What would your journal say if it could talk back? Using journals as a technique for interactive exchange between participant and facilitator in group level adolescent HIV/STD prevention programs

Adolescents are at-risk for HIV/STDs. They initiate sexual activity at young ages, are less likely to use condoms, and use alcohol and drugs in combination with sex. Many group level interventions try to reduce the risk of HIV/STDs among youth. Although group level interventions allow information to be passed to many individuals at once, challenges exist with this strategy, including inability to tailor the intervention to individual needs, know if all participants understand and personalize the information, and answer everyone's questions. We have identified using journals as a technique to foster participant-facilitator communication. We discuss how using journaling was helpful to us and how we used it to (1) personalize our messages, (2) check comprehension of material, (3) discuss group dynamics and logistical issues within the group, (4) answer questions on a non-program specific topic, (5) help facilitators refocus each week, (6) provide a place for less vocal participants to speak, (7) address unsafe behavior and (8) to build self efficacy. We describe how trainers reviewed, responded to, timed and distributed journals. We address concerns about using journals in this way, including (1) ethical concerns (i.e. assuring confidentiality, responsibility of trainers to report/address issues and knowing how to respond appropriately) and (2) logistical concerns (i.e. how to handle participants who do not like to or cannot write well). We include sample journal questions that we used as part of our intervention. Finally, we suggest recommendations for using journals as part of future adolescent HIV/STD prevention programs and other health interventions.