there’s been a good deal of press around the unfortunately insignificant results of a major HIV prevention trial with products for women in south africa, uganda and zimbabwe. the results had little to do with efficacy of the products (a pill and a gel) but rather with the fact that most of the participating women did not use the treatments as recommended – or at all.
one potential response is to improve our behavioral interventions to support adherence to treatment regimens (and prevention regimens) and integrate these methods more directly into medication trials. adherence and persistence with medication are global problems and we are just beginning to learn – with the help of health psychology and behavioral economics – how to tackle the challenge. efforts so far include high- and low-tech solutions, though not all the promises of the former, in terms of mhealth to facilitate behavior change and adherence, have yet been borne out.
another, not mutually exclusive, response would be to actually ask the women what they would like to see and use in the way of HIV prevention – a tool which should be empowering for them. the press seems full of comments like “the women are trying to tell us something!” why does it seem that, then, for a product made for them, they have to work so hard to tell us those things? why are we not hearing more sentences that start “the women told us…” that is, why, after such a big trial, am i not hearing anything about on-going qualitative and observational follow-up efforts to learn more about what exactly didn’t work about the methods offered to women?
there’s often a lot to learn from null results (that’s science, right?) but it doesn’t just come from brainstorming what went wrong. asking helps.
i don’t suggest that people are perfectly prescient about what they need or want. often, the innovations that we can’t live without now – smartphones, for example – weren’t a need or even desire that most people could have articulated 20 years ago. as such, directly asking people what it would take to get them to engage in X desirable behavior can’t determine the research agenda. but it should certainly be part of figuring it out.