Advertisement

Journal of General Internal Medicine

, Volume 33, Issue 10, pp 1661–1668 | Cite as

Development and Content Validation of a Patient-Reported Sexual Risk Measure for Use in Primary Care

  • Rob J. FredericksenEmail author
  • Kenneth H. Mayer
  • Laura E. Gibbons
  • Todd C. Edwards
  • Frances M. Yang
  • Melonie Walcott
  • Sharon Brown
  • Lydia Dant
  • Stephanie Loo
  • Cristina Gutierrez
  • Edgar Paez
  • Emma Fitzsimmons
  • Albert W. Wu
  • Michael J. Mugavero
  • William C. Mathews
  • William B. Lober
  • Mari M. Kitahata
  • Donald L. Patrick
  • Paul K. Crane
  • Heidi M. Crane
Original Research

Abstract

Background

Patient-provider sexual risk behavior discussions occur infrequently but may be facilitated by high-quality sexual risk screening tools.

Objective

To develop the Sexual Risk Behavior Inventory (SRBI), a brief computer-administered patient-reported measure.

Design

Qualitative item development/quantitative instrument validation.

Participants

We developed SRBI items based on patient interviews (n = 128) at four geographically diverse US primary care clinics. Patients were diverse in gender identity, sex, sexual orientation, age, race/ethnicity, and HIV status. We compared sexual risk behavior identified by the SRBI and the Risk Assessment Battery (RAB) among patients (n = 422).

Approach

We constructed an item pool based on validated measures of sexual risk, developed an in-depth interview guide based on pool content, and used interviews to elicit new sexual risk concepts. We coded concepts, matched them to item pool content, and developed new content where needed. A provider team evaluated item clinical relevance. We conducted cognitive interviews to assess item comprehensibility. We administered the SRBI and the RAB to patients.

Key Results

Common, clinically relevant concepts in the SRBI included number of sex partners; partner HIV status; partner use of antiretroviral medication (ART)/pre-exposure prophylaxis (PrEP); and recent sex without barrier protection, direction of anal sex, and concern regarding HIV/STI exposure. While 90% reported inconsistent condom use on the RAB, same-day SRBI administration revealed that for over one third, all their partners were on ART/PrEP.

Conclusion

The SRBI is a brief, skip-patterned, clinically relevant measure that ascertains sexual risk behavior across sex, sexual orientation, gender identity, partner HIV serostatus, and partner treatment status, furnishing providers with context to determine gradations of risk for HIV/STI.

KEY WORDS

sexual risk behavior measurement patient-reported outcomes 

Notes

Acknowledgments

We thank our patients for their time, candor, and insights. This research was funded by a cooperative agreement awarded to the University of Washington (Principal Investigators: D Patrick, H Crane, P Crane) from the National Institute of Allergy and Infectious Diseases (NIAID) and National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (Grant No. U01 AR057954). Support was also provided by the National Institute of Allergy and Infectious Diseases (NIAID) University of Washington Center for AIDS Research (Grant No. P30 AI027757) and CNICS (R24AI067039) and National Institute of Alcohol Abuse and Alcoholism (NIAAA) (ARCH Grants U01 AA020802, U01 AA020793, and U24AA020801).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

