Project IMAGE


Jane Dimmitt Champion, Ph.D., D.N.P., R.N., F.N.P., A.H.-P.M.H.-C.N.S., F.A.A.N.

Program Summary

Project IMAGE is a cognitive behavioral intervention intended to reduce subsequent STIs among ethnic minority adolescent women with a history of sexual or physical abuse and STIs. It is delivered through small group workshops and individual counseling sessions and draws on health-promoting elements of African- and Mexican-American culture.

Intended Population

The program was designed for African- and Mexican-American adolescents aged 14-18 who have a history of STIs and physical or sexual abuse.

Program Setting

The program was designed for and evaluated in a health clinic setting.

Contact and Availability Information

Nancy Gonzalez-Caro, MPH
Evidence-Based Product Specialist
100 Enterprise Way, Suite G300
Scotts Valley, CA 95066
Ph: 800-321-4407 x237

Cody Sigel, MPH, CHES
Health Education Training Coordinator
1333 Broadway, Suite P110
Oakland, CA 94612
Phone: 510-858-0995
Sample of curriculum available for review prior to purchase
Adaptation guidelines or kit available
Languages available
Program Core Components
Category Component Core Component Component present Notes Lesson number(s) / activities where present
Content Cognitive behavioral therapy (CBT) No
Content Brain development and emotions No
Content Other
Content Volunteering/civic engagement No
Content Spirituality No
Content Morals/values No
Content Identity development No
Content Social support/capital No
Content Social influence/actual vs. perceived social norms No
Content Social competence No
Content Parenting skills No
Content Normative beliefs No
Content Leadership No
Content Gender roles No
Content Communication skills No
Content Child development No
Content Boundary setting/refusal skills No
Content Substance use cessation No
Content Substance use - Other drugs No
Content Substance use - Alcohol No
Content Substance use - Abstinence No
Content Brain development and substance use No
Content Vocational/skills training No
Content Supplemental academic services No
Content School engagement No
Content Graduating from high school No
Content College preparation
Content Alternative schooling No
Content Self-regulation No
Content Self-esteem Yes (both versions) Workshop 1, Activity 11
Content Self-efficacy/empowerment No
Content Resilience No
Content Personal vulnerability No
Content Motivational interviewing Yes (both versions) Group and individual counseling sessions
Content Mindfulness No
Content Healthy romantic relationships Yes (both versions) Workshop 2, Activity 2
Content Healthy relationships Yes (both versions) Workshop 2, Activity 6, 7
Content Decision making Yes (both versions) Workshop 2, Activity 8, 9
Content Consent Yes (both versions) Workshop 2, Activity 7, 8
Content Body image No
Content Social media, texting and online interactions No
Content Contraception - Pills, patches, rings, and shots Yes (both versions) Workshop 2, Activity 2
Content Contraception - Other Yes (both versions) Workshop 2, Activity 2
Content Contraception - Long-acting reversible contraceptives Yes (both versions) Workshop 2, Activity 2
Content Contraception - Condoms Yes (both versions) Workshop 2, Activity 2, 4, 5
Content Anatomy/physiology No
Content Meditation No
Content Values and sexuality No
Content Goal setting No
Content Conflict resolution/social problem solving No
Program Objectives

Project IMAGE seeks to reduce HIV/STI high-risk behaviors and STIs among ethnic minority adolescent women by helping them recognize the risk of STI transmission, learn strategies to reduce sexual risk behavior, and improve communication and decision-making skills. The intervention stresses contraceptive use and choice of sexual partner.

Program Content

Project IMAGE is an adaptation of Project SAFE, an intervention for ethnic minority women based on the AIDS Risk Reduction Model. It consists of three main components: workshops, support groups, and individual counseling sessions.

Component 1 - Workshop Sessions:  Two small group sessions are conducted using the principles of motivational interviewing and focus on the following topics: 

  1. Awareness and Perception of Risk. The first session helps participants recognize the risks of STIs. They receive information on disease transmission and protection methods and strategies.
  2. Commitment to Change: Strategies to Reduce Risk Behavior. In the second session, participants receive information on sex, drugs, STIs, HIV, contraception, and how to prevent infection and unintended pregnancy. They also learn how to make decisions about sex and improve communication skills.

Component 2 - Support Group Sessions:  Support groups are led by a trained facilitator who uses principles of motivational interviewing to discuss topics such as interpersonal relationships, contraceptive use, and health risk behaviors. The topics and discussion are tailored to the particular needs of each group.

