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Reed ND, Bull S, Shrestha U, Sarche M, Kaufman CE. Combating Fraudulent Participation in Urban American Indian and Alaska Native Virtual Health Research: Protocol for Increasing Data Integrity in Online Research (PRIOR). JMIR Res Protoc 2024; 13:e52281. [PMID: 38869930 DOI: 10.2196/52281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/15/2024] [Accepted: 04/18/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND While the advantages of using the internet and social media for research recruitment are well documented, the evolving online environment also enhances motivations for misrepresentation to receive incentives or to "troll" research studies. Such fraudulent assaults can compromise data integrity, with substantial losses in project time; money; and especially for vulnerable populations, research trust. With the rapid advent of new technology and ever-evolving social media platforms, it has become easier for misrepresentation to occur within online data collection. This perpetuation can occur by bots or individuals with malintent, but careful planning can help aid in filtering out fraudulent data. OBJECTIVE Using an example with urban American Indian and Alaska Native young women, this paper aims to describe PRIOR (Protocol for Increasing Data Integrity in Online Research), which is a 2-step integration protocol for combating fraudulent participation in online survey research. METHODS From February 2019 to August 2020, we recruited participants for formative research preparatory to an online randomized control trial of a preconceptual health program. First, we described our initial protocol for preventing fraudulent participation, which proved to be unsuccessful. Then, we described modifications we made in May 2020 to improve the protocol performance and the creation of PRIOR. Changes included transferring data collection platforms, collecting embedded geospatial variables, enabling timing features within the screening survey, creating URL links for each method or platform of data collection, and manually confirming potentially eligible participants' identifying information. RESULTS Before the implementation of PRIOR, the project experienced substantial fraudulent attempts at study enrollment, with less than 1% (n=6) of 1300 screened participants being identified as truly eligible. With the modified protocol, of the 461 individuals who completed a screening survey, 381 did not meet the eligibility criteria assessed on the survey. Of the 80 that did, 25 (31%) were identified as ineligible via PRIOR. A total of 55 (69%) were identified as eligible and verified in the protocol and were enrolled in the formative study. CONCLUSIONS Fraudulent surveys compromise study integrity, validity of the data, and trust among participant populations. They also deplete scarce research resources including respondent compensation and personnel time. Our approach of PRIOR to prevent online misrepresentation in data was successful. This paper reviews key elements regarding fraudulent data participation in online research and demonstrates why enhanced protocols to prevent fraudulent data collection are crucial for building trust with vulnerable populations. TRIAL REGISTRATION ClinicalTrials.gov NCT04376346; https://www.clinicaltrials.gov/study/NCT04376346. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52281.
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Affiliation(s)
- Nicole D Reed
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Sheana Bull
- Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Umit Shrestha
- Colorado School of Public Health, Colorado State University, Fort Collins, CO, United States
| | - Michelle Sarche
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Carol E Kaufman
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Wagner AD, Njuguna IN, Neary J, Lawley KA, Louden DKN, Tiwari R, Jiang W, Kalu N, Burke RM, Mangale D, Obermeyer C, Escudero JN, Bulterys MA, Waters C, Mollo B, Han H, Barr-DiChiara M, Baggaley R, Jamil MS, Shah P, Wong VJ, Drake AL, Johnson CC. Demand creation for HIV testing services: A systematic review and meta-analysis. PLoS Med 2023; 20:e1004169. [PMID: 36943831 PMCID: PMC10030044 DOI: 10.1371/journal.pmed.1004169] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/05/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND HIV testing services (HTS) are the first steps in reaching the UNAIDS 95-95-95 goals to achieve and maintain low HIV incidence. Evaluating the effectiveness of different demand creation interventions to increase uptake of efficient and effective HTS is useful to prioritize limited programmatic resources. This review was undertaken to inform World Health Organization (WHO) 2019 HIV testing guidelines and assessed the research question, "Which demand creation strategies are effective for enhancing uptake of HTS?" focused on populations globally. METHODS AND FINDINGS The following electronic databases were searched through September 28, 2021: PubMed, PsycInfo, Cochrane CENTRAL, CINAHL Complete, Web of Science Core Collection, EMBASE, and Global Health Database; we searched IAS and AIDS conferences. We systematically searched for randomized controlled trials (RCTs) that compared any demand creation intervention (incentives, mobilization, counseling, tailoring, and digital interventions) to either a control or other demand creation intervention and reported HTS uptake. We pooled trials to evaluate categories of demand creation interventions using random-effects models for meta-analysis and assessed study quality with Cochrane's risk of bias 1 tool. This study was funded by the WHO and registered in Prospero with ID CRD42022296947. We screened 10,583 records and 507 conference abstracts, reviewed 952 full texts, and included 124 RCTs for data extraction. The majority of studies were from the African (N = 53) and Americas (N = 54) regions. We found that mobilization (relative risk [RR]: 2.01, 95% confidence interval [CI]: [1.30, 3.09], p < 0.05; risk difference [RD]: 0.29, 95% CI [0.16, 0.43], p < 0.05, N = 4 RCTs), couple-oriented counseling (RR: 1.98, 95% CI [1.02, 3.86], p < 0.05; RD: 