References

  1. 1.
    Reported cases of STD’s on the rise in the U.S. 2015. March 2, 2018. Available from: http://www.cdc.gov/nchhstp/newsroom/2015/std-surveillance-report-press-release.html.
  2. 2.
    Wimberly YH, Hogben M, Moore-Ruffin J, Moore SE, Fry-Johnson Y. Sexual history-taking among primary care physicians. J Natl Med Assoc 2006;98(12):1924–9.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Talking with patients about sexuality and sexual health. Clinical fact sheets [Internet]. 2010; (March 2, 2018). Available from: http://www.arhp.org/publications-and-resources/clinical-fact-sheets/shf-talking.
  4. 4.
    Glaude-Hosch JA, Smith ML, Heckman TG, Miles TP, Olubajo BA, Ory MG. Sexual Behaviors, Healthcare Interactions, and HIV-Related Perceptions Among Adults Age 60 Years and Older: An Investigation by Race/Ethnicity. Curr HIV Res 2015;13(5):359–68.CrossRefPubMedGoogle Scholar
  5. 5.
    Savasta AM. HIV: associated transmission risks in older adults—an integrative review of the literature. J Assoc Nurses AIDS Care 2004;15(1):50–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Wolitski RJ, Fenton KA. Sexual health, HIV, and sexually transmitted infections among gay, bisexual, and other men who have sex with men in the United States. AIDS Behav 2011;15 Suppl 1:S9–17.CrossRefPubMedGoogle Scholar
  7. 7.
    Gardner LI, Metsch L, Strathdee SA, del Rio C, Mahoney P, Holmberg SD, et al. Frequency of discussing HIV prevention and care topics with patients with HIV: influence of physician gender, race/ethnicity, and practice characteristics. Gender Medicine 2008;5(3):259–69.CrossRefPubMedGoogle Scholar
  8. 8.
    Marquez C, Mitchell SJ, Hare CB, John M, Klausner JD. Methamphetamine use, sexual activity, patient-provider communication, and medication adherence among HIV-infected patients in care, San Francisco 2004-2006. AIDS Care 2009;21(5):575–82.CrossRefPubMedGoogle Scholar
  9. 9.
    Laws MB, Bradshaw YS, Safren SA, Beach MC, Lee Y, Rogers W, et al. Discussion of sexual risk behavior in HIV care is infrequent and appears ineffectual: a mixed methods study. AIDS Behav 2011;15(4):812–22.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Drainoni ML, Dekker D, Lee-Hood E, Boehmer U, Relf M. HIV medical care provider practices for reducing high-risk sexual behavior: results of a qualitative study. AIDS Patient Care STDs 2009;23(5):347–56.CrossRefPubMedGoogle Scholar
  11. 11.
    Morin SF, Koester KA, Steward WT, Maiorana A, McLaughlin M, Myers JJ, et al. Missed opportunities: prevention with HIV-infected patients in clinical care settings. J Acquir Immune Defic Syndr 2004;36(4):960–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Burd ID, Nevadunsky N, Bachmann G. Impact of physician gender on sexual history taking in a multispecialty practice. J Sex Med 2006;3(2):194–200.CrossRefPubMedGoogle Scholar
  13. 13.
    Politi MC, Clark MA, Armstrong G, McGarry KA, Sciamanna CN. Patient-provider communication about sexual health among unmarried middle-aged and older women. J Gen Intern Med 2009;24(4):511–6.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Hayes V, Blondeau W, Bing-You RG. Assessment of Medical Student and Resident/Fellow Knowledge, Comfort, and Training With Sexual History Taking in LGBTQ Patients. Fam Med 2015;47(5):383–7.PubMedGoogle Scholar
  15. 15.
    Lurie N, Margolis K, McGovern PG, Mink P. Physician self-report of comfort and skill in providing preventive care to patients of the opposite sex. Arch Fam Med 1998;7(2):134–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Tao G, Irwin KL, Kassler WJ. Missed opportunities to assess sexually transmitted diseases in U.S. adults during routine medical checkups. Am J Prev Med 2000;18(2):109–14.CrossRefPubMedGoogle Scholar
  17. 17.
    Morrison-Beedy D, Carey MP, Tu X. Accuracy of audio computer-assisted self-interviewing (ACASI) and self-administered questionnaires for the assessment of sexual behavior. AIDS Behav 2006;10(5):541–52.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Dolezal C, Marhefka SL, Santamaria EK, Leu CS, Brackis-Cott E, Mellins CA. A comparison of audio computer-assisted self-interviews to face-to-face interviews of sexual behavior among perinatally HIV-exposed youth. Arch Sex Behav 2012;41(2):401–10.CrossRefPubMedGoogle Scholar
  19. 19.
    Macalino GE, Celentano DD, Latkin C, Strathdee SA, Vlahov D. Risk behaviors by audio computer-assisted self-interviews among HIV-seropositive and HIV-seronegative injection drug users. AIDS Educ Prev 2002;14(5):367–78.CrossRefPubMedGoogle Scholar
  20. 20.
