HEART (Health Education and Relationship Training)

About the program

HEART is a brief web-based program for adolescent girls that provides motivation enhancement, skill-building and information about HIV and other STDs and unplanned pregnancy. The program focuses on developing sexual communication and assertiveness skills.

HEART is a single session intervention with 5 modules that target 5 areas of sexual decision-making:

1. Safer sex motivation
2. Knowledge regarding HIV and other STDs
3. Sexual norms and attitudes
4. Safer sex self-efficacy
5. Sexual communication skills
   

Who does it work for?

The program is designed for 10th grade girls (typically ages 14-15). HEART has only been evaluated in the USA. A randomized controlled trial (Widman et al., 2018) was conducted with 221 participants (107 in the intervention group and 114 in the control group).

Study participants were recruited from rural high schools in low-income areas. Girls in both intervention and control groups were roughly one third white, black, or Hispanic, with a slightly higher percentage of white girls in each group. A higher percentage of girls in the control group had mothers who had less than a high school education (24%) than mothers of the girls in the intervention group (19%). Over three quarters of girls in both conditions identified as heterosexual with just under half of both groups reporting ever having engaged in sexual activity. Condom use was slightly higher for the control group at baseline (64%) than the intervention group (57%). Very few girls reported ever having been pregnant across the sample.

HEART has not been evaluated in Australia or with Aboriginal Australians.

What outcomes does it contribute to?

Positive:

• HEART participants had improved attitudes towards condoms
• HEART participants condom self-efficacy increased

No effect:

• The program had no effect on participants’ sexual assertiveness
• The program had no effect on participants’ condom norms
• The program had no effect on participants’ intention to use condoms
• The program had no effect on communications intentions of participants.
• The program had no effect on participants’ communication self-efficacy.

How effective is it?

Overall, HEART had mixed effects on client outcomes.

How strong is the evidence?

Mixed research evidence (with no adverse effects):

• At least one high-quality randomised controlled trial (RCT)/quasi-experimental design (QED) study reports statistically significant positive effects for at least one outcome, AND
• An equal number or more RCT/QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
• No RCT/QED studies show statistically significant adverse effects.

How is it implemented?

HEART is a single session web-based program that lasts for 45 minutes. The program is delivered in school settings and can be completed on a computer, tablet, or smart-phone device.

Modules are taught within a sexual health paradigm emphasizing personal values, positive aspects of sexuality, and the importance of competent interpersonal skills, as well as risk reduction. Inside each module, users receive age-appropriate audio and video clips, tips from other adolescents, interactive games and quizzes, infographics, and skill-building exercises with self-feedback given in real time.

Communication self-efficacy and assertiveness skills are emphasized throughout the program, but particularly in the communication module. In this module, users receive didactic training and modelling from same-age peers. Users can also practice skills through an audio-recording and playback feature whereby they respond to hypothetical scenarios of sexual pressure from a partner depicted with a pre-recorded male voice. Girls record and rate their own responses and continue practicing until they become more comfortable.

How much does it cost?

The costs for HEART were not reported in the study.

What else should I consider?

Added material or modifications are necessary to enhance the potency of the HEART program. Sexual assertiveness and negotiation skills are difficult skills to learn and master, so youths will likely need ongoing modelling and opportunities to practice and refine these skills beyond a 45-minute intervention.

Though computerized administration may help youths learn skills in a controlled environment, it is likely that ongoing practice in “real-life” settings will help them sustain communication skills over time.

Where does the evidence come from?

1 RCT conducted in the USA with 221 participants (Widman et al., 2018).

Further resources

Widman, L, Golin, CE, Kamke, K, Burnette, JL, & Prinstein, MJ 2018, ‘Sexual assertiveness skills and sexual decision-making in adolescent girls: Randomized controlled trial of an online program’, American Journal of Public Health, vol. 108, pp. 96-102, https://doi.org/10.2105/AJPH.2017.304106