Project IMAGE

Developers

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. The program was evaluated with female adolescents with 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
ETR
100 Enterprise Way, Suite G300
Scotts Valley, CA 95066
Ph: 800-321-4407 x237
Website: https://www.etr.org/store/curricula/project-image/

Cody Sigel, MPH, CHES
Health Education Training Coordinator
ETR
1333 Broadway, Suite P110
Oakland, CA 94612
Phone: 510-858-0995
Website: https://www.etr.org/store/curricula/project-image/
Sample of Curriculum Available for Review Prior to Purchase
Yes
Languages Available
English
Monitoring and Evaluation Tools
Monitoring and evaluation tools available
Yes
Monitoring and evaluation tool usage required
No
Information about available monitoring and evaluation tools (if applicable)

Unknown

Program Core Components

Last updated in 2023

The data presented on this page reflects responses from the program’s developer or distributor to a program component checklist that asked them to report on the individual components within their TPP program. The same program component checklist was sent to the developer or distributor of every active TPP program with evidence of effectiveness. The program component table provides data on seven types of program components including content, delivery mechanism, dosage, staffing, format, environment, and intended population characteristics; whether the component was present or optional in the program; whether the component is considered to be core to the program; and the lesson number or activity where the component can be found in the program. For more details, refer to the FAQ.

Category Component Core Component Component present Notes Lesson number(s) / activities where present
Content Substance use - Abstinence No
Content Substance use - Alcohol No
Content Substance use - Other drugs No
Content Substance use cessation No
Content Boundary setting/refusal skills No
Content Child development No
Content Communication skills No
Content Gender roles No
Content Leadership No
Content Normative beliefs No
Content Parenting skills No
Content Social competence No
Content Social influence/actual vs. perceived social norms No
Content Social support/capital No
Content Identity development No
Content Morals/values No
Content Spirituality No
Content Volunteering/civic engagement No
Content Other
Delivery mechanism Method: Anonymous question box No
Delivery mechanism Method: Artistic expression No
Delivery mechanism Method: Assessment/survey Yes (both versions) Workshop 1, Activity 3
Delivery mechanism Method: Booster session Yes (both versions) Content can be reinforced in support group and individual counseling sessions.
Delivery mechanism Method: Case management No
Delivery mechanism Method: Cognitive behavioral therapy (CBT) No
Delivery mechanism Method: Demonstration No
Delivery mechanism Method: Discussion/debrief No
Delivery mechanism Method: Family session No
Delivery mechanism Method: Game No
Delivery mechanism Method: Home visiting No
Delivery mechanism Method: Homework assignment Yes (both versions) Homework is assigned in Workshop 1, Activity 12 and Workshop 2, Activity 11.
Delivery mechanism Method: In-session assignment Yes (both versions) Workshop 1, Activity 7, 12; Workshop 2, Activity 4, 9, 10
Delivery mechanism Method: Introduction Yes (both versions) Workshop 1, Activity 1, 2
Delivery mechanism Method: Lecture Yes (both versions) All workshop activities include some facilitator instruction and guided discussion.
Delivery mechanism Method: Motivational interviewing Yes (both versions) Individual counseling sessions
Delivery mechanism Method: Music No
Delivery mechanism Method: Parent-focused activity No
Delivery mechanism Method: Peer-to-peer No
Delivery mechanism Method: Public service announcement No
Delivery mechanism Method: Reading Optional The facilitator reads and goes over the handouts with participants. They don't read on their own.
Delivery mechanism Method: Role play/Practice No
Delivery mechanism Method: Self-guided activity No
Delivery mechanism Method: Service learning No
Delivery mechanism Method: Slide show No
Delivery mechanism Method: Social media No
Delivery mechanism Method: Spiral learning Yes (both versions) Content is reinforced across the workshop activities.
Delivery mechanism Method: Storytelling No
Delivery mechanism Method: Text message No
Delivery mechanism Method: Video No
Delivery mechanism Method: Other
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.
Staffing
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.
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.
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
Fidelity benchmarks and other materials related to fidelity and adaptation are in development and will be found here: https://www.etr.org/store/curricula/project-image/.
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.
Adaptation Guidelines or Kit
Yes
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.
KEY
Evidence Indication
Favorable findings
Two or more favorable impacts and no unfavorable impacts, regardless of null findings
Potentially favorable findings
At least one favorable impact and no unfavorable impacts, regardless of null findings
Indeterminate findings
Uniformly null findings
Conflicting findings
At least one favorable and at least one unfavorable impact, regardless of null findings
Potentially unfavorable findings
At least one unfavorable impact and no favorable impacts, regardless of null findings
Unfavorable findings
Two or more unfavorable impacts and no favorable impacts, regardless of null findings
Note: n.a. indicates the study did not examine any outcome measures within that particular outcome domain, or the study examined outcome measures within that domain but the findings did not meet the review evidence standards.
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.

Notes

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.