0.12, 95% CI [0.03, 0.21], p < 0.05, N = 4 RCTs), peer-led interventions (RR: 1.57, 95% CI [1.15, 2.15], p < 0.05; RD: 0.18, 95% CI [0.06, 0.31], p < 0.05, N = 10 RCTs), motivation-oriented counseling (RR: 1.53, 95% CI [1.07, 2.20], p < 0.05; RD: 0.17, 95% CI [0.00, 0.34], p < 0.05, N = 4 RCTs), short message service (SMS) (RR: 1.53, 95% CI [1.09, 2.16], p < 0.05; RD: 0.11, 95% CI [0.03, 0.19], p < 0.05, N = 5 RCTs), and conditional fixed value incentives (RR: 1.52, 95% CI [1.21, 1.91], p < 0.05; RD: 0.15, 95% CI [0.07, 0.22], p < 0.05, N = 11 RCTs) all significantly and importantly (≥50% relative increase) increased HTS uptake and had medium risk of bias. Lottery-based incentives and audio-based interventions less importantly (25% to 49% increase) but not significantly increased HTS uptake (medium risk of bias). Personal invitation letters and personalized message content significantly but not importantly (<25% increase) increased HTS uptake (medium risk of bias). Reduced duration counseling had comparable performance to standard duration counseling (low risk of bias) and video-based interventions were comparable or better than in-person counseling (medium risk of bias). Heterogeneity of effect among pooled studies was high. This study was limited in that we restricted to randomized trials, which may be systematically less readily available for key populations; additionally, we compare only pooled estimates for interventions with multiple studies rather than single study estimates, and there was evidence of publication bias for several interventions. CONCLUSIONS Mobilization, couple- and motivation-oriented counseling, peer-led interventions, conditional fixed value incentives, and SMS are high-impact demand creation interventions and should be prioritized for programmatic consideration. Reduced duration counseling and video-based interventions are an efficient and effective alternative to address staffing shortages. Investment in demand creation activities should prioritize those with undiagnosed HIV or ongoing HIV exposure. Selection of demand creation interventions must consider risks and benefits, context-specific factors, feasibility and sustainability, country ownership, and universal health coverage across disease areas.
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Affiliation(s)
- Anjuli D. Wagner
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Irene N. Njuguna
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Jillian Neary
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Kendall A. Lawley
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Diana K. N. Louden
- University Libraries, University of Washington, Seattle, Washington, United States of America
| | - Ruchi Tiwari
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Wenwen Jiang
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Ngozi Kalu
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rachael M. Burke
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Malawi Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Dorothy Mangale
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Chris Obermeyer
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Jaclyn N. Escudero
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Michelle A. Bulterys
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Chloe Waters
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Bastien Mollo
- Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Hannah Han
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | | | - Rachel Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S. Jamil
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Purvi Shah
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
- UNAIDS, Asia Pacific, Regional Support Team, Bangkok, Thailand
| | - Vincent J. Wong
- USAID, Division of HIV Prevention, Care and Treatment, Office of HIV/AIDS, Washington DC, United States of America
| | - Alison L. Drake
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Cheryl C. Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
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Bailey JV, Wayal S, Aicken CR, Webster R, Mercer CH, Nazareth I, Rait G, Peacock R, Murray E. Interactive digital interventions for prevention of sexually transmitted HIV. AIDS 2021; 35:643-653. [PMID: 33259345 PMCID: PMC7924981 DOI: 10.1097/qad.0000000000002780] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Digital technology offers good opportunities for HIV prevention. This systematic review assesses the effectiveness of interactive digital interventions (IDIs) for prevention of sexually transmitted HIV. METHODS We conducted a systematic search for randomized controlled trials (RCTs) of IDIs for HIV prevention, defining 'interactive' as producing personally tailored material. We searched databases including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, grey literature, reference lists, and contacted authors if needed.Two authors screened abstracts, applied eligibility and quality criteria and extracted data. Meta-analyses used random-effects models with standardized mean differences (SMD) for continuous outcomes and odds ratios (OR) for binary outcomes, assessing heterogeneity using the I2 statistic. RESULTS We included 31 RCTs of IDIs for HIV prevention. Meta-analyses of 29 RCTs comparing IDIs with minimal interventions (e.g. leaflet, waiting list) showed a moderate increase in knowledge (SMD 0.56, 95% CI 0.33 to 0.80), no effect on self-efficacy (SMD 0.13, 95% CI 0.00 to 0.27), a small improvement in intention (SMD 0.16, 95% CI 0.06 to 0.26), improvement in HIV prevention behaviours (OR 1.28, 95% CI 1.04 to 1.57) and a possible increase in viral load, but this finding is unreliable.We found no evidence of difference between IDIs and face-to-face interventions for knowledge, self-efficacy, intention, or HIV-related behaviours in meta-analyses of five small RCTs. We found no health economic studies. CONCLUSION There is good evidence that IDIs have positive effects on knowledge, intention and HIV prevention behaviours. IDIs are appropriate for HIV prevention in a variety of settings.Supplementary Video Abstract, http://links.lww.com/QAD/B934.
