Sisters Saving Sisters

Developers
Loretta Sweet Jemmott, Ph.D., R.N., F.A.A.N., John B. Jemmott III, Ph.D., and Konstance McCaffree, Ph.D., R.N., F.A.A.N.
Program Summary
Sisters Saving Sisters aims to address the higher risk of HIV/STDs in Latina and African American female adolescent populations. The program is designed to reduce frequency of unprotected sexual intercourse (with and without drug and alcohol use), number of sexual partners, and incidence of sexually transmitted infections. Sisters Saving Sisters is a skills-based risk-reduction intervention administered in small groups of female adolescents, and led by trained facilitators in a community- based clinic setting.
Intended Population
Sisters Saving Sisters is designed for Latina and African American female adolescents. It was evaluated with sexually active Latina and African American females at an adolescent medicine clinic.
Program Setting

The program was designed for and evaluated in a community-based clinic setting.

Contact and Availability Information

Program Contact Information
Email: sales@etr.org
Phone: (800) 321-4407
Website: https://www.etr.org/ebi/programs/sisters-saving-sisters/

Training Contact Information 
Kelly Gainor, M.Ed.
ebptraining@etr.org
Website: https://www.etr.org/ebi/programs/sisters-saving-sisters/

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)

ETR provides pre- and post-tests.

Program Components and Core Components

Last updated in 2024

The data presented on this page reflect 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 information on seven types of program components including content, delivery mechanism, dosage, staffing, format, context, 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.

In the drop-down menu below, under “Has component,” there are four options that indicate a component as present in the program: (1) “Yes” indicates that the component is present in at least one version of the program (whether that be the program version that was evaluated, the current version, or both versions); (2) “Yes (both versions)” indicates that the component is present in both the evaluated version of the program and the current version of the program; (3) “Yes (current version)” indicates that the component is present in the current, but not the evaluated, version of the program; and (4) “Yes (evaluated version)” indicates that the component is present in the evaluated version of the program, only. Note that for dosage components, the dosage itself is described in the Notes when available.

Some of the components identified are noted as core components of the evidence-based program, but this does not necessarily mean that these components have been rigorously tested and show evidence of effectiveness. Most often developers denoted components as core based on theory or experience in the field. Click here for the list of evidence-based components.

For more details about program components, refer to the FAQ page.

Category Component Core Component Component present Notes Lesson number(s) / activities where present
Content Graduating from high school No No
Content Leadership No No
Content Other
Content Volunteering/civic engagement No No
Content Spirituality No No
Content Morals/values No No
Content Identity development No No
Content Social support/capital No No
Content Social influence/actual vs. perceived social norms No No
Content Social competence No No
Content Parenting skills No No
Content Normative beliefs No No
Content Gender roles No No
Content Gender identity No No
Content Cultural values No No
Content Connections with trusted adults No No
Content Conflict resolution/social problem solving Yes Yes (both versions) Module 4, Activity B (p 98), Activity C (p 103), Activity D (p 105); Module 5, Activity A (p 116)
Content Communication skills Yes Yes (both versions) Module 4, Activity B (p 98), Activity C (p 103), Activity D (p 105); Module 5, Activity A (p 116)
Content Child development No No
Content Boundary setting/refusal skills Yes Yes (both versions) Module 4, Activity B (p 98), Activity C (p 103), Activity D (p 105); Module 5, Activity A (p 116)
Content Substance use cessation No No
Content Substance use - Other drugs No No
Content Substance use - Alcohol No No
Content Substance use - Abstinence No No
Content Brain development and substance use No No
Content Vocational/skills training No No
Content Supplemental academic services No No
Content School engagement No No
Content College preparation No No
Content Alternative schooling No No
Content Self-regulation No No
Content Self-esteem No No
Content Self-efficacy/empowerment Yes Yes (both versions) Module 3, Activity D (p 84); Module 4, Activity B (p 98)
Content Resilience No No
Content Personal vulnerability Yes Yes (both versions) Module 3, Activity D (p 84); Module 4, Activity B (p 98)
Content Risk of STIs and Pregnancy Yes Yes (both versions) Module 1, Activity E (p 43), Activity F (p 54); Module 2, All Activities (p 59), Module 4, All Activities (p 95)
Content STIs - Screening No Yes (current version) Included in the updated Nicole's Choice video. Module 1, Activity E (p 43) - HIV; Module 3, Activity B (p 77)
Content STIs - Prevention Yes Yes (both versions) Module 1, Activity D (p 41), Activity E (p 43) and Activity F (p 54) - HIV; Module 2, Activity B (p 63), Activity c (p 65); Module 3, Activity A (p 74), Activity B (p 77), Activity C (p 79), Activity F (p 91)
Content STIs - Information Yes Yes (both versions) Module 1, Activity D (p 41) and Activity E (p 43) - HIV; Module 2, Activity B (p 63) - STIs
Content Sexual risk reduction Yes Yes (both versions) Module 1, Activity E (p 43), Activity F (p 54); Module 2, All Activities; Module 3, All Activities; Module 4, Activity B (p 98); Module 5, Activity A (p 116), Activity B (p 120), Activity C (p 123)
Content Sexual risk discontinuation Yes Yes (both versions) Module 1, Activity E (p 43), Activity F (p 54); Module 2, All Activities; Module 4, Activity B (p 98); Module 5, Activity A (p 116), Activity B (p 120), Activity C (p 123)
Content Sexual risk avoidance Yes Yes (both versions) Module 1, Activity E (p 43), Activity F (p 54); Module 2, Activity C; Module 4, Activity B (p 98); Module 5, Activity C (p 123)
Content Sexual orientation No No
Content Motivational interviewing No No
Content Contraception - Pills, patches, rings, and shots No Optional Birth Control Methods Demonstration Optional Activity presents information about these options. Appendix A (p 207)
Content Anatomy/physiology No No
Content Contraception - Condoms Yes Yes (both versions) Module 3, all activities (71)
Content Contraception - Long-acting reversible contraceptives No Optional Birth Control Methods Demonstration Optional Activity presents information about LARCs. Appendix A (p 207)
Content Contraception - Other No Optional Birth Control Methods Demonstration Optional Activity presents information about these options. Appendix A (p 207)
Content Puberty/development No No
Program Objectives
The Sisters Saving Sisters curriculum aims to empower young women by increasing their knowledge about the prevention of HIV, STDs, and pregnancy, and their confidence in their ability to negotiate safe sex and use condoms correctly. The program seeks to improve condom skills, strengthen intentions to use condoms, and reduce the incidence of HIV/STD risk-associated sexual behaviors.
Program Content

The curriculum is comprised of five modules:

  • Module 1: Introduction and Overview
  • Module 2: Understanding Personal Vulnerability
  • Module 3: Developing Condom Use Skills
  • Module 4: Improving Sexual Choices and Negotiation Skills
  • Module 5: Role-Play, AIDS Basketball, and Review

The five-session curriculum addresses four types of core behavioral beliefs and outcome expectancies:

  • Goals and Dreams Beliefs: The belief that unprotected sex can interfere with one’s goals and dreams for education and a career.  In Session 1, the participants engage in a goals and dreams activity and discuss obstacles to goals and dreams.  Having unprotected sex is listed and discussed as an obstacle.  This belief is also incorporated throughout the curriculum. 
  • Prevention Beliefs: The belief that condoms can reduce the risk of pregnancy, sexually transmitted diseases and HIV/AIDS.  This belief is incorporated throughout the curriculum. 
  • Partner-Reaction Beliefs: The belief that one’s boyfriend/girlfriend would not approve of condom use and will react negatively to it.  This belief may prevent a person from negotiating condom use.  In Sessions 4 and 5, participants learn and practice how to use negotiation and refusal skills to communicate with their partners about safer sex. 
  • Hedonistic Beliefs: The belief that condom use interferes with sexual pleasure.  For example, many people believe that condoms reduce physical sensations during sexual activity or ruin the mood. Therefore, they are less likely to use condoms during sexual intercourse.  In Sessions 4 and 5, youth learn that sex is still fun and pleasurable when a condom is used and are taught how to incorporate this belief into role-play scenarios.
Program Methods

Sisters Saving Sisters aims to create a youth-centered, positive learning environment for adolescent girls. The program engages participants in activities such as role-playing where all participants learn, practice and receive feedback on their negotiation and refusal skills in various role-play scenarios. They handle and practice correct placement of condoms using anatomical models. The curriculum also discusses the barriers to condom use such as alcohol and drug use.

The program's activities incorporate social cognitive-behavioral skill-building strategies (i.e., presentation, modeling, and the practice of abstinence negotiation skills). The curriculum involves culturally appropriate video clips, games, brainstorming, role-playing, skill-building activities and small group discussions that build group cohesion and enhance learning. Each activity lasts a brief time, and most are active exercises in which the adolescents get out of their seats and interact with each other.

Program Structure and Timeline
Sisters Saving Sisters consists of five 1-hour modules, designed to be delivered to small groups of two to six participants.
Staffing
Facilitators must be female and are expected to be health educators, social workers, nurses, and others who provide social service programs to youth. 
  • They must have attended the 2-day training and be well trained in the program.
  • They must be able to use highly participatory and interactive skills.
  • They must be able to work with youth and relate to them and their life circumstances. 
  • They must believe in the teens and believe in their resilience. 

Staffing should consist of 1 facilitator for 6 to 8 youth as well as support staff to assist if the program is delivered in larger class size settings.

Staff Training

It is highly recommended that educators who plan to teach Sisters Saving Sisters receive research-based professional development to prepare them to effectively implement and replicate the curriculum with fidelity for the intended target group.

Training on Sisters Saving Sisters is available through ETR's Professional Learning Services. Visit http://www.etr.org/ebi/training-ta/types-of-services/training-of-educators/ for more information or submit a Training & TA Request Form (http://www.etr.org/solutions/professional-development/training-ta-request-form/).

 

Program Materials and Resources
The Sisters Saving Sisters program consists of:
  • Facilitator Curriculum
  • Activity Set (hand-outs, posters, role-play cards)
  • Curriculum DVDs
    - Nicole's Choice
    - The Hard Way
    - The Subject Is: HIV (Safer Sex)
    - The Subject Is: STDs (Safer Sex)
    - Wrap It Up & Condom Animation
Additional Needs for Implementation
The curriculum requires the use of a monitor with DVD capabilities.
Fidelity

The developers provide specific fidelity guidelines consisting of core components, key characteristics and logic model. Fidelity monitoring checklists are also available. Adaptation guidance can be found on ETR’s Program Success Center website: http://www.etr.org/ebi/programs/sisters-saving-sisters/ 

Developers have identified three areas where there may be challenges to fidelity:

  1. Peer-facilitation: Two peers should not implement this intervention. The best way to use peers is to have a peer co-facilitate with an adult facilitator.
  2. Integration into a normal classroom setting: In normal classroom settings, the time frame is about 45 minutes. The Sisters Saving Sisters intervention modules are each 55 minutes long. Therefore, to identify strategies on how to integrate the program into a classroom setting with fidelity, providers must request technical assistance.
  3. Implementing this curriculum with large groups of more than 15 students: This intervention was evaluated with adolescent females in small groups of about 6 to 8 youth in a group. For larger group settings, providers may need additional training.
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. Contact ETR’s Professional Learning Services through the Program Support Help Desk (https://programsupport.etr.org/) or visit http://www.etr.org/ebi/training-ta/.
Allowable Adaptations
The developer has noted several allowable adaptations, but consultation with the model developers in the adaptation process is necessary to ensure fidelity:
  • The "Sisters Saving Sisters" curriculum was designed to be used with smaller groups ranging from two to eight participants, but can be implemented with larger numbers, in consultation with the developer.
  • It is appropriate for various community settings, including schools, and youth agencies.
  • The five-hour intervention may be delivered in different ways, such as 1 module a day for 5 days or 1-2 modules per day over 3-4 days.  
  • The original study used Latina and African-American female facilitators.  The program may be implemented using facilitators of different ethnic or professional backgrounds, so long as the facilitators are trained, possess the skills and characteristics of a good facilitator, and have experience working with teens.
  • Teens of different racial and ethnic groups may participate, and changing the names and settings of the situations in the role-plays to reflect the culture of participants is allowed.
Adaptation Guidelines or Kit
No
Reviewed Studies
Citation High-Quality Randomized Trial Moderate-Quality Randomized Trial Moderate-Quality Quasi-Experiment Low Study Rating Did Not Meet Eligibility Criteria

Jemmott et al. 2005

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

Jemmott et al. 2005

 		Health clinic or medical facility 14 to 17 African American or Black Young women

682
Study Findings

Evidence by Outcome Domain and Study

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

Jemmott et al. 2005

 		n.a. Favorable evidence Potentially favorable evidence Potentially 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

Jemmott et al. 2005

The program was evaluated using a randomized controlled trial involving adolescents recruited from a family planning clinic in Philadelphia, PA. Study participants were randomly assigned to one of three groups: (1) a treatment group that received the Sisters Saving Sisters intervention, (2) a treatment group that received an informational session on HIV/STD risk reduction without any skill-building activities, or (3) a control group that received a general health promotion program on risk behaviors for cancer, heart disease, and stroke. This report focuses only on the comparison of the group receiving Sisters Saving Sisters versus the health-promotion control group. Surveys were administered before the intervention and at follow- ups conducted 3, 6, and 12 months after the intervention. Biological testing for chlamydia, gonorrhea, and trichomonas was also conducted.

Three months after the intervention the study found no statistically significant program impacts on condom use or number of sexual partners in the past three months. Six months after the intervention the study found no statistically significant program impacts on condom use in the past three months, number of sexual partners in the past three months, or testing positive for chlamydia, gonorrhea, or trichomonas. Twelve months after the intervention adolescents participating in the intervention reported significantly fewer days of sex without condom use in the previous 3 months and significantly fewer sexual partners in the previous 3 months. Adolescents participating in the intervention were significantly less likely to report having had multiple sex partners in the previous 3 months, and were significantly less likely to test positive for gonorrhea, chlamydia, or trichomonas.

The study also examined program impacts on measures of sexual activity while under the influence of drugs or alcohol; STD/HIV knowledge; condom-use knowledge, attitudes, and intentions; impulse control beliefs; and negotiation skill beliefs. Findings for these outcomes were not considered for the review because they fell outside the scope of the review.

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.