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

Nancy Gonzalez-Caro, MPH
Evidence-Based Product Specialist
ETR
100 Enterprise Way, Suite G300
Scotts Valley, CA 95066
Phone: 1-800-321-4407
Website: http://www.etr.org/ebi/programs/sisters-saving-sisters/

Cody Sigel, MPH, CHES
Health Education Training Coordinator
ETR
1333 Broadway, Suite P110
Oakland, CA 94612
Phone: 510-858-0995
Website: http://www.etr.org/ebi/programs/sisters-saving-sisters/

Sample of curriculum available for review prior to purchase
Yes
Adaptation guidelines or kit available
No
Languages available
English
Program Core Components
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.

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.
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/).

 

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.
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.
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.