard-Smith, and C. Tunstall, "The Women and Infants Demonstration Project: An Integrated Approach to AIDS Prevention and Research, AIDS Education and Prevention, 1999, vol. 11, pp. 107-21; J. L. Lauby, P. J. Smith, M. Stark, B. Person, and J. Adams, "A Community-level HIV Prevention Intervention for Inner-city Women: Results of the Women and Infants Demonstration Projects," American Journal of Public Health, February 2000, vol. 90, no. 2, pp. 216-22.