Original Study
Results of a Randomized Controlled Trial of a Brief Behavioral Intervention for Pelvic Inflammatory Disease in Adolescents

https://doi.org/10.1016/j.jpag.2009.06.005Get rights and content

Abstract

Objective

The objective of this research was to examine the effectiveness of a brief behavioral intervention, provided at the time of diagnosis of pelvic inflammatory disease, on subsequent behaviors by patients who were urban adolescents in a community in which sexually transmitted infection was prevalent.

Methods

121 adolescents aged 15 to 21 years with mild to moderate pelvic inflammatory disease were enrolled in a randomized trial. All participants received standardized care, completed baseline audio computerized self-interviews, received full courses of medication at discharge, and were interviewed after the 2-week treatment course. The intervention group also watched a 6-minute intervention video.

Main Outcome Measures

Medication completion, temporary sexual abstinence during the 14-day treatment period, partner notification, partner treatment, and return for 72-hour follow-up were studied. Data were evaluated using multivariate regression analysis.

Results

Of the participants, 61% were located and could participate in the 2-week interview by the disease intervention specialist. The intervention participants had higher rates of 72-hour follow-up (32% vs. 16%) and partner treatment (71% vs. 53%) in bivariate analyses at a P = 0.1 level. There were no differences in medication completion (66% vs. 66%), sexual abstinence (78% vs. 89%), or partner notification (88% vs. 92%). Only the partner-treatment finding persisted in multivariate models (AOR = 3.10; 95% CI, 1.03-9.39, P = .045).

Conclusions

Adolescent girls randomized to a community-specific video intervention at diagnosis of pelvic inflammatory disease were three times more likely to have their partners treated than those in the control group. Given the value of partner treatment in secondary prevention of sexually transmitted diseases, this video may be an essential component of discharge programming in urgent care settings. Additional structural supports may be necessary to facilitate improved adherence to other key adherence behaviors.

Introduction

Although the current generation of screening programs for asymptomatic sexually transmitted infection (STI) has been successful in reducing the overall rates of pelvic inflammatory disease (PID) in women in the United States, PID rates remain unacceptably high among adolescent minority girls.1 In the past, one method of ensuring adherence and reducing the complications of PID in adolescent girls has been to hospitalize these patients for 48 to 72 hours of aggressive management with intravenous antibiotics followed by discharge and close follow-up during the remaining days of the 2- week antibiotic therapy.2

In recent years, clinical trials in adolescent and adult women have demonstrated that outpatient management alone for mild to moderate PID is equivalent to several days of inpatient management followed by an outpatient course of treatment.3 This has resulted in a shift to outpatient therapy for women of all ages, including adolescents. Unfortunately, several studies have demonstrated poor adherence to regimens by both adult women and adolescent girls when they are outpatients and have found that this may be the result of incorrect prescriptions and limited instructions for self-care at discharge.4, 5, 6 The objective of this research was to examine the effectiveness of a brief behavioral intervention at the time of PID diagnosis on subsequent patient adherence behaviors among urban adolescents from an STI-prevalent community.

Section snippets

Patient Selection

Adolescents were recruited from five clinical sites in two institutions (a large academic medical center and a community hospital with close ties, for resident training, to the larger academic center). The five sites of recruitment included the pediatric and adult emergency departments at both centers and the combined general pediatrics and adolescent medicine clinic in the large academic center. Both institutions are located in a large urban center on the east coast of the United States that

Selected Demographics

We approached 162 patients about recruitment for participation in the study, and 131 were enrolled. Of those who were enrolled, 62% (N = 81) had 2-week follow-up visits with DISs. Data gathered from 126 participants were successfully transferred at enrollment, and the 2-week follow-up visits of these participants (N = 77) were used for the analysis (Figure 1).

The mean age of participants was 17.3 (SD 1.7). Participants had a mean age of sexual debut of 14.2 (SD 1.7) and a mean of 7.4 (SD 10.3)

Discussion

This study demonstrates that among adolescents with mild to moderate PID, randomization to a 6-minute video intervention at the time of discharge from an urgent or emergency care setting results in increased treatment of partners, a key form of secondary prevention of STIs. Despite this finding, we were not able to demonstrate differences in all PID-adherence behaviors. For example, almost one third of participants did not complete their medications despite the intervention.

Our baseline data

Acknowledgements

This project was supported by funding from the Robert Wood Johnson Generalist Faculty Scholars Program, the Centers for Disease Control and Prevention, the Thomas Wilson Foundation for the Children of Baltimore City, and the John and Mary McCarthy Foundation. We are also especially grateful to Dr. Iris Litt, the research assistants and disease intervention specialists who worked on this study, the health providers who referred patients to the study, and the many adolescent girls who

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