Use of Stage of Change (SOC) to develop an STD/HIV behavioral intervention: Phase 1. A system to classify SOC for STD/HIV sexual risk behaviors - Development and reliability in an STD clinic

This paper reports on the initial phase in the development, program impleme ntation, and inter-rater reliability of an application of Stage of Change ( SOC) behavioral theory for use in STD/HIV risk reduction. SOC was adapted t o assess readiness for sexual behavior change in an urban STD clinic in Roc hester, New York. A standardized staging grid and protocol were developed a nd implemented as part of HIV pre- and post-test counseling. A "client inst ructor" methodology was used to assess standardization and staff inter-rate r reliability. Percent agreement for stage assessment for target behaviors was calculated. The Rochester STD/HIV Behavioral Counseling (RoSHBeC) Stagi ng Grid and Protocol was used to train staff and this staging system was im plemented in the STD Clinic. After training, staff identified the correct b ehavioral target and stage 90% of the time. Inter-rater agreement for SOC c lassification was greater than 70%. Our experience demonstrates that it is possible to develop, implement, and sustain an integrated provider-delivere d STD/HIV behavioral intervention in a busy urban STD Clinic. This staging system has the potential for use in other settings and for other health-rel ated behaviors.