Peer Group Focused eHealth Strategies to Promote HIV Prevention, Testing, and Care Engagement

Feasibility and Acceptability of a Motivational Interviewing-Based Telehealth Intervention for Bacterial Sexually Transmitted Infection Screening: Protocol for a Sequential Explanatory Mixed Methods Study

BACKGROUND

Gay, bisexual, and other men who have sex with men living with HIV (GBMSM-LWH) in the United States bear a heavy burden of bacterial sexually transmitted infections (STIs). Timely diagnosis and treatment are key to prevention. Only a few studies have combined home specimen self-collection for bacterial STI screening with live audio and video (AV) conferencing. None have focused on GBMSM-LWH or incorporated motivational interviewing (MI), a client-centered, strengths-based counseling approach that seeks to support individuals to create positive behavioral change.

OBJECTIVE

Our study seeks to investigate the feasibility and acceptability of an MI-based telehealth intervention that integrates home specimen self-collection from different anatomical sites of possible exposure and MI delivered via live AV conferencing to engage sexually active GBMSM-LWH in bacterial STI screening.

METHODS

Participants are being recruited from across the United States via advertising on mobile dating apps and social networking sites and via peer referral. Phase 1 involves piloting the delivery of an innovative telehealth intervention for bacterial STI screening to 75 GBMSM-LWH. Our intervention includes three components: (1) a pretest live AV conferencing session involving an MI-guided discussion to elicit awareness of bacterial STIs; fill any knowledge gaps; bolster the perceived importance of regularly testing for gonorrhea, chlamydia, and syphilis; and build self-efficacy for specimen self-collection; (2) home self-collection and return via mail of a urine sample (for gonorrhea and chlamydia testing), a throat swab (for gonorrhea and chlamydia testing), a rectal swab (for gonorrhea and chlamydia testing), and a finger-stick blood sample (for syphilis testing); and (3) a posttest live AV conferencing session involving an MI-guided discussion to prepare participants for receiving test results and formulate personalized action plans for seeking treatment (if warranted) and repeat testing. Descriptive statistics and progression ratios will be calculated, and potential variations in our intervention's feasibility and acceptability will be numerically summarized and graphically visualized. Phase 2 involves elucidating attitudes, facilitators, and barriers related to engaging in each intervention component via semistructured in-depth interviews with a purposive subsample of 20 participants who complete progressively smaller subsets of the pretest session, specimen return for bacterial STI testing, and the posttest session. Thematic analysis will be used to identify, analyze, and report patterns in the data. Quantitative and qualitative data will be integrated at the design, methods, interpretation, and reporting levels.

RESULTS

Study procedures were approved by the Institutional Review Board at the University of Michigan in September 2023. Participant recruitment began in April 2024.

CONCLUSIONS

Our study will advance multiple goals of the STI National Strategic Plan for the United States for 2021 to 2025, specifically those pertaining to preventing new STIs; accelerating progress in STI research, technology, and innovation; and reducing STI-related health disparities.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06100250; https://www.clinicaltrials.gov/study/NCT06100250.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/64433.

Developing Social Enhancements for a Web-Based, Positive Emotion Intervention for Alzheimer Disease Caregivers: Qualitative Focus Group and Interview Study

BACKGROUND

Alzheimer disease is a degenerative neurological condition that requires long-term care. The cost of these responsibilities is often borne by informal caregivers, who experience an elevated risk of negative physical and psychological outcomes. Previously, we designed a positive emotion regulation intervention that was shown to improve well-being among dementia caregivers when delivered through one-on-one videoconferencing lessons with a trained facilitator. However, the format required significant resources in terms of logistics and facilitator time. To broaden the reach of the intervention, we aimed to develop the Social Augmentation of Self-Guided Electronic Delivery of the Life Enhancing Activities for Family Caregivers (SAGE LEAF) program, an iteration of the intervention in a self-guided, web-based format with enhanced opportunities for social connection.

OBJECTIVE

The aim of this study was to gather feedback to inform the design of social features for the SAGE LEAF intervention. In the absence of a facilitator, our goal with the self-guided SAGE LEAF intervention was to integrate various social features (eg, discussion board, automated support, and profiles) to maximize engagement among participants.

METHODS

Qualitative data were collected from 26 individuals through (1) interviews with participants who completed a previous version of the intervention via videoconferencing with a facilitator, (2) focus groups with dementia caregivers who had not previously experienced the intervention, and (3) focus groups with Alzheimer disease clinical care providers. We conducted a qualitative thematic analysis to identify which social features would be the most helpful and how they could be implemented in a way that would be best received by caregivers.

RESULTS

Interview and focus group feedback indicated that participants generally liked the potential features suggested, including the discussion boards, multimedia content, and informational support. They had valuable suggestions for optimal implementation. For example, participants liked the idea of a buddy system where they would be matched up with another caregiver for the duration of the study. However, they expressed concern about differing expectations among caregivers and the possibility of matched caregivers not getting along. Participants also expressed interest in giving caregivers access to a podcast on the skills, which would allow them to review additional content when they wished.

CONCLUSIONS

Taken together, the discussions with caregivers and providers offered unique insights into the types of social features that may be integrated into the SAGE LEAF intervention, as well as implementation suggestions to improve the acceptability of the features among caregivers. These insights will allow us to design social features for the intervention that are optimally engaging and helpful for caregivers.

Peer ambassador stories: formative qualitative research to enhance the reach of PrEP, HIV testing, and behavioral health treatments to LMSM in South Florida

Existing HIV prevention interventions, such as pre-exposure prophylaxis (PrEP), and behavioral health treatments inadequately reach Latino men who have sex with men (LMSM) in the US. This study involved formative research to inform the content, design, and implementation of a scalable, low resource implementation strategy - peer ambassador stories - stories from peers to normalize using PrEP, HIV testing, and behavioral health treatment. We conducted semi-structured interviews with 20 LMSM to elucidate their content, design, and implementation preferences for peer ambassador stories. Men were asked about story prompts, story contributor characteristics, story platform features, design preferences, and recommendations for enhancing the adoption and use of the peer ambassador technology platform among LMSM. Interviews were transcribed and analyzed via rapid qualitative analysis. Qualitative analyses identified 14 themes within 4 pre-specified domains. Collectively, the themes unified around the central concept that technology-delivered peer ambassador stories require a personalized, relational, culturally relevant touch to be acceptable and appropriate for LMSM. This study suggests that disseminating peer ambassador stories using electronic platforms and audio/video formats may enhance the reach of services and if they are personalized, relational, and culturally relevant. Findings have broad implications for informing other peer-based strategies to mitigate HIV disparities among LMSM.

Acceptability, feasibility and potential of an intervention using secret Facebook groups to complement existing HIV prevention strategies among female sex workers in Cameroon, a randomized pilot study

This randomized pilot project evaluated an intervention promoting health care literacy around HIV, pre-exposure prophylaxis (PrEP), and stigma reduction using private social media groups that complemented existing HIV prevention services among female sex workers (FSWs) in Cameroon. The intervention was 12 HIV and sexual health videos tailored to FSWs that were released over 8 weeks through a secret Facebook group platform. In-person surveys were administered before, after the intervention, and three months later. No HIV seroconversions were detected; all participants completed follow-up and agreed to recommend the intervention to a coworker. Although the intervention was assessed to be acceptable and feasible to implement, poor internet connectivity was a key barrier. In time-series analysis, the intervention group participants reported improved PrEP interest, PrEP knowledge, and condom use along with reduced PrEP and HIV-related stigma, but no impact on sex-work related stigma or social cohesion. Similar results occurred in the control group. Cross-contamination and small pilot study size might have hindered the ability to detect the differential impact of this intervention. As communications technology increases in Cameroon, it is essential to learn more about FSWs preferences on the use of social media platforms for HIV prevention strategies.

Facilitated WhatsApp Support Groups for Youth Living With HIV in Nairobi, Kenya: Single-Arm Pilot Intervention Study

BACKGROUND

Mobile technology can support HIV care, but studies in youth are limited. In 2014, youth receiving HIV care at several health care facilities in Nairobi, Kenya spontaneously formed peer support groups using the social media platform WhatsApp.

OBJECTIVE

Inspired by youth-initiated groups, we aimed to evaluate the use of WhatsApp to deliver a social support intervention to improve HIV treatment and psychosocial outcomes in youth. We developed a facilitated WhatsApp group intervention (named Vijana-SMART), which was grounded in social support theory and guided by the design recommendations of youth living with HIV. This paper evaluates the intervention's acceptability and pre-post changes in health outcomes.