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Affiliation(s)
- Julia V. Bailey
- e-Health Unit, Research Department of Primary Care and Population Health, University College London
| | - Sonali Wayal
- e-Health Unit, Research Department of Primary Care and Population Health, University College London
- Development Media International
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London
| | - Catherine R.H. Aicken
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London
- School of Health Sciences, University of Brighton, Falmer, Brighton
| | - Rosie Webster
- e-Health Unit, Research Department of Primary Care and Population Health, University College London
| | - Catherine H. Mercer
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London
| | - Irwin Nazareth
- Research Department of Primary Care and Population Health, University College London
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London
| | - Richard Peacock
- Whittington Health Library, The Whittington Hospital, London, UK
| | - Elizabeth Murray
- e-Health Unit, Research Department of Primary Care and Population Health, University College London
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4
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Brøgger-Mikkelsen M, Ali Z, Zibert JR, Andersen AD, Thomsen SF. Online Patient Recruitment in Clinical Trials: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22:e22179. [PMID: 33146627 PMCID: PMC7673977 DOI: 10.2196/22179] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/19/2020] [Accepted: 09/15/2020] [Indexed: 12/21/2022] Open
Abstract
Background Recruitment for clinical trials continues to be a challenge, as patient recruitment is the single biggest cause of trial delays. Around 80% of trials fail to meet the initial enrollment target and timeline, and these delays can result in lost revenue of as much as US $8 million per day for drug developing companies. Objective This study aimed to conduct a systematic review and meta-analysis examining the effectiveness of online recruitment of participants for clinical trials compared with traditional in-clinic/offline recruitment methods. Methods Data on recruitment rates (the average number of patients enrolled in the study per month and per day of active recruitment) and conversion rates (the percentage of participants screened who proceed to enroll into the clinical trial), as well as study characteristics and patient demographics were collected from the included studies. Differences in online and offline recruitment rates and conversion rates were examined using random effects models. Further, a nonparametric paired Wilcoxon test was used for additional analysis on the cost-effectiveness of online patient recruitment. All data analyses were conducted in R language, and P<.05 was considered significant. Results In total, 3861 articles were screened for inclusion. Of these, 61 studies were included in the review, and 23 of these were further included in the meta-analysis. We found online recruitment to be significantly more effective with respect to the recruitment rate for active days of recruitment, where 100% (7/7) of the studies included had a better online recruitment rate compared with offline recruitment (incidence rate ratio [IRR] 4.17, P=.04). When examining the entire recruitment period in months we found that 52% (12/23) of the studies had a better online recruitment rate compared with the offline recruitment rate (IRR 1.11, P=.71). For cost-effectiveness, we found that online recruitment had a significantly lower cost per enrollee compared with offline recruitment (US $72 vs US $199, P=.04). Finally, we found that 69% (9/13) of studies had significantly better offline conversion rates compared with online conversion rates (risk ratio 0.8, P=.02). Conclusions Targeting potential participants using online remedies is an effective approach for patient recruitment for clinical research. Online recruitment was both superior in regard to time efficiency and cost-effectiveness compared with offline recruitment. In contrast, offline recruitment outperformed online recruitment with respect to conversion rate.
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Affiliation(s)
- Mette Brøgger-Mikkelsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.,Studies&Me A/S, LEO Innovation Lab, Copenhagen, Denmark
| | - Zarqa Ali
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - John R Zibert
- Studies&Me A/S, LEO Innovation Lab, Copenhagen, Denmark
| | | | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Nijdam-Jones A, McNiel DE. Prospective study of mental health court and life satisfaction. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2020; 73:101643. [PMID: 33099161 DOI: 10.1016/j.ijlp.2020.101643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 06/11/2023]
Abstract
Many communities have created specialized mental health courts (MHCs) to reduce unnecessary criminal justice involvement of persons with mental disorders. Although MHCs have shown favorable public safety outcomes, such as reducing risk for criminal recidivism and violent behavior, there has been little study of issues important to consumers, such as life satisfaction. This study prospectively evaluated the association between MHC participation and life satisfaction using data from 140 participants in a quasi-experimental research project on the San Francisco MHC. A fixed-effects regression model was used to examine whether MHC involvement predicted life satisfaction at 6-month follow-up while controlling for baseline life satisfaction, age, gender, and schizophrenia diagnosis. MHC involvement, baseline life satisfaction, and schizophrenia diagnosis significantly predicted life satisfaction at 6-months. Although the public safety benefits of MHCs are important, the present study also shows the potential for MHC to enhance important outcomes such as life satisfaction.
