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APHA Scientific Session and Event Listing

Recorded presentation

Paul A. Gilbert, MSPH¹, Dale Danley, MPH¹, Karen Herzig, PhD¹, Dhara Thakar, BA¹, Daniel Ciccarone, MD, MPH², Stuart A. Gansky, MS, DrPH³, and Barbara Gerbert, PhD¹. (1) Center for Health Improvement and Prevention Studies, University of California San Francisco, 350 Parnassus Avenue, Suite 905, San Francisco, CA 94117, 415-502-7288, paul.gilbert@ucsf.edu, (2) Family and Community Medicine, University of California San Francisco, 3180 18th Street, Suite 302, San Francisco, CA 94110, (3) Center to Address Disparities in Children's Oral Health, University of California, San Francisco, 3333 California St, Ste 495, San Francisco, CA 94143-1361

Background: Positive Choice, a randomized, controlled trial of a “prevention with positives” intervention, requires accurate identification of substance use and sexual risk behaviors. We assessed agreement between patients' disclosure of risks through our computerized assessment and providers' knowledge of these risks, as well as the degree and direction of any disagreement about risky behaviors.

Methods: After completing our in-depth computerized risk assessment, a convenience sample of Positive Choice participants also completed a brief interview about risk disclosure issues, including Paulhus's Self-Deception scale and Anderson and Dedrick's Trust-In-Physician scale. For each participating patient, his or her medical provider also completed a self-administered survey about knowledge of that patient's risks.

Results: Our sub-study examined 25% of the Positive Choice sample. Overall, concordance between the computerized assessment and providers' knowledge of patients' risks was good; 69%–86% of pairs agreed. Among discordant pairs, the computerized assessment consistently detected more risky behaviors; however, the difference was not statistically significant. Sexual risks were difficult to confirm because 30% of providers reported “don't know.” Assuming patient self-report as the “gold standard,” providers achieved low sensitivity (0.17–0.55) but higher specificity (0.77–0.91). Self-Deception and Trust-In-Provider scores were not associated with patients' disclosure.

Discussion: Practice guidelines recommend providers screen HIV-infected patients for ongoing behavioral risks. We found that providers were able to rule out patients' risky behaviors with accuracy, but were less accurate in detecting risks. Our computerized assessment elicited greater disclosure, especially for risky sexual behaviors, and is an appropriate adjunct to providers' risk reduction efforts.

Learning Objectives:

• Describe the degree of concordance between patients’ disclosure of risky behavior through the Positive Choice computer program and the medical providers’ knowledge of any risky behavior.
• Identify possible psychosocial influences on risk disclosure, such as self-deceptive tendencies and trust in provider.
• Discuss the clinical implications of risk assessment methods and disclosure issues for “prevention with positives” interventions.

Keywords: Risk Assessment, Prevention

Related Web page: www.ucsf.edu/chips

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation