Seventeen Days (formerly What Could You Do?)
Julie Downs, Ph.D., Pamela Murray, M.D., M.P.H., Wandi Bruine de Bruin, Ph.D., and Baruch Fischoff, Ph.D.
Seventeen Days (formerly called What Could You Do?) is a theory-based interactive DVD designed to educate young women about contraception and STDs. The DVD presents the viewer with different scenarios involving decision that young women face in relationships. Participants can practice what they would do in similar situations through the frequent use of "cognitive rehearsal."
The intervention was designed for sexually active girls ages 14 to 19. The original DVD was evaluated with predominately African American teens who were patients at an urban health care clinic. A more recent study evaluated the program with White teens who were patients at health clinics in Ohio, Pennsylvania, and West Virginia.
The program can be implemented in any setting where participants can use the DVD privately, such as in a health care clinic setting, a classroom, a computer laboratory, or at a library where individuals could check the DVD out to use on site or at home. It was evaluated in a health clinic setting.
|Category||Component||Core Component||Component present||Notes||Lesson number(s) / activities where present|
|Content||Contraception - Condoms||Yes||Yes (both versions)||Hailey's condom do's and don'ts|
|Content||Anatomy/physiology||No||Yes (both versions)||Know your body|
|Content||Social influence/actual vs. perceived social norms||No|
|Content||Connections with trusted adults||No|
|Content||Conflict resolution/social problem solving||No|
|Content||Boundary setting/refusal skills||Yes||Yes (both versions)||Jessica and her friends|
|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||Supplemental academic services||No|
|Content||Graduating from high school||No|
|Content||Self-efficacy/empowerment||Yes||Yes (both versions)||Jessica and her friends;|
|Content||Sexual health||Yes||Yes (both versions)||Jessica and her friends|
|Content||STIs - Treatment||No||Yes (both versions)||Going to the gynecologist|
|Content||STIs - Screening||No||Yes (both versions)||Going to the gynecologist|
|Content||STIs - Prevention||Yes||Yes (both versions)||Watch out for STIs; Hailey's condom do's and don'ts;I got birth control and so can you|
|Content||STIs - Information||Yes||Yes (both versions)||Watch out for STIs|
|Content||Sexual risk reduction||Yes||Yes (both versions)||Jessica and her friends; I got birth control and so can you; Watch out for STIs; Hailey's condom do's and don'ts|
|Content||Sexual risk discontinuation||No|
|Content||Sexual risk avoidance||Yes||Yes (both versions)||Jessica and her friends|
|Content||Contraception - Long-acting reversible contraceptives||Yes||Yes (both versions)||I got birth control and so can you|
|Content||Contraception - Other||Yes||Yes (both versions)||I got birth control and so can you|
|Content||Contraception - Pills, patches, rings, and shots||Yes||Yes (both versions)||I got birth control and so can you|
|Content||Risk of STIs and Pregnancy||Yes||Yes (both versions)||Jessica and her friends; Going to the gynecologist; I got birth control and so can you; Watch out for Sts'Ailes's condom do's and don'ts|
The goal of Seventeen Days is to prevent HIV and STIs by improving young women's ability to make less risky sexual health choices. The video features six vignettes that follow different story lines with a unique set of issues and possible outcomes, identifies choice points in the story, suggests risk-reduction strategies, and allows viewers to practice what they would do.
The intervention is based on a "mental models" (a person's thought process about how something works) approach of understanding perceptions of risk. The video addresses potential gaps in adolescent girls' mental models of STI risk. The video consists of six vignettes, a condom demonstration, and mini-documentaries, which together cover the following topics:
- Sexual situations, in which a female character negotiated for safer outcomes
- Risk reduction, in which the concept of relative risk was explained and applied to sexual behavior
- Reproductive health, including anatomy, and physiology
- Gynecological exam, including asking for birth control
- Sexually transmitted infections, explaining viruses, bacteria and eight common STIs.
- Hormonal birth control, including a behavioral focus on how to choose and adhere to a method
The program is currently delivered through the interactive DVD. A mobile app is also expected to be available beginning in April 2015. Usage of the app will be linked to a website with an educator portal for tracking milestones.
The first viewing of the DVD is designed to be around 55 minutes, but viewing time varies depending on the participant's choices at key decision points during the video. The mini documentaries range from two to ten minutes long. Overall duration is about 3.5 hours of content.