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Affiliation(s)
- Alicia Nijdam-Jones
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.
| | - Dale E McNiel
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
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Grov C, Westmoreland D, Rendina HJ, Nash D. Seeing Is Believing? Unique Capabilities of Internet-Only Studies as a Tool for Implementation Research on HIV Prevention for Men Who Have Sex With Men: A Review of Studies and Methodological Considerations. J Acquir Immune Defic Syndr 2019; 82 Suppl 3:S253-S260. [PMID: 31764261 PMCID: PMC6880799 DOI: 10.1097/qai.0000000000002217] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 2014, Grov et al published a comprehensive review cataloguing both men who have sex with men's (MSM's) sexual behavior transitions in online environments from the 1990s through 2013, as well as researchers' efforts in tandem to use the internet to engage MSM into research, treatment, and prevention. METHODS In this article, we discuss historical events and research having occurred in the half decade since the Grov et al publication. RESULTS Notable transitions include MSM's expanded use of geosocial networking apps, as well as other forms of social media accessed primarily through mobile devices, as well as the addition of biomedical prevention strategies (eg, pre-exposure prophylaxis and undetectable = untransmittable) to the proverbial HIV prevention toolkit. In tandem, researchers have rapidly expanded their employment of internet-mediated methods for the recruitment and engagement of key populations for HIV research, treatment, and prevention. In this article, we discuss methodological considerations for using the internet to conduct HIV prevention research with MSM: (1) sources of recruitment (eg, geosocial apps, Facebook, crowdsourced online panels); (2) design (eg, cross sectional, longitudinal, diaries); (3) incentives (including disincentivizing fraudulent participants and/or spam bots); (4) confidentiality; and (5) representativeness. CONCLUSION We conclude by discussing future directions in HIV prevention research in light of forthcoming technologies such as fifth generation (5G) mobile networks, combined use of self-collected biological data alongside self-report, and the utility of metadata and metaresearch to document, evaluate, and inform best practices.
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Affiliation(s)
- Christian Grov
- CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
| | - Drew Westmoreland
- CUNY Institute for Implementation Science in Population Health, New York, NY
| | | | - Denis Nash
- CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
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Miller-Perusse M, Horvath KJ, Chavanduka T, Stephenson R. Recruitment and Enrollment of a National Sample of Transgender Youth via Social Media: Experiences from Project Moxie. Transgend Health 2019; 4:157-161. [PMID: 31346546 PMCID: PMC6657294 DOI: 10.1089/trgh.2018.0062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This report compares social media strategies for enrolling transgender youth (TY) into online HIV prevention research. Over 12 months, 202 TY enrolled in Project Moxie, a randomized trial of an at-home HIV testing intervention. Free Craigslist advertisements showed promising success in enrolling TY, especially those of color. Paid Facebook advertising was successful in reaching a large sample of TY, as was participant referral. This supports previous literature suggesting peer referral as an effective strategy for reaching TY. High levels of attempted fraud were detected and mitigated. Findings demonstrate that recruitment and enrollment of a diverse TY sample is possible online.
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Affiliation(s)
- Michael Miller-Perusse
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Keith J Horvath
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Tanaka Chavanduka
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, Michigan.,Department of Systems, Population and Leadership, School of Nursing, University of Michigan, Ann Arbor, Michigan
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Abstract
HealthMpowerment.org (HMP), is a mobile optimized, online intervention to reduce sexual risk behaviors among HIV-positive and HIV-negative young Black men who have sex with men (BMSM) by providing information and resources, fostering social support, and including game-based elements. A randomized controlled trial with 474 young BMSM compared HMP to an information-only control website. The rate of self-reported condomless anal intercourse (CAI) at 3-months was 32% lower in the intervention group compared to the control group (IRR 0.68, 95% CI 0.43, 0.93), however this effect was not sustained at 12 months. Among HIV-positive participants, the rate of CAI at 3-month follow-up was 82% lower among participants with detectable viral loads in the intervention group compared to the control group (IRR 0.18, 95% CI 0.04, 0.32). In a secondary analysis, when we limited to those who used HMP for over 60 min during the 3-month intervention period (n = 50, 25.8%), we estimated 4.85 (95% CI 2.15, 7.53) fewer CAI events than we would have expected in control participants, had they used the intervention at the same rate as the intervention group. Findings suggest that exposure to an online intervention can reduce the rate of CAI among young BMSM, at least in the short term. Given the stronger effect seen among those participants who complied with HMP, additional intervention engagement strategies are warranted.
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Feasibility and Acceptability of an Online Positive Affect Intervention for Those Living with Comorbid HIV Depression. AIDS Behav 2019; 23:753-764. [PMID: 30701389 DOI: 10.1007/s10461-019-02412-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Positive affect has unique beneficial effects on psychological and physical health, independent of the effects of negative affect. Interventions that explicitly target positive affect show promise for improving health outcomes in a number of chronic illnesses. In this article, we present pilot data on the acceptability and feasibility of an online intervention to increase positive affect in those living with comorbid human immunodeficiency virus (HIV) and depression. The intervention was rated both acceptable and feasible by participants. Six of nine participants completed the intervention and the subsequent follow-up assessment and a post-intervention phone call. We also present outcomes of planned comparisons of intervention effects on emotion, which indicate that positive affect increased significantly in the intervention group. Based upon results of the current study, future research should continue the development of positive affect interventions for people living with comorbid HIV and depression.