METHODS

The intervention involved interactive WhatsApp groups facilitated by study staff for 6 months, with each group having approximately 25 members. Study staff sent weekly structured messages, and the message content was based on social support theory and encouraged unstructured peer-to-peer messaging and support. We conducted a single-arm pilot among 55 youth living with HIV aged 14-24 years recruited from a government health care facility serving a mixed-income area of Nairobi. At enrollment and follow-up, self-report questionnaires assessed acceptability; antiretroviral therapy (ART) information, motivation, and behavioral skills (IMB); depression; social support; stigma; resilience; and ART adherence. All participants received the intervention. We used generalized estimating equations (GEEs) clustered by participant to evaluate changes in scores from baseline to follow-up, and correlates of participant WhatsApp messaging.

RESULTS

The median participant age was 18 years, and 67% (37/55) were female. Intervention acceptability was high. All participants reported that it was helpful, and 73% (38/52) sent ≥1 WhatsApp message. Messaging levels varied considerably between participants and were higher during school holidays, earlier in the intervention period, and among youth aged ≥18 years. IMB scores increased from enrollment to follow-up (66.9% to 71.3%; P<.001). Stigma scores also increased (8.3% to 16.7%; P=.001), and resilience scores decreased (75.0% to 70.0%; P<.001). We found no significant change in ART adherence, social support, or depression. We detected a positive association between the level of messaging during the study and the resilience score, but no significant association between messaging and other outcomes. Once enrolled, it was common for participants to change their phone numbers or leave the groups and request to be added back, which may present implementation challenges at a larger scale.

CONCLUSIONS

Increased IMB scores following WhatsApp group participation may improve HIV outcomes. Increased stigma and decreased resilience were unintended consequences and may reflect transient effects of group sharing of challenging experiences, which should be addressed in larger randomized evaluations. WhatsApp groups present a promising and acceptable modality to deliver supportive interventions to youth living with HIV beyond the clinic, and further evaluation is warranted.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT05634265); https://clinicaltrials.gov/study/NCT05634265.

"Whenever you need support, you first turn to the group": motivations and functions of WhatsApp groups for youth living with HIV

Social support is a critical component of achieving positive health outcomes for youth living with HIV (YLWH). Mobile health (mHealth) has significant potential for providing social support to YLWH. However, little is known about the domains of social support most needed by YLWH which mHealth interventions might address. Drawing on the spontaneous creation of WhatsApp support groups by YLWH in Nairobi, Kenya, we characterized Kenyan YLWH's social support needs and potential roles of social media groups in meeting them. We conducted interviews and focus-groups with 68 YLWH, 24 caregivers and 20 healthcare workers, and observed two YLWH-led WhatsApp groups for 6 weeks. Youth reported that existing support systems, including family and healthcare workers, already provided informational and instrumental support. However, they emphasized unmet companionship and emotional support needs, leading to isolation, hopelessness, and medication adherence challenges. Participants identified connection with other YLWH as a unique source of emotional and companionship support that allowed them to feel more secure and less isolated. Interviews and observed WhatsApp chats demonstrated that WhatsApp groups were a desirable medium for companionship support that overcame barriers to in-person connection.

The mental health of university students in South Africa: Results of the national student survey

BACKGROUND

We estimate 30-day prevalence of 11 common mental disorders among a representative sample of university students in South Africa and explore disparities in student mental health across historically segregated institutions and marginalised groups.

METHODS

Cross-sectional data collected in self-report surveys of students (n = 28,268) from 17 universities were weighted to adjust for differences in survey responses. Poisson regression was used to estimate risk ratios (RRs).

RESULTS

Prevalence estimates were highest (21.0-24.5 %) for two anxiety disorders (social anxiety disorder, PTSD) and two disruptive behavior disorders (eating disorder, ADHD). Prevalence estimates were higher for any anxiety disorder (37.1 %) and any disruptive behavior disorder (38.7 %) than for any mood disorder (16.3 %) or any substance use disorder (6.6 %). Prevalence estimates varied significantly by historical segregation status of institutions (F₃ = 221.6, p < .001), with prevalence consistently highest in Historically White Institutions (HWIs). Across all institutions, risk of any disorder was lower among oldest than younger students (RR = 0.7, 95%CI = 0.7-0.8), and elevated among gender non-conforming (RR = 1.3, 95%CI = 1.1-1.4), female (RR = 1.2, 95%CI = 1.1-1.2), and sexual minority (RR = 1.2, 95%CI = 1.2-1.3) students. Black students attending HWIs had elevated risk of any disorder relative to White students.

