“Safe in Chicago”: Using formative & process evaluation methods to pilot an HIV intervention in sexually transmitted infection (STI) clinic settings

Sexually Transmitted Infection (STI) clinics are ideal settings for delivering HIV prevention interventions because of the potential to reach high volumes of diverse and high-risk individuals at a “teachable moment.” The Chicago Women's AIDS Project, a grassroots non-profit organization, has worked for over a decade providing STI/HIV prevention in STI clinics to 15,000 clinic patients annually. Partnered with a local university, they developed “Safe in Chicago,” an adaptation of an evidence-based HIV prevention intervention designed for delivery in clinic waiting rooms, involving a DVD and group discussion. The intervention was delivered in three diverse-audience serving clinics in many of Chicago's low-income and underserved communities. Formative/process evaluations included over 1,300 participants. Feasibility/acceptability of three different intervention delivery conditions were assessed: 1) a standard city clinic orientation video (control), 2) an adaptation of an evidence-based DVD intervention (“Safe in the City”), and 3) “Safe in Chicago”, which includes the “Safe in the City” DVD + a facilitator-led discussion intervention. When developing and implementing health education programs, application of formative and process evaluation methods should occur at the earliest development stages – when opportunities for influence/modification are likely the greatest. The evaluation consisted of observations, key informant interviews, patient/clinic staff focus groups, facilitator self-evaluations, ongoing feedback loops among staff/evaluation team and weekly meetings. This approach helped to a) improve understanding of the multiple factors influencing program outcomes, b) ensure the program was designed to meet the diverse communities' needs and c) address the complex, multifaceted nature of communicating topics like STIs and HIV/AIDS.