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Garnett C, Perski O, Tombor I, West R, Michie S, Brown J. Predictors of Engagement, Response to Follow Up, and Extent of Alcohol Reduction in Users of a Smartphone App (Drink Less): Secondary Analysis of a Factorial Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e11175. [PMID: 30552081 PMCID: PMC6315249 DOI: 10.2196/11175] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/28/2018] [Accepted: 08/28/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Digital interventions for alcohol can help achieve reductions in hazardous and harmful alcohol consumption. The Drink Less app was developed using evidence and theory, and a factorial randomized controlled trial (RCT) suggested that 4 of its intervention modules may assist with drinking reduction. However, low engagement is an important barrier to effectiveness, and low response to follow up is a challenge for intervention evaluation. Research is needed to understand what factors influence users' level of engagement, response to follow up, and extent of alcohol reduction. OBJECTIVE This study aimed to investigate associations between user characteristics, engagement, response to follow up, and extent of alcohol reduction in an app-based intervention, Drink Less. METHODS This study involved a secondary data analysis of a factorial RCT of the Drink Less app. Participants (N=672) were aged 18 years or older, lived in the United Kingdom, and had an Alcohol Use Disorders Identification Test score >7 (indicative of excessive drinking). Sociodemographic and drinking characteristics were assessed at baseline. Engagement was assessed in the first month of use (number of sessions, time on app, number of days used, and percentage of available screens viewed). Response to follow up and extent of alcohol reduction (change in past week consumption) were measured after 1 month. Associations were assessed using unadjusted and adjusted linear or logistic regression models. RESULTS Age (all unstandardized regression coefficients [B] >.02, all P<.001) and post-16 educational qualifications (all B>.18, all P<.03) were positively associated with all engagement outcomes. Age (odds ratio [OR] 1.04, P<.001), educational qualifications (OR 2.11, P<.001), and female gender (OR 1.58, P=.02) were positively associated with response to follow up. Engagement outcomes predicted response to follow up (all OR>1.02, all P<.001) but not the extent of alcohol reduction (all -.14.07). Baseline drinking characteristics were the only variables associated with the extent of alcohol reduction among those followed up (all B>.49, all P<.001). CONCLUSIONS Users of the alcohol reduction app, Drink Less, who were older and had post-16 educational qualifications engaged more and were more likely to respond at 1-month follow up. Higher baseline alcohol consumption predicted a greater extent of alcohol reduction among those followed up but did not predict engagement or response to follow up. Engagement was associated with response to follow up but was not associated with the extent of alcohol reduction, which suggests that the Drink Less app does not have a dose-response effect. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number ISRCTN40104069; http://www.isrctn.com/ISRCTN40104069 (Archived by WebCite at http://www.webcitation.org/746HqygIV).
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Affiliation(s)
- Claire Garnett
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Olga Perski
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- Department of Clinical, Education and Health Psychology, University College London, London, United Kingdom
| | - Ildiko Tombor
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Susan Michie
- Department of Clinical, Education and Health Psychology, University College London, London, United Kingdom
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, United Kingdom
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Madkins K, Greene GJ, Hall E, Jimenez R, Parsons JT, Sullivan PS, Mustanski B. Attrition and HIV Risk Behaviors: A Comparison of Young Men Who Have Sex with Men Recruited from Online and Offline Venues for an Online HIV Prevention Program. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2135-2148. [PMID: 30069614 PMCID: PMC6197065 DOI: 10.1007/s10508-018-1253-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 05/29/2018] [Accepted: 06/02/2018] [Indexed: 06/08/2023]
Abstract
In addition to offline venue-based and time-space sampling, recruitment of young men who have sex with men (YMSM) into HIV surveillance and prevention studies has expanded over time to include Internet-based approaches. Despite broadening recruitment strategies, enrolling racially and ethnically diverse YMSM who are disproportionately impacted by HIV continues to be challenging. Additionally, there is little literature on the impact of recruitment venue on participant characteristics and likelihood to enroll YMSM into online randomized control trials (RCT). This study used data from the multisite RCT, Keep It Up! 2.0, to examine the impact of recruitment venue on participant demographics, behavioral HIV risks, and enrollment. A total of 2984 participants were screened for eligibility from community-based organizations, Facebook, dating apps, and outreach events. There were significant differences by venue in age (χ2[3] = 54.38, p < .001), race/ethnicity (χ2[9] = 110.78, p < .001), sexual orientation (χ2[3] = 7.85, p < .05), relationship status (χ2[6] = 27.71, p < .001), and region of recruitment (χ2[6] = 1480.51, p < .001). There were no significant differences by venue in attrition during the enrollment process. The only difference in attrition was by race/ethnicity. Compared to White participants, eligible Black (OR: 0.35, p < .01) and Latino (OR: 0.46, p < .05) participants were significantly less likely to enroll in the intervention. There were also no significant differences by recruitment venue in sexual risk behaviors among enrolled participants. These findings suggest that recruitment into online HIV interventions from a variety of venues is feasible for diverse YMSM who are at similar risk for HIV infection.
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Affiliation(s)
- Krystal Madkins
- Department of Medical Social Sciences, Feinberg School of Medicine and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA
| | - George J Greene
- Department of Medical Social Sciences, Feinberg School of Medicine and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA
| | - Eric Hall
- Programs, Research and Innovation in Sexual Minority Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Ruben Jimenez
- Center for HIV Educational Studies and Training, Hunter College and the Graduate Center of the City University of New York, New York, NY, USA
| | - Jeffrey T Parsons
- Center for HIV Educational Studies and Training, Hunter College and the Graduate Center of the City University of New York, New York, NY, USA
| | - Patrick S Sullivan
- Programs, Research and Innovation in Sexual Minority Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA.