    Schroder KE, Carey MP, Vanable PA. Methodological challenges in research on sexual risk behavior: II. Accuracy of self-reports. Ann Behav Med 2003;26(2):104–23.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Sharma P, Dunn RL, Wei JT, Montie JE, Gilbert SM. Evaluation of point-of-care PRO assessment in clinic settings: integration, parallel-forms reliability, and patient acceptability of electronic QOL measures during clinic visits. Qual Life Res 2016;25(3):575–83.CrossRefPubMedGoogle Scholar
  22. 22.
    Stover A, Irwin DE, Chen RC, Chera BS, Mayer DK, Muss HB, et al. Integrating Patient-Reported Outcome Measures into Routine Cancer Care: Cancer Patients’ and Clinicians’ Perceptions of Acceptability and Value. EGEMS (Wash DC) 2015;3(1):1169.Google Scholar
  23. 23.
    Jones J, Stephenson R, Smith DK, Toledo L, La Pointe A, Taussig J, et al. Acceptability and willingness among men who have sex with men (MSM) to use a tablet-based HIV risk assessment in a clinical setting. Springerplus 2014;3:708.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Fredericksen RJ, Tufano J, Ralston J, McReynolds J, Stewart M, Lober WB, et al. Provider perceptions of the value of same-day, electronic patient-reported measures for use in clinical HIV care. AIDS Care 2016 1–6.Google Scholar
  25. 25.
    Crane HM, Crane PK, Tufano JT, Ralston JD, Wilson IB, Brown TD, et al. HIV Provider Documentation and Actions Following Patient Reports of At-risk Behaviors and Conditions When Identified by a Web-Based Point-of-Care Assessment. AIDS Behav 2017;21(11):3111–21.CrossRefPubMedGoogle Scholar
  26. 26.
    Metraux S, Metzger DS, Culhane DP. Homelessness and HIV risk behaviors among injection drug users. J Urban Health 2004;81(4):618–29.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Rosenberg SD, Trumbetta SL, Mueser KT, Goodman LA, Osher FC, Vidaver RM, et al. Determinants of risk behavior for human immunodeficiency virus/acquired immunodeficiency syndrome in people with severe mental illness. Compr Psychiatry 2001;42(4):263–71.CrossRefPubMedGoogle Scholar
  28. 28.
    Noar SM, Cole C, Carlyle K. Condom use measurement in 56 studies of sexual risk behavior: review and recommendations. Arch Sex Behav 2006;35(3):327–45.CrossRefPubMedGoogle Scholar
  29. 29.
    George W, Zawacki T, Simoni J, Stephens K, Lindgren K. Assessment of sexually risky behaviors. Assessment of addictive behaviors. 2nd ed: Guilford Press; 2007.Google Scholar
  30. 30.
    Fenton KA, Johnson AM, McManus S, Erens B. Measuring sexual behaviour: methodological challenges in survey research. Sex Transm Infect 2001;77(2):84–92.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Sheeran P, Abraham C. Measurement of condom use in 72 studies of HIV-preventive behaviour: a critical review. Patient Educ Couns 1994;24(3):199–216.CrossRefPubMedGoogle Scholar
  32. 32.
    Turchik JA, Garske JP. Measurement of sexual risk taking among college students. Arch Sex Behav 2009;38(6):936–48.CrossRefPubMedGoogle Scholar
  33. 33.
    Cella D, Yount S, Rothrock N, Gershon R, Cook K, Reeve B, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap cooperative group during its first two years. Med Care 2007;45(5 Suppl 1):S3-S11.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    DeWalt DA, Rothrock N, Yount S, Stone AA, Group PC. Evaluation of item candidates: the PROMIS qualitative item review. Med Care 2007;45(5 Suppl 1):S12–21.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Metzger DS, Nalvalline HA, Woody GE. Assessment of substance abuse: HIV risk assessment battery. In: Carson-Dewitt, editor. Encyclopedia of Drugs, Alcohol, and Addictive Behavior. Farmington Hills, MI: Macmillian Reference USA; 2001.Google Scholar
  36. 36.
    Murphy DA, Brecht ML, Herbeck DM, Huang D. Trajectories of HIV risk behavior from age 15 to 25 in the national longitudinal survey of youth sample. Journal of Youth and Adolescence 2009;38(9):1226–39.CrossRefPubMedGoogle Scholar
  37. 37.
    Kauth MR, St Lawrence JS, Kelly JA. Reliability of retrospective assessments of sexual HIV risk behavior: a comparison of biweekly, three-month, and twelve-month self-reports. AIDS Educ Prev 1991;3(3):207–14.PubMedGoogle Scholar
  38. 38.
    Fredericksen R, Crane PK, Feldman BJ, Tufano J, Harrington RD, Dhanireddy S, et al. Impact of same-day pre-visit electronic patient-reported outcome (PRO) collection on provider assessment of sexual risk and other behaviors of HIV-infected patients in routine clinical care. American Public Health Association 139th Annual Meeting; Oct 29-Nov 2, 2011; Washington, D.C.2011.Google Scholar
