Journal Information
Vol. 13. Issue 2.
Pages 150-162 (March - April 1999)
Vol. 13. Issue 2.
Pages 150-162 (March - April 1999)
Open Access
Prevención del SIDA en adolescentes escolarizados: una revisión sistemática de la efectividad de las intervenciones
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O. Juárez, E. Díez*
Centre d'Estudis per a la Prevenció de la SIDA Institut Municipal de Salut Pública
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Resumen
Antecedentes y objetivos

Las intervenciones preventivas escolares suelen considerarse necesarias aunque deficientemente evaluadas. En los últimos años están apareciendo publicaciones sobre intervenciones escolares de prevención de SIDA eficaces. Los objetivos de este estudio son: revisar los programas evaluados de prevención de SIDA entre adolescentes escolarizados de 13 a 19 años publicados entre 1990 y 1995, analizar la calidad de cada evaluación e intervención, valorar su efectividad y establecer los elementos que influyen en su posible efecto.

Métodos

Localización de los estudios mediante búsqueda informatizada en Medline de artículos de evaluación y revisiones que cumplan los siguientes criterios de selección: programas de prevención de SIDA en el medio escolar, dirigidos a adolescentes de 13 a 19 años, publicados en castellano, francés o inglés en revistas científicas desde 1990 a 1995 y que evalúen los cambios en la conducta o sus determinantes en forma cuantitativa. Análisis de la calidad de la evaluación en función del tamaño muestral, de la existencia o no de un grupo control, de la comparabilidad de los grupos, del análisis de pérdidas y del tiempo entre el pre y el post-test. Análisis de la calidad de la intervención en función del uso de un modelo teórico de cambio conductual y del número de sesiones. Valoración del efecto en los estudios de calidad alta o intermedia a través del porcentaje de cambio en los conocimientos, actitudes, intención o conducta.

Resultados

Se han identificado 29 estudios que cumplen los criterios de selección. Respecto a la calidad de evaluación, un 28% es de calidad alta, un 14% de calidad intermedia y un 58% de calidad baja. En cuanto a la calidad de la intervención, un 27% es de calidad alta, un 41% de calidad intermedia y un 32% de calidad baja. En total 11 estudios (38%) presentan una calidad intermedia o alta tanto en la evaluación como en la intervención. De éstos, todos modifican los conocimientos y las actitudes, un 80% modifica la intención de conducta y un 86% la conducta. La mejora en los conocimientos y actitudes respecto a la prevención suele ser cuantitativamente importante, superior al 10%, y las modificaciones en las intenciones y los comportamientos suelen ser inferiores al 10%, aunque relevantes.

Conclusiones

Globalmente sólo un 38% de los programas puede considerarse de calidad alta o intermedia, aunque la calidad aumenta progresivamente a lo largo del tiempo. Los programas correctamente evaluados que se basan en un modelo teórico y constan de más de cuatro sesiones reducen moderadamente, aunque de forma relevante, las prácticas de riesgo de transmisión de SIDA, y de forma importante los determinantes de la conducta futura.

Palabras clave:
Educación sanitaria
Síndrome de Inmunodeficiencia Adquirida
Estudios de evaluación
Estudios de intervención
Conocimientos
actitudes
prácticas
Adolescencia
Summary
Background and aims

Preventive interventions are considered useful although poorly evaluated. Since 1990 there are growing evidences of effective school aids prevention interventions. This paper aims to identify school aids prevention programs among youngsters aged 13 to 19, published between 1990 and 1995, to analyze each evaluation and intervention quality, to assess their effectiveness as well as identifying the possible contributing factors.

Methods

Location of reports by means of a Medline computerized search of published articles and reviews, which should include the following criteria: school aids prevention programs, adressed to youngsters aged 13 to 19, published in Spanish, French or English between 1990 and 1995 in scientific literature, and evaluating changes in behavior or its determinants through quantitative measures. Analysis of the evaluation quality through the assessment of the sample size, the use of a control group, the groups comparability, the drop out analysis and the time between the pretest and the posttest. Intervention quality analysis through the use of a psychological behavioral change model and the number of sessions. The effectiveness of the high quality interventions in changing behaviors, intentions, attitudes and knowledge was assessed.

Results

29 studies were selected. Of these studies, relating the quality of evaluation criteria, a 28% was considered a high quality study, a 14% an intermediate quality study and a 58% a low quality one. In relation to intervention quality criteria, a 27% was found to be a high quality study, a 41% an intermediate quality study and 32% a low quality one. 38% (11 studies) showed high or intermediate quality criteria at the same time in intervention and in evaluation. All these studies modified knowledge and attitudes, an 80% modified the intention to behave and a 86% modified behavior. The increase in knowledge and attitudes was in general quite important, greater than 10%, and changes in intentions and behaviors were smaller than 10%, although relevant.

Conclusions

Only 38% of the studies may be considered of high or intermediate quality. Preventive interventions correctly evaluated which rely on a theoretical model and offer 4 or more sessions show evidence of moderate but relevant reduction of aids risk practices, and important changes of the future behavior determinants.

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