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12
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HIV Risk Behaviors and Utilization of Prevention Services, Urban and Rural Men Who Have Sex with Men in the United States: Results from a National Online Survey. AIDS Behav 2018; 22:2127-2136. [PMID: 28986669 DOI: 10.1007/s10461-017-1912-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Rural men who have sex with men (MSM) are heavily affected by HIV, and many lack culturally competent HIV prevention resources. Rural MSM may find sexual partners on the internet, which may also be a way to deliver prevention services to them. To understand the differences between rural and urban MSM with respect to HIV risk factors and behaviors and the utilization of online HIV prevention services, we used data from the 2012 Web-Based HIV Behavioral Survey (WHBS). Using WHBS data collected between June and August 2012, we compared the characteristics of MSM with positive or unknown HIV infection status who had sex with a male in the past 12 months, from rural vs urban areas using Chi square tests and median tests. We used logistic regression and calculated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) to compare self-reported HIV risk behaviors, HIV/STI testing behaviors, use of prevention services, and perceived discrimination. Of the 8166 MSM included in our analysis, 3583 (44%) were from rural areas, and 4583 (56%) were from urban areas. Compared to urban MSM, rural MSM were less likely to ever test for HIV (aPR = 0.94, CI 0.92-0.95), to be tested for HIV in the last year (aPR = 0.83, CI 0.79-0.87), or to receive free condoms (aPR = 0.83, CI 0.79-0.86) or individual prevention counseling in the past year (aPR = 0.86, CI 0.78-0.95). Rural MSM were less likely to have been tested in the last year for syphilis, gonorrhea, or chlamydia (aPR = 0.70, CI 0.62-0.78; aPR = 0.72, CI 0.64-0.81; aPR = 0.75, CI 0.67-0.85, respectively). Rural MSM also reported perceiving less tolerance of gays and bisexuals within their community (aPR = 0.80, CI 0.77-0.84). HIV prevalence is lower among MSM in rural areas compared to MSM in urban areas, but rural MSM report that they are more likely to face intolerance and are less likely to use basic HIV prevention services compared to urban MSM. Therefore, this hard-to-reach population could benefit from prevention services offered through the internet.
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13
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Flowers P, Wu O, Lorimer K, Ahmed B, Hesselgreaves H, MacDonald J, Cayless S, Hutchinson S, Elliott L, Sullivan A, Clutterbuck D, Rayment M, McDaid L. The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development. Health Technol Assess 2018; 21:1-164. [PMID: 28145220 DOI: 10.3310/hta21050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) experience significant inequalities in health and well-being. They are the group in the UK at the highest risk of acquiring a human immunodeficiency virus (HIV) infection. Guidance relating to both HIV infection prevention, in general, and individual-level behaviour change interventions, in particular, is very limited. OBJECTIVES To conduct an evidence synthesis of the clinical effectiveness of behaviour change interventions to reduce risky sexual behaviour among MSM after a negative HIV infection test. To identify effective components within interventions in reducing HIV risk-related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention. DATA SOURCES All major electronic databases (British Education Index, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Educational Resource Index and Abstracts, Health and Medical Complete, MEDLINE, PsycARTICLES, PsycINFO, PubMed and Social Science Citation Index) were searched between January 2000 and December 2014. REVIEW METHODS A systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique (BCT) taxonomy, theory coding assessment, mode of delivery and proximity to HIV infection testing. Data were summarised in narrative review and, when appropriate, meta-analysis was carried out. Supplemental analyses for the development of the candidate intervention focused on post hoc realist review method, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of implementation and optimisation. RESULTS Overall, trials included in this review (n = 10) demonstrated that individual-level behaviour change interventions are effective in reducing key HIV infection risk-related behaviours. However, there was considerable clinical and methodological heterogeneity among the trials. Exploratory meta-analysis showed a statistically significant reduction in behaviours associated with high risk of HIV transmission (risk ratio 0.75, 95% confidence interval 0.62 to 0.91). Additional stratified analyses suggested that effectiveness may be enhanced through face-to-face contact immediately after testing, and that theory-based content and BCTs drawn from 'goals and planning' and 'identity' groups are important. All evidence collated in the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways that the candidate intervention could be optimised to enhance UK implementation. LIMITATIONS There was a limited number of primary studies. All were from outside the UK and were subject to considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must therefore be treated with caution. The lack of detailed intervention manuals limited the assessment of intervention content, delivery and fidelity. CONCLUSIONS Evidence regarding the effectiveness of behaviour change interventions suggests that they are effective in changing behaviour associated with HIV transmission. Exploratory stratified meta-analyses suggested that interventions should be delivered face to face and immediately after testing. There are uncertainties around the generalisability of these findings to the UK setting. However, UK experts found the intervention acceptable and provided ways of optimising the candidate intervention. FUTURE WORK There is a need for well-designed, UK-based trials of individual behaviour change interventions that clearly articulate intervention content and demonstrate intervention fidelity. STUDY REGISTRATION The study is registered as PROSPERO CRD42014009500. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Paul Flowers
