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This article is part of the supplement: Social audit: building the community voice into health service delivery and planning

Open Access Research article

Impact of community-based interventions on condom use in the Tłįchǫ region of Northwest Territories, Canada

Karen E Edwards12*, Nancy Gibson2, Jim Martin3, Steven Mitchell2 and Neil Andersson4

Author Affiliations

1 Universidad Autónoma de Guerrero, Mexico

2 CIETcanada, Ottawa, Canada

3 Tłįchǫ Community Services Agency, Canada

4 Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Mexico

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BMC Health Services Research 2011, 11(Suppl 2):S9  doi:10.1186/1472-6963-11-S2-S9

Published: 21 December 2011

Abstract

Background

Since 2005, the Tłįchǫ Community Services Agency (TCSA) in Canada's Northwest Territories (NT) has addressed rising rates of sexually transmitted infections (STI). In 2009, STI rates in the NT were ten times higher than the national rate and Tłįchǫ regional rates were nearly four times that of the NT – 91 cases per 1000 people. We describe a social audit process that assessed the impact of an evidence-based community-led intervention.

Methods

A baseline survey of sexual health knowledge, attitudes and behaviours in 2006/07 provided evidence for a Community Action Research Team (CART) to develop and to put in place culturally appropriate interventions in the Tłįchǫ region. A follow-up study in 2010 sought to assess the impact of CART activities on condom use and underlying conscious knowledge, attitudes, subjective norms, intention to change, sense of agency and discussions related to condom use and STI risks. We report the contrasts using Odds Ratios (OR) and 95% confidence intervals (CI).

Results

One in every three follow-up respondents (315/808) participated in at least one CART activity. Participation in highly ranked interventions was associated with increased condom use during the last sexual encounter (OR 1.45, 95%CI 1.07-1.98). Those exposed to three or more activities were more likely to talk openly about condoms (OR 2.08, 95%CI 1.41-3.28), but were also less likely to be monogamous (OR 0.49, 95%CI 0.29-0.90).

Conclusions

The measurable impact on condom use indicates a strong beginning for the Tłįchǫ community intervention programmes. The interventions also seem to generate increased discussion, often a precursor to action. The Tłįchǫ can use the evidence to improve and refocus their programming, increase knowledge and continue to improve safe condom use practices.

Keywords:
Tlicho (Tłįchǫ); social audit; Northwest Territories; sexually transmitted infections; condom use