Interactive computer packages are effective in improving knowledge about sexual health, according to a new study by Cochrane researchers. Computer-based approaches could help to tackle problems such as sexually transmitted infections and unwanted pregnancy.

Patients may be unlikely to discuss sexual health concerns with health professionals because of the sensitivity of the issues, or simply because healthcare providers have limited time. Computer-based interventions are a promising alternative and have already proved successful in the promotion of HIV-related sexual health, but there is less certainty about whether computer-based interventions can help with other sexual health concerns such as unwanted pregnancy, psychosexual difficulties or relationship problems.

The authors reviewed data from 15 trials which tested interactive computer-based interventions (ICBIs), involving a total of 3,917 people. Interactive packages require input from the user, for instance making choices that result in personalised feedback. The interactive packages in these 15 trials made imaginative use of multimedia capability, for example games, animations, scenarios, simulations and interactive characters. The authors combined the results from the trials to answer three questions: are ICBIs effective, are they as effective as face-to-face interventions, and how do they work?

According to the researchers, ICBIs moderately increased knowledge about sexual health issues and had smaller effects on increasing people's confidence in their actions to protect sexual health, and on actual sexual behaviour. In one study for instance, condom use in the previous month was increased. They also concluded that ICBIs seem as effective as face-to-face interventions for improving knowledge but were unable to draw clear conclusions about how ICBIs might work.

"This review suggests interactive computer-based interventions are effective tools for learning about sexual health and could be used by people of different ages and sexuality, at least in high-income countries," said lead researcher Julia Bailey from the e-Health Unit at University College London in London, UK. "We need some new ways of tackling problems such as genital Chlamydia: More and more people have access to mobile phones and the Internet, and these routes can be used to provide personally relevant health promotion."

More evidence is needed for the cost effectiveness of ICBIs, and the relative effectiveness of different designs. The latter may rely on unpicking the complexities of sexual behaviour. "Knowing the main reasons for risky behaviour in a given population would help to suggest which factors a computer package should target. For example, are there particular myths that need to be addressed? Computer packages will not be a magic bullet, but people can access them anonymously and at convenient times, which is especially important for sexual health," said Bailey.

Sources: Wiley - Blackwell, AlphaGalileo Foundation.