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment and National Institute for Health Research Complex Reviews Support Unit, University of Glasgow, Glasgow, UK
| | - Karen Lorimer
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Bipasha Ahmed
- GCU London, Glasgow Caledonian University, London, UK
| | - Hannah Hesselgreaves
- Health Economics and Health Technology Assessment and National Institute for Health Research Complex Reviews Support Unit, University of Glasgow, Glasgow, UK
| | - Jennifer MacDonald
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Sandi Cayless
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Sharon Hutchinson
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lawrie Elliott
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Lisa McDaid
- Chief Scientist Office/Medical Research Council Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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14
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Knight R, Karamouzian M, Salway T, Gilbert M, Shoveller J. Online interventions to address HIV and other sexually transmitted and blood-borne infections among young gay, bisexual and other men who have sex with men: a systematic review. J Int AIDS Soc 2018; 20. [PMID: 29091340 PMCID: PMC5810340 DOI: 10.1002/jia2.25017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 10/02/2017] [Indexed: 12/14/2022] Open
Abstract
Introduction Globally, young gay, bisexual and other men who have sex with men (gbMSM) continue to experience disproportionately high rates of HIV and other sexually transmitted and blood‐borne infections (STBBIs). As such, there are strong public health imperatives to evaluate innovative prevention, treatment and care interventions, including online interventions. This study reviewed and assessed the status of published research (e.g. effectiveness; acceptability; differential effects across subgroups) involving online interventions that address HIV/STBBIs among young gbMSM. Methods We searched Medline, Embase, PsycINFO, CINAHL, and Google Scholar to identify relevant English‐language publications from inception to November 2016. Studies that assessed an online intervention regarding the prevention, care, or treatment of HIV/STBBIs were included. Studies with <50% gbMSM or with a mean age ≥30 years were excluded. Results Of the 3465 articles screened, 17 studies met inclusion criteria. Sixteen studies assessed interventions at the “proof‐of‐concept” phase, while one study assessed an intervention in the dissemination phase. All of the studies focused on behavioural or knowledge outcomes at the individual level (e.g. condom use, testing behaviour), and all but one reported a statistically significant effect on ≥1 primary outcomes. Twelve studies described theory‐based interventions. Twelve were conducted in the United States, with study samples focusing mainly on White, African‐American and/or Latino populations; the remaining were conducted in Hong Kong, Peru, China, and Thailand. Thirteen studies included gay and bisexual men; four studies did not assess sexual identity. Two studies reported including both HIV+ and HIV− participants, and all but one study included one or more measure of socio‐economic status. Few studies reported on the differential intervention effects by socio‐economic status, sexual identity, race or serostatus. Conclusion While online interventions show promise at addressing HIV/STBBI among young gbMSM, to date, little emphasis has been placed on assessing: (i) potential differential effects of interventions across subgroups of young gbMSM; (ii) effectiveness studies of interventions in the dissemination phase; and (iii) on some “key” populations of young gbMSM (e.g. those who are: transgender, from low‐income settings and/or HIV positive). Future research that unpacks the potentially distinctive experiences of particular subgroups with “real world” interventions is needed.
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Affiliation(s)
- Rod Knight
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Mohammad Karamouzian
- British Columbia Centre on Substance Use, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada.,HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Travis Salway
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | - Mark Gilbert
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | - Jean Shoveller
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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15
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Characteristics of Stress and Suicidal Ideation in the Disclosure of Sexual Orientation among Young French LGB Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020290. [PMID: 29414915 PMCID: PMC5858359 DOI: 10.3390/ijerph15020290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/02/2018] [Accepted: 02/04/2018] [Indexed: 11/24/2022]
Abstract
Background: Lesbians, gays, and bisexual people (LGB) present high levels of suicidal ideation. The disclosure of sexual orientation is a stressful experience which presents a high suicide risk. Research has not paid sufficient attention to stress during this disclosure in order to understand suicide among LGB people. The aims of this study were to investigate: (1) the characteristics of stress during this revelation, more precisely cognitive appraisal, emotions, and coping; and (2) associations between these characteristics and suicidal ideation. Method: A total of 200 LGB young adults answered the “Stressful situation assessment questionnaire”, focusing on the most stressful disclosure of sexual orientation they have ever experienced. Results: Avoidance coping is a good predictor of suicidal ideation, and mediates the association between primary appraisal (risk “Harm myself and others”) and suicidal ideation. Conclusions: Our study illustrates the need to better understand stress during the disclosure of sexual orientation to prevent and care for suicide risk among LGB young adults.
