1-to-1 information and advice
What is the activity?
Information and advice interventions typically offer individuals the opportunity to have a short discussion about sexual health needs and concerns, face-to-face.
1-to-1 information and advice is typically client-led but can also be used as a tool to promote particular mass media and small media interventions. It is a low threshold intervention which should be easily accessed, usually where the target group meet for other purposes.
Engaging individuals in discussion, listening to their needs, experiences and feelings, and offering information and advice is at the centre of many activities undertaken in the name of HIV prevention. Although the contexts through which individual users come into contact with such services vary widely, many core principles of information and advice provision remain the same, regardless of the setting in which it is offered.
Many agencies tend to focus on their detached or outreach work as the main way of giving information and advice, but we also include centre-based services (offered on a drop-in or appointment basis) and helpline (offered by telephone) and chat-room interventions (on the internet), although the latter two interventions do not strictly occur face-to-face.
Listening in an open, non-judgmental way helps those providing this intervention to get a better sense of how to tailor the information and advice that they give. However, HIV prevention need reaches beyond access to adequate sexual health information, and includes needs related to personal safety, productivity and freedom from discrimination. The provision of information and advice on welfare beneﬁts, immigration, housing, employment and training are also interventions that help to reduce HIV prevention need among MSM in England.
Strengths and limitations
The highly personalised delivery of 1-to-1 talking interventions means they can be responsive to service users’ needs, in ways that are not possible in written interventions.
Some men report a benefit to encountering 1-to-1 information providers, even if they do not directly interact with them. For example, seeing outreach workers in public sex environments may foster a sense of safety among men using that site with regard to crime or violence.
One of the most signiﬁcant challenges in the provision of 1-to-1 advice and information (particularly through outreach or detached work), is the recruitment, training and retention of people willing to work unsociable hours who also have excellent communication skills and sufﬁcient sexual health expertise to deliver the intervention.
Outreach and detached work can have one compelling limitation: the setting it occurs in are intended for other activities such as socialising, drinking, cruising and having sex. Some men may not want to be approached or engage in conversations in social settings; when searching for, or having sex; or in settings where sexual encounters might be considered risky or illegal (such as public ouitdoor spaces).
Where does it happen?
During detached work or outreach, information and advice can be delivered in public, private and commercial spaces where gay men and other MSM socialise and meet for sex, including pubs, clubs, saunas and other businesses and community centres. Access is immediate, and interactions tend to be short - typically 5-15 minutes.
Workers generally operate in pairs in order to ensure their own safety, and also to protect themselves against accusations of misconduct. Advice is usually information-based, and the session can be used as a means of promoting other interventions and referring individuals to other services and distributing HIV prevention resources (such as leaﬂets and condoms) where appropriate.
Wherever possible, centre-based drop-in should take place in an area away from other service users and staff, offering people privacy while discussing personal issues. There should be a secure area for keeping conﬁdential records, and private rooms may be equipped with a panic button system to be used if there is a physical danger.
Telephone helplines and web-based personal support interventions provide users with direct, 1-to-1 information and advice, at times and in settings that are most comfortable for them. Once again, they often demand self-referral, although accessibility is increased compared to centre-based interventions, and is in the control of the user. Such interactions do not require an appointment, and can be of varying durations and intensities. In such interventions, the technology affords relative anonymity to the user, while the provider can tailor the information and advice offered to the needs of individuals accessing the service.
Frequently delivered alongside ...
- Interactive distribution
- Motivational interviewing
- Group information and advice
- Small media
- Mass media
Issues to consider
Providers of 1-to-1 information and advice should be knowledgeable about a range of sexual health issues such as the transmission, prevention and treatment of sexually transmitted infections (including HIV). Beyond this, they also require familiarity with related issues, in order to identify acute needs (relating say to domestic violence, homelessness, or non-consensual sex) and to be familiar with an array of services to which they can make appropriate referrals. Positions demanding this type of expertise and experience are ideally paid as it is difﬁcult to ensure adequate quality of provision by volunteers. Workers providing information and advice should have proven listening and communication skills.
It is essential that workers display a professional, non-judgmental, knowledgeable and reliable persona while communicating with service users.
Agencies will need to have procedural and boundary guidelines for 1-to-1 advice workers, and will need to ensure that these are built into staff inductions, and are regularly revisited. These should aim to maximise the physical safety and comfort of workers while also ensuring a standardised and reliable service. The providers’ credibility is paramount to the success of these interventions, therefore workers will need training about personal, professional and social boundaries during work (and about contact with clients outside of work).
Advice (outreach) workers will generally need to be equipped with:
- identiﬁcation cards
- relevant written resources and other materials such as condoms / femidoms
- contact details for other services
- mobile phone
- a letter on agency-headed paper explaining their presence
- monitoring instruments
Agencies in larger cities could consider pooling their sessional outreach staff in order to ensure high quality provision, as well as ensuring that there is enough work to keep individuals in post.