LIMITATIONS

Reliance on self-report measures together with relatively low and variable response rates across institutions limit generalizability of results.

CONCLUSIONS

Modest risks associated with sociodemographic factors suggest a need to focus on mental health of female, gender nonconforming and sexual minority students at all universities along with Black students attending HWIs.

Optimizing Internet Use during Adolescence: eHealth Solutions

Internet offers an immense opportunity as a resource for education, training, and health promotion. This narrative review summarizes the opportunities for health promotion among adolescents through use of the Internet and technology (defined as eHealth). The details of technology and use of Internet for adolescent-health related topics such as nutrition, fitness, sexual health, adventure, and violence were searched through PubMed. The review reports few digital solutions to address key challenges during adolescence like promotion of nutrition and sexual reproductive health, prevention of noncommunicable diseases, substance abuse, and mental health issues. eHealth was concluded as a potential solution for preventive and promotional health practices during adolescence. However, concerns of Internet addiction, safety, privacy, mental health disorders, and misinformation need to be addressed and monitored during adolescence.

Internet-based peer support interventions for people living with HIV: A scoping review

Peer support interventions for people living with HIV and AIDS (PLWHA) are effective, but their associated time and material costs for the recipient and the health system make them reachable for only a small proportion of PLWHA. Internet-based interventions are an effective alternative for delivering psychosocial interventions for PLWHA as they are more accessible. Currently, no reviews are focusing on internet-based interventions with peer support components. This scoping review aims to map the existing literature on psychosocial interventions for PLWHA based on peer support and delivered through the internet. We conducted a systematic scoping review of academic literature following methodological guidelines for scoping reviews, and 28 articles met our criteria. We summarized the main characteristics of the digital peer support interventions for PLWHA and how they implemented peer support in a virtual environment. Overall the reported outcomes appeared promising, but more robust evidence is needed.

Mobile technology access and use among youth in Nairobi, Kenya: implications for mobile health intervention design

BACKGROUND

Social media can be used to support the health of underserved youth beyond clinical settings. Young people are avid users of social media, but estimates of smartphone access among youth in sub-Saharan Africa are lacking, making it difficult to determine context-appropriateness of online and social media interventions.

METHODS

We conducted a cross-sectional observational survey assessing technology access and use among youth aged 14-24 receiving general outpatient or human immunodeficiency virus (HIV) care in three hospitals in Nairobi, Kenya. Correlates of smartphone access and social media use were evaluated by Poisson regression.

RESULTS

Of 600 youth, 301 were receiving general outpatient care and 299 HIV care. Median age was 18 years. Overall, 416 (69%) had access to a mobile phone and 288 (48%) to a smartphone. Of those with smartphones, 260 (90%) used social media. Smartphone access varied by facility (40% at the sub-county hospital vs. 55% at the national referral hospital, P=0.004) and was associated with older age [65% in 20-24-year-old vs. 37% in 14-19-year-old, adjusted prevalence ratio (aPR) 1.58, 95% CI: 1.30-1.92], secondary vs. primary education (aPR 2.59, 95% CI: 1.76-3.81), and HIV vs. general outpatient care (aPR 1.18, 95% CI: 1.01-1.38). Social media use was similarly associated with facility, older age, higher education, and male gender.

CONCLUSIONS

These data suggest that smartphone-based and social media interventions are accessible in Nairobi, Kenya, in the general population and youth living with HIV, and most appropriate for older youth. Intervention developers and policymakers should consider smartphone and social media interventions as candidates for youth health programs, while noting that heterogeneity of access between and within communities requires tailoring to the specific intervention context to avoid excluding the most vulnerable youth.

Digital Formats for Community Participation in Health Promotion and Prevention Activities: A Scoping Review

Objectives: Digital technologies in public health are primarily used in medical settings and mostly on an individual and passive way of use. There are research gaps on digital media facilitating participation, empowerment, community engagement, and participatory research in community settings. This scoping review aims to map existing literature on digital formats that enable participation in the field of health promotion and prevention in community settings.