The minimum required dosage for completing the program is for participants to view one completed vignette and the condom demonstration. The developers recommend monthly booster sessions in which participants watch one additional vignette and one mini documentary. The booster sessions are 20 to 40 minutes total.
The original “What Could You Do?” video is no longer available. The new version of the video, Seventeen Days, has updated content including updated medical terminology, information about emerging tools for treatment and management of STIs, and six vignettes instead of four.
The developer offers the following materials:
- Seventeen Days DVD (for purchase)
- Seventeen Days mobile app (Available April 2015)
- Seventeen Days User's Guide (Beta version, free to download)
- Seventeen Days Quick User's Guide (Beta version, free to download)
- Seventeen Days DVD Cover (Beta version, free to download)
- Educator portal companion to forthcoming mobile app (with license)
Materials required for program delivery are the Seventeen Days DVD, a computer or portable device for viewing the DVD, and headphones. A space is required that will allow the participant to view the video privately and with minimal distractions.
Participants must be given flexibility to select which video segments to watch and to make progress at their own pace.
Participants must view one completed vignette and the condom demonstration, ideally followed by monthly booster sessions in which they watch one additional vignette and mini-documentary.
The program identifies to the viewer when they have completed their “first visit” (approximately 35 minutes in length), which corresponds to the minimum dosage. For the DVD implementation, providers would need to ask their clients when they got to this point. In the upcoming mobile app, however, providers would have access to data on whether each registered user had reached this milestone.
The DVD format currently does not permit any monitoring. However, a mobile app is under development (currently in beta format, expected in full release in late April 2015), which will include extensive tracking tools that will allow providers to monitor progress and milestones for registered users.
Training sessions are currently being developed for organizations wishing to implement the program. For more information, providers should contact the CMU team directly at firstname.lastname@example.org.
Although the intervention was evaluated in a health care clinic setting, the developers note that it could be used in a classroom or computer laboratory where participants can use the intervention privately, or, at a library where individuals could check the DVD out to use on site or at home.
The developer notes that it is not recommended that the program be used with its current formulation in a group delivery setting, due to the theoretical benefits of individual exposure to modeling and cognitive rehearsal, as well as the privacy and agency afforded by making individual choices within the many interactive features.
Downs et al. 2004
|The program was evaluated in a randomized controlled trial conducted in four clinic-based healthcare sites in Pittsburgh, PA. Adolescents participating in the study were randomly assigned to one of three groups: (1) a treatment group that watched the intervention video, (2) a control group that received the same information from the video but as a book, and (3) a control group that received commercially-available brochures on STD risk. Study data were collected with surveys administered immediately before the intervention and at follow-ups conducted 3 and 6 months after the intervention ended. Biological testing for chlamydia was conducted at the 6-month follow-up.
Three months after the program ended, participants who watched the intervention video were more likely to report having been abstinent in the past three months. In addition, six months after the program ended, participants who watched the intervention video were less likely to report having been diagnosed with an STD. The study found no statistically significant program impacts on rates of abstinence in the past three months, self-reported condom use in the past three months, or the biological tests for chlamydia at the 6-month follow-up.
The study also examined program impacts on measures of STD knowledge and self-reported condom failures. Findings for those outcomes were not considered for the review because they fell outside the scope of the review.
Eichner et al. 2015
Downs et al. 2016
|A more recent study evaluated the program using a randomized controlled trial that involved 1,317 young women who sought treatment at health clinics in Ohio, Pennsylvania, and West Virginia. The young women participating in the study were randomly assigned to either a treatment group that watched a 2.5 hours video with the Seventeen Days program content, or to a control group that watched a video providing information on how to reduce driving risks, the Driving Skills for Life video. The study administered surveys immediately before random assignment (baseline), and again three and six months after the baseline. Three and six months after the baseline, the study found no evidence of statistically significant program impacts on rates of abstinence, defined as not having vaginal sex in the last three months, and on rates of safe sexual behavior, defined as either abstaining from vaginal sex or as having sex using a condom every time in the last three months. The study also examined program impacts on measures of pregnancy and having an STI. Findings for those outcomes were not considered for the review because they did not meet the review standards. Specifically, attrition for the sample on which those outcomes were measured was high and therefore those findings received a Moderate rating. That rating is not consistent with the overall rating of the study (High). Attrition was assessed separately for the pregnancy and STI tests because they were administered in a different data collection effort—vaginal swab tests kits—than the surveys used to measure abstinence and contraceptive use at the 3- and 6|