HIV prevention and participatory program strategies for youth: Are voice, choice, decision-making, and opportunities for personal development linked to risk reduction practices?

Background: HIV prevention programs often use participatory strategies, including active engagement of youth in decision-making. Measures of active program participation are generally used to assess/evaluate program processes rather than specific health-related impacts. Our study examined program participation in relation to HIV risk reduction practices. Methods: We developed an eight item scale regarding young people's influence/voice within programs and program-generated opportunities for personal development which was piloted among youth involved in four state-funded adolescent HIV prevention programs. We evaluated the scale using confirmatory factor analysis, reliability analysis (Cronbach's alpha was .86 for the overall sample, and ranged between .73 and .91 when sub-samples from the four programs were analyzed separately), and assessment of construct validity (inter-item correlations: .34 - .73; item-total correlations: .54 - .69). The scale was well received and viewed as valid by youth involved in the study. Results: Active program participation was strongly correlated with reported sexual risk reduction practices during the past year (r = .34, p = .001) and during the past three months (r = .30, p = .004), and also correlated with a summary scale of sexual and drug related risk reduction practices (r = .24, p = .031). Conclusions: Higher levels of participation correlated with less risk taking. The scale measuring active participation was reliable and easily administered. Longitudinal study is needed to demonstrate causal relationships between active participation and HIV risk reduction. However, the findings suggest that highly participatory programs hold potential to enhance young people's capacity to practice safer behaviors.