We have found this newly developed HCV computerized intervention to be a viable approach to health related behavior changes in a high risk Hispanic population. To our knowledge there have been no previous HCV educational multimedia interventions culturally adapted to the Hispanic population. As reported by others,14–16
this type of intervention has the potential advantage of improved health status in several major areas of care. Computer-based strategies offer an opportunity for systematically exposing high risk individuals to individually relevant, effective health promotion messages.14–16
The present intervention may reduce HCV primary infection as well as re-infection and super-infection with the virus. In addition improvement in HCV knowledge in already infected persons could reduce the spread of the virus to uninfected IDUs. Because knowledge improvement was measured through participants’ perceptions, their reports could be affected by a desire to give socially desirable answers. Additionally, the small sample size could have a possible limitation effect in the study findings. A pre and post intervention study is currently underway to objectively assess changes in HCV knowledge after the computer-based intervention.
These multimedia tools hold promise for filling a critical gap in HIV and HCV infection prevention. In Puerto Rico the majority of persons at risk for these conditions are Spanish speakers, medically indigent, and with a low educational level – all barriers limiting their access to opportune and adequate primary, secondary and tertiary prevention. To address illiteracy, our intervention uses cartoons and pictures that illustrate in detail, the most common risky behaviors and rituals performed by local person when preparing, using and sharing their drugs. To enhance understandability and acceptability, the intervention employs the most common jargon used by IDUs. The program is narrated by a Puerto Rican man in a local accent, which should decrease cultural communication barriers. These approaches could explain the high acceptance of the intervention despite participants’ lack of formal education and prior computer experience.
IDUs characteristically have little patience, low concentration levels and low self esteem; characteristics that obstruct their learning process by the classic reading methods. Consequently cartoons, pictures and narration are important tools in the design and creation of effective educational intervention directed to this population. Computerized interventions more easily capture and maintain the participants’ attention to the sessions. Higher attention and higher interest leads to knowledge improvement as reported by the study participants. These findings endorse the potential benefits of multimedia programs for the dissemination of HCV prevention strategies in populations with a high risk level. Moreover, the improvement of the participants’ computer experience acquired through the sessions, could produce an elevation of the individual self esteem, which could, in turn, directly or indirectly enhance their learning capacity.
This multimedia intervention provides additional benefits to both health care providers and their patients. This electronic intervention could be disseminated inexpensively through the internet to a wide number of health care providers or health educators and then used in clinics or other settings. For the patients, the intervention is private (requiring only interaction with a computer) and allows them to move at their own pace.
If this intervention decrease HCV infection among drug users, it will lower the incidence in a hard-to-reach population and thereby decrease an important and intransigent health disparity.