Design: The databases Medline, EMBASE, and PsycINFO were used to identify studies published from 2010 up to date (date of literature search) onward that used digital formats in all or in the main sequences of the process to enable high levels of participation in health promotion and prevention activities in community settings.

Results: This review identified nine out of 11 included studies relevant to the research question. We found five studies that applied qualitative participatory research, two studies on peer support and one study each on empowerment and crowdsourcing. The digital technologies used varied widely and included social media platforms, bulletin boards, online forum webpages, and customized web providers and programs. Most studies mentioned anonymity, flexibility, and convenience as benefits of digital interventions. Some papers reported limitations such as difficulties by interpreting written-only data or the possibility of selection bias due to the digital divide.

Conclusion: This scoping review identified only few studies relevant to our objective, indicating an existing gap in research on this topic. Digital formats were found to be particularly suitable for purposes where anonymity and flexibility are beneficial, such as for online peer exchange and peer support programs.

Elements that underpin the design, development and evaluation of social media health interventions. A Scoping Review Protocol

Background

Social media use has grown tremendously over the years. Given the volume and diversity of people on social media and the amount of information being exchanged, it is perhaps unsurprising that social media is being used as an avenue to disseminate and deliver health interventions. There exists an opportunity for social media health interventions to make a positive impact on health. However, there is a need to understand more about the ways in which these interventions are designed, developed, and evaluated. This scoping protocol will review the current state of this field by charting the elements that drive the design, development, and evaluation of these interventions. This includes charting models, frameworks, and rationales for the interventions, as well as the platforms being used, and the health behaviors being targeted. This intention of this scoping review is to help inform those who wish to develop effective social media health interventions.

Objective

The objective of this review is to map the elements that drive the design, development, and evaluation of social media health interventions. We define “social media health intervention” as interventions that make use of social media platforms to disseminate or deliver health-related information and educational initiatives to the public. We will seek to chart the elements that drive the design, development, and delivery of such interventions, including their platforms and targeted health behaviors.

Methods

The methodological framework for this review is guided by Arksey and O’Malley and enhancements by later studies. We will search relevant literature from 9 databases: (1) PubMed, (2) PsycINFO, (3) EMBASE, (4) Web of Science, (5) Scopus, (6) CINAHL, (7) ERIC, (8) MEDLINE, and (9) Google Scholar. The literature will be screened by at least two reviewers in 2 stages: (1) title/abstract screening against the eligibility criteria; and (2) eligible articles will then undergo a full-text screening. Data will be charted using the data charting tool developed by the authors.

Results

The results of this study will be presented in a final scoping review paper, divided into 2 sections. The first section will describe the search strategy and study selection process and will contain the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart. The second section will provide key details pertaining to the review objective and question.

Conclusions

This review will help guide scholars looking to build social media health interventions toward evidence-based practices in design and evaluation.

International Registered Report Identifier (IRRID)

PRR1-10.2196/31911

Social Media Use for Health Purposes: Systematic Review

Background

Social media has been widely used for health-related purposes, especially during the COVID-19 pandemic. Previous reviews have summarized social media uses for a specific health purpose such as health interventions, health campaigns, medical education, and disease outbreak surveillance. The most recent comprehensive review of social media uses for health purposes, however, was conducted in 2013. A systematic review that covers various health purposes is needed to reveal the new usages and research gaps that emerge in recent years.

Objective

This study aimed to provide a systematic review of social media uses for health purposes that have been identified in previous studies.

Methods

The researchers searched for peer-reviewed journal articles published between 2006 and 2020 in 12 databases covering medicine, public health, and social science. After coding the articles in terms of publication year, journal area, country, method, social media platform, and social media use for health purposes, the researchers provided a review of social media use for health purposes identified in these articles.

Results

This study summarized 10 social media uses for various health purposes by health institutions, health researchers and practitioners, and the public.

Conclusions

Social media can be used for various health purposes. Several new usages have emerged since 2013 including advancing health research and practice, social mobilization, and facilitating offline health-related services and events. Research gaps exist regarding advancing strategic use of social media based on audience segmentation, evaluating the impact of social media in health interventions, understanding the impact of health identity development, and addressing privacy concerns.