  39. 39.
    Fredericksen RJ, Edwards TC, Merlin JS, Gibbons LE, Rao D, Batey DS, et al. Patient and provider priorities for self-reported domains of HIV clinical care. AIDS Care 2015;27(10):1255–64.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Fairley CK, Sze JK, Vodstrcil LA, Chen MY. Computer-assisted self interviewing in sexual health clinics. Sex Transm Dis 2010;37(11):665–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Meanley S, Gale A, Harmell C, Jadwin-Cakmak L, Pingel E, Bauermeister JA. The role of provider interactions on comprehensive sexual healthcare among young men who have sex with men. AIDS Educ Prev 2015;27(1):15–26.CrossRefPubMedGoogle Scholar
  42. 42.
    Fisher JD, Fisher WA, Cornman DH, Amico RK, Bryan A, Friedland GH. Clinician-delivered intervention during routine clinical care reduces unprotected sexual behavior among HIV-infected patients. J Acquir Immune Defic Syndr 2006;41(1):44–52.CrossRefPubMedGoogle Scholar
  43. 43.
    Jensen RE, Rothrock NE, DeWitt EM, Spiegel B, Tucker CA, Crane HM, et al. The role of technical advances in the adoption and integration of patient-reported outcomes in clinical care. Med Care 2015;53(2):153–9.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Fredericksen R, Crane P, Tufano J, Ralston J, Schmidt S, Brown T, et al. Integrating a web-based patient assessment into primary care for HIV-infected adults. J AIDS HIV Res 2012;4(1).Google Scholar
  45. 45.
    Golub SA, Tomassilli JC, Pantalone DW, Brennan M, Karpiak SE, Parsons JT. Prevalence and correlates of sexual behavior and risk management among HIV-positive adults over 50. Sex Transm Dis 2010;37(10):615–20.PubMedGoogle Scholar
  46. 46.
    Parsons JT, Schrimshaw EW, Wolitski RJ, Halkitis PN, Purcell DW, Hoff CC, et al. Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation. AIDS 2005;19 Suppl 1:S13–25.CrossRefPubMedGoogle Scholar
  47. 47.
    Grov C, Rendina HJ, Moody RL, Ventuneac A, Parsons JT. HIV Serosorting, Status Disclosure, and Strategic Positioning Among Highly Sexually Active Gay and Bisexual Men. AIDS Patient Care STDs 2015;29(10):559–68.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Bruce D, Harper GW, Suleta K, Adolescent Medicine Trials Network for HIVAI. Sexual risk behavior and risk reduction beliefs among HIV-positive young men who have sex with men. AIDS Behav 2013;17(4):1515–23.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Daar ES, Corado K. Condomless Sex With Virologically Suppressed HIV-Infected Individuals: How Safe Is It? JAMA 2016;316(2):149–51.CrossRefPubMedGoogle Scholar
  50. 50.
    Vernazza P, Hirschel B, Bernasconi E, Flepp M. Les personnes séropositives ne souffrant d’aucune autre MST et suivant un traitement antirétroviral efficace ne transmettent pas le VIH par voie sexuelle. Bulletin des médecins suisses 2008;89(5):165–9.Google Scholar
  51. 51.
    Loutfy MR, Wu W, Letchumanan M, Bondy L, Antoniou T, Margolese S, et al. Systematic review of HIV transmission between heterosexual serodiscordant couples where the HIV-positive partner is fully suppressed on antiretroviral therapy. PLoS One 2013.  https://doi.org/10.1371/journal.pone.0055747 CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Donenberg GR, Emerson E, Bryant FB, Wilson H, Weber-Shifrin E. Understanding AIDS-risk behavior among adolescents in psychiatric care: links to psychopathology and peer relationships. J Am Acad Child Adolesc Psychiatry 2001;40(6):642–53.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Healthy people 2020: Lesbian, gay, bisexual, and transgender health. Office of Disease Prevention and Health Promotion.Google Scholar

Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Rob J. Fredericksen
    • 1
    Email author
  • Kenneth H. Mayer
    • 2
  • Laura E. Gibbons
    • 1
  • Todd C. Edwards
    • 1
  • Frances M. Yang
    • 3
  • Melonie Walcott
    • 4
  • Sharon Brown
    • 1
  • Lydia Dant
    • 2
  • Stephanie Loo
    • 2
  • Cristina Gutierrez
    • 2
  • Edgar Paez
    • 5
  • Emma Fitzsimmons
    • 1
  • Albert W. Wu
    • 6
  • Michael J. Mugavero
    • 4
  • William C. Mathews
    • 5
  • William B. Lober
    • 1
  • Mari M. Kitahata
    • 1
  • Donald L. Patrick
    • 1
  • Paul K. Crane
    • 1
  • Heidi M. Crane
    • 1
  1. 1.Center for AIDS Research University of WashingtonSeattleUSA
  2. 2.Fenway Community HealthBostonUSA
  3. 3.Augusta UniversityAugustaUSA
  4. 4.University of AlabamaBirminghamUSA
  5. 5.University of CaliforniaSan DiegoUSA
  6. 6.Johns Hopkins UniversityBaltimoreUSA

Personalised recommendations