Making arrangements to gain access to community and commercial venues can be time-consuming, but careful preparation and community consultation will help agencies to successfully identify appropriate venues.
Aims and outcomes
The outcomes from this intervention are primarily knowledge-based, but 1-to-1 information and advice can address motivation and simple skills such as using a condom appropriately. The list below offers some examples of the aims and outcomes associated with 1-to1 information and advice, but is not exhaustive.
- Increased understanding that different sexual activities carry differing risks of HIV transmission (see associated choices such as avoiding anal intercourse or using condoms for anal intercourse and aims such as knowing the risks associated with anal intercourse and the benefits of condom use).
- Increased understanding of the benefits of condom use for anal intercourse (see associated choice regarding condoms for anal intercourse and aims such as knowing the benefits of condom use and having the resources and opportunities to access them and the skills to appropriately use them).
- Increased understanding of the alternatives to risky behaviour (see associated choices such as avoiding anal intercourse or using condoms for anal intercourse and aims such as knowing the risks associated with anal intercourse and the benefits of condom use).
- Increased control over involvement in HIV exposure and transmission in their lives (see associated choices such as declining or deferring a new sexual partner or choosing monogamous rather than open regular relationships with men and aims such as knowing the increasing risks associated with having higher numbers of male partners.
- Increased understanding of means of HIV risk reduction when unprotected anal intercourse does occur (see associated choices such as withdrawal before ejaculation and the knowledge and skills required).
Monitoring and evaluation
Outreach and detached work is notoriously difﬁcult to monitor and evaluate, and there can be resistance among some workers to using monitoring tools in the ﬁeld. Similarly, service-users’ interactions in settings outside of the agency may be ﬂeeting, making data collection very challenging.
It is most common for 1-to-1 information and advice to be delivered alongside interactive distribution of resources. The outcomes associated with the activity are rarely evaluated, though it is sometimes subject to monitoring and evaluation which collates information about service users’ basic demographics (age, ethnicity, gender etc.) in order to assess if the intervention is reaching the desired targets.
It is possible that innovative and lower-cost evaluation models such as mystery-shopping or the use of peer evaluation would contribute to the monitoring and evaluation of this HIV prevention activity.
Page last updated: 17 June 2013
Outreach on cruising sites
Information and advice is provided by The Eddystone Trust through outreach to a busy cruising site in Devon. Workers engage with MSM who may not identify as gay or bisexual including conversations about HIV and STIs. Workers have discussions about relationships and managing expectations of pleasure and risk. Relationships developed with regular cruisers help to pass information into networks if there is an STI outbreak or new dangers in cruising areas. The site poses challenges, following complaints of littering and concerns from statutory bodies. Building and maintaining relationships with the police and statutory authorities, and community engagement has been key to these concerns.
Terrence Higgins Trust's Netreach intervention operates in a range of online chat rooms on commercial gay dating and hook-up websites. It allows men to engage with trained outreach workers using net chat. Workers operate under guidelines developed and agreed with the service provider, including a rule that workers cannot directly approach men nor chat to them in open forums. Chats can be brief information queries or can be more complex and lengthy. Netreach allows men to get information and support anonymously and without having to access a service centre or the commercial gay scene. Workers can post web-links allowing men to access further information - including details of their local sexual health clinic or support agency.
Peer mentoring programme
The Metro Centre runs the Metrosafe mentoring programme, to assist men in taking control of their sex lives and their health. Referrals come through Health Trainers or clinics. Men are initially assessed using a behaviour, attitude, skills and knowledge scale called the BASK Inventory. Men work through structured modules with trained volunteer mentors, looking at how sexual behaviour might be affected by issues such as self-esteem, drugs and alcohol. Participants complete the BASK Inventory again during and at the end of the programme to measure changes. Key to the programme’s success is its mixture of structure and informality. Mentors share their own experiences, helping to empower men and engender ownership of their sexual health and well-being.
Outreach support materials
Outreach support materials (‘knick knacks’) have been central to CHAPS national campaigns for the last decade. They facilitate face-to-face interventions between workers and men and are highly valued by outreach staff as an aid to their work. Knick knacks typically cost around 50p - £1 per unit, and carry the core campaign message (and website address). Evaluation shows they work best when they are high quality, with a practical use and relate to the campaign topic. They also aid in targeting sub-populations: button badges and lip balm were chosen to increase younger men’s engagement with a recent condom campaign as previous experience showed these had particular appeal with this group.
The Metro Centre Health trainers outreach team speaks to men in a range of social, sexual and clinical settings, encouraging them to reflect on their lives, particularly in the areas of sexual and mental health and physical well-being. To facilitate this, the team uses smart phones to deliver a quick questionnaire called the BASK Inventory. This assesses a man’s behaviour, attitude, skills and knowledge with respect to sexual health and well-being. The BASK Inventory helps identify needs and generates a bespoke action plan to address them, referring onto services and setting a follow-up date. Clients work with the team on an on-going basis and complete further BASK Inventories with the aim of continued improvement.