Component 3 - Individual Counseling Sessions:  The individual sessions are initiated by the participant and conducted by a trained facilitator. Each session focuses on the expressed needs of the participant and may include referral to other services.

Program Methods
The program is delivered through small group discussions, support groups, and individual counseling.
Program Structure and Timeline
The intervention is organized as follows:
  • Two small group workshop sessions
  • Three to five support group sessions
  • Two or more individual counseling sessions.
The small group workshop sessions last 3-4 hours, and are delivered ideally one week apart, to groups of 4-8 participants.
Support group sessions last one hour, and are delivered weekly starting one week after the completion of the workshop sessions to groups of 4-8 participants.
Individual counseling sessions vary depending on the participant's needs.
One female leader (community health worker or women’s sexual health professional) is recommended to lead each Project IMAGE workshop. Support groups and counseling sessions should be led by women’s sexual health professionals. Facilitators should ideally have a background in social work, primary health care, or psychology.
Program Materials and Resources
• Facilitator’s Manual
• Slide Presentation PowerPoints
• Participant Handouts
• Curriculum DVDs
• Pamphlets on various STDs
Additional Needs for Implementation
Core intervention materials include a Leader's Guide, slide presentations and DVDs.
Fidelity benchmarks and other materials related to fidelity and adaptation are in development and will be found here:
Staff Training

It is recommended that clinic staff selected to implement Project IMAGE receive research-based professional development to prepare them to effectively implement the curriculum with its intended target group. Training on Project IMAGE is available through ETR’s Professional Learning Services. Training options include:

  1. Two-day Training of Educators (TOE)—the learning process includes pre-work, skill-based instruction and post-training follow-up support.
  2. Four-day Training of Trainers (TOT)—available for seasoned trainers who have experience in delivering the intervention. Completion entitles participants to use ETR’s research-based training designs to conduct TOEs for their organization or designated affiliate group. TOT attendees who have completed the four-day TOT are eligible to attend a condensed TOT course on additional EBIs.
Technical Assistance and Ongoing Support
ETR provides in-person and web- or phone-based technical assistance before, during and/or after program implementation. TA is tailored to the needs of the site and is designed to support quality assurance, trouble-shoot adaptation issues, and boost implementation. ETR also provides evaluation support for EBI implementation. Services address process and outcome evaluation and include assistance with evaluation planning, instrument design and development, implementation fidelity, data management and analysis, performance measurement, continuous quality improvement (CQI) protocols, and effective tools and strategies for reporting results.
Allowable Adaptations
Examples of allowable adaptations include updating statistics or facts and tailoring the content for visual learners or particular racial/ethnic groups.
Reviewed Studies
Citation High-Quality Randomized Trial Moderate-Quality Randomized Trial Moderate-Quality Quasi-experiment Low Study Rating Did Not Meet Eligibility Criteria

Champion and Collins 2012

Study Characteristics
Citation Setting Majority Age Group Majority Racial/Ethnic Group Gender Sample Size

Champion and Collins 2012

Health clinic or medical facility 14 to 17 Hispanic or Latinx of any race Young women 409
Study Findings

Evidence by Outcome Domain and Study

Citation Sexual Activity Number of Sexual Partners Contraceptive Use STIs or HIV Pregnancy

Champion and Collins 2012

n.a. n.a. n.a. Favorable evidence n.a.
Detailed Findings
Citation Details

Champion and Collins 2012

Project IMAGE was evaluated with a randomized controlled trial involving African- and Mexican-American adolescent women recruited from a community-based health clinic. All study participants had a history of physical or sexual abuse and sexually transmitted infection. About half the women were randomly selected for a treatment group that received the Project IMAGE program and half were selected for a control group that received abuse and enhanced clinical counseling. The study conducted STI testing before the program started (baseline) and again 6 and 12 months later.

The study found that at both the 6- and 12-month follow-ups, adolescents who were assigned to the treatment group were statistically significantly less likely to experience any new STI than adolescents who were assigned to the control group.


Some study entries may include more than one citation because each citation examines a different follow-up period from the same study sample, or because each citation examines a different set of outcome measures on the same study sample. A blank cell indicates the study did not examine any outcome measures within the particular outcome domain or the findings for the outcome measures within that domain did not meet the review evidence standards.

Information on evidence of effectiveness is available only for studies that received a high or moderate rating. Read the description of the review process for more information on how these programs are identified.