Feasibility study of the Kinsey Institute Homework Intervention (KIHISUK) to promote correct and consistent condom use

What is the problem? Rates of sexually transmitted infections (STIs) in England have increased by around 50% over the last 10 years, with about half a million new cases occurring every year. The health, social, and economic costs of STIs are huge. Untreated chlamydia, for example, can lead to pelvic inflammatory disease and infertility. The current estimated cost of treatment to the NHS is £620 million per year. The Department of Health has identified the need to reduce STI rates as a priority for improving sexual health and have recognised young heterosexuals as target 'at-risk' groups.

Why do we need to do something? Although condoms can be protective against STIs when used correctly and consistently, there are many barriers to their use such as negative attitudes, reduced sexual pleasure, "fit-and-feel " problems, and erection difficulties. The effectiveness of condoms is also reduced by incomplete use of condoms (i.e. not using condoms from start to the finish of sex), which is more commonly reported by men who experience problems whilst using condoms. Many health promotion interventions try to improve knowledge and skills to increase condom use; results, however, have been mixed. Although there is some evidence that these interventions can be effective, in practice health promotion staff may not have the time or the money to use these. There is therefore an urgent need to develop quick but effective interventions to improve condom use experiences, increase consistent and correct condom use, and reduce sexual risk among young people.

What are we going to do? We want to adapt a condom promotion programme which has been developed and tested in the US for use among young men in the UK. The US programme gives out "condom kits" (containing different condoms and lubricants) asks men to try out the condoms at home by themselves by completing various homework exercises. As they test each condom they are asked to think about their own pleasure and which condoms they like best. Men then score/rate the condoms they use. The aim of the programme is for men to improve their condom skills by 1) finding the "right/best" types of condoms and lubricants, 2) testing techniques of applying them, and 3) by practicing with them in no pressure situations (on their own).

In this study we want to see if the idea can be adapted for use with men in the UK to improve their skills in applying condoms and their pleasure in using them. To do this we will be speaking to young men and health promotion professionals to find out their views and help us modify and develop the components of the new programme. We will then invite young people's information and advice services in community and educational establishments in Hampshire and the West Midlands to take part and help recruit 50 young men aged 16-25 to test out the programme.

What we will measure: We want to know if young men like the different elements of the programme and if it is possible to run our study in the different settings. We are also testing whether it is possible to do a larger trial to see if the programme can change men's views and use of condoms, and to estimate the costs, time, resources, sample sizes, outcome measures etc. needed to carry this out. At the end of the programme we will ask participants for their views about the study and what we asked them to do.

This work will increase the likelihood of developing an effective condom promotion intervention, and to assess whether a larger trial is justified and appropriate.

The DoH has identified the need to reduce rates of HIV, sexually transmitted infections (STIs), and unintended pregnancies as priorities for improving sexual health. Although male condoms can be highly protective against pregnancy and the transmission of most STIs, there is evidence that they are often not used consistently or correctly. There is a need to develop effective brief interventions designed to promote correct and consistent condom use.

In line with MRC guidance for developing and evaluating complex interventions, the aims of this early phase study are to adapt, specify, and assess the feasibility of a behaviour change intervention to increase condom use (The Kinsey Institute Homework Intervention Strategy; KIHIS) for use in the UK. The KIHIS, designed to improve condom skills, enjoyment, and self-efficacy, has demonstrated early evidence of efficacy in two studies. The proposed KIHIS-UK intervention is novel in that it a) aims to increase condom use by targeting outcome expectancies related to enjoyment of sex, which have been identified in previous research as important determinants of behaviour amongst non-users; b) will have been adapted with extensive user participation to ensure future successful implementation, and c) will have an accompanying intervention manual specifying targeted outcomes, behaviour, behavioural determinants, behaviour change techniques, methods of delivery, and proposed mechanisms of action, thus ensuring that the future main study can draw conclusions about what has worked and why or, indeed, what does not work.

The target population will be young men aged 16-25, recruited from young people's information, advice, counselling and support services located in community settings and educational establishments in Hampshire and the West Midlands. The early phase study will involve a literature review, development/design consultation, intervention delivery and feasibility, follow-up, and recommendations for a definitive trial.