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16
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Buckingham L, Becher J, Voytek CD, Fiore D, Dunbar D, Davis-Vogel A, Metzger DS, Frank I. Going social: Success in online recruitment of men who have sex with men for prevention HIV vaccine research. Vaccine 2017; 35:3498-3505. [PMID: 28526330 DOI: 10.1016/j.vaccine.2017.05.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 04/29/2017] [Accepted: 05/02/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the use of four different social media sites to recruit men who have sex with men (MSM) and transgender women to a phase 2b HIV prevention vaccine trial, HVTN 505. DESIGN Retrospective, observational study. METHODS The University of Pennsylvania HIV Vaccine Trials Unit (Penn HVTU) employed street outreach and online recruitment methods to recruit participants for HVTN 505 using a combination of national recruitment images/messages with Philadelphia-specific language and imagery. We compared the efficiency (number of enrolled participants per number of completed phone screens) and effectiveness (number of enrolled participants per time interval employed) of each strategy, as well as the demographics and risk behaviors of the populations. RESULTS Online recruitment strategies populated 37% (71/191) of trial participants at our site. Among the four social media strategies employed, 45.1% (32/71) were enrolled through Facebook, 16.9% (12/71) through Craigslist, 15.5% (11/71) through a web-based marketing company (WBMC), and 22.5% (16/71) via GRINDR. The number of participants enrolled per month of strategy and the months the strategy was employed were Facebook - 32(33months), Craigslist - 12(33months), WBMC - 11(6months), and GRINDR - 16(0.56months). In-person and online recruitment strategies yielded participants of similar demographics and levels of risk behavior. CONCLUSION Use of several social media recruitment modalities produced large numbers of MSM engaging in high risk behavior and willing to participate in an HIV prevention vaccine trial. In comparison to other social media and online strategies, recruitment via GRINDR was the most effective.
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Affiliation(s)
- Lindsey Buckingham
- HIV Prevention Research Division, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Julie Becher
- HIV Prevention Research Division, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chelsea D Voytek
- HIV Prevention Research Division, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Danielle Fiore
- HIV Prevention Research Division, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Debora Dunbar
- HIV Prevention Research Division, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Annet Davis-Vogel
- HIV Prevention Research Division, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David S Metzger
- HIV Prevention Research Division, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ian Frank
- HIV Prevention Research Division, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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17
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Miranda J, Côté J. The Use of Intervention Mapping to Develop a Tailored Web-Based Intervention, Condom-HIM. JMIR Public Health Surveill 2017; 3:e20. [PMID: 28428162 PMCID: PMC5415661 DOI: 10.2196/publichealth.7052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/07/2017] [Accepted: 02/18/2017] [Indexed: 01/29/2023] Open
Abstract
Background Many HIV (human immunodeficiency virus) prevention interventions are currently being implemented and evaluated, with little information published on their development. A framework highlighting the method of development of an intervention can be used by others wanting to replicate interventions or develop similar interventions to suit other contexts and settings. It provides researchers with a comprehensive development process of the intervention. Objective The objective of this paper was to describe how a systematic approach, intervention mapping, was used to develop a tailored Web-based intervention to increase condom use among HIV-positive men who have sex with men. Methods The intervention was developed in consultation with a multidisciplinary team composed of academic researchers, community members, Web designers, and the target population. Intervention mapping involved a systematic process of 6 steps: (1) needs assessment; (2) identification of proximal intervention objectives; (3) selection of theory-based intervention methods and practical strategies; (4) development of intervention components and materials; (5) adoption, implementation, and maintenance; and (6) evaluation planning. Results The application of intervention mapping resulted in the development of a tailored Web-based intervention for HIV-positive men who have sex with men, called Condom-HIM. Conclusions Using intervention mapping as a systematic process to develop interventions is a feasible approach that specifically integrates the use of theory and empirical findings. Outlining the process used to develop a particular intervention provides clarification on the conceptual use of experimental interventions in addition to potentially identifying reasons for intervention failures.
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Affiliation(s)
- Joyal Miranda
- Faculty of Community ServicesDaphne Cockwell School of NursingRyerson UniversityToronto, ONCanada
| | - José Côté
- Faculté des sciences infirmièresUniversité de MontréalMontreal, ONCanada
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18
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Tarzia L, Valpied J, Koziol-McLain J, Glass N, Hegarty K. Methodological and Ethical Challenges in a Web-Based Randomized Controlled Trial of a Domestic Violence Intervention. J Med Internet Res 2017; 19:e94. [PMID: 28351830 PMCID: PMC5388827 DOI: 10.2196/jmir.7039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/08/2017] [Accepted: 02/16/2017] [Indexed: 11/13/2022] Open
Abstract
The use of Web-based methods to deliver and evaluate interventions is growing in popularity, particularly in a health care context. They have shown particular promise in responding to sensitive or stigmatized issues such as mental health and sexually transmitted infections. In the field of domestic violence (DV), however, the idea of delivering and evaluating interventions via the Web is still relatively new. Little is known about how to successfully navigate several challenges encountered by the researchers while working in this area. This paper uses the case study of I-DECIDE, a Web-based healthy relationship tool and safety decision aid for women experiencing DV, developed in Australia. The I-DECIDE website has recently been evaluated through a randomized controlled trial, and we outline some of the methodological and ethical challenges encountered during recruitment, retention, and evaluation. We suggest that with careful consideration of these issues, randomized controlled trials can be safely conducted via the Web in this sensitive area.
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Affiliation(s)
- Laura Tarzia
- Department of General Practice, The University of Melbourne, Carlton, Australia
| | - Jodie Valpied
- Department of General Practice, The University of Melbourne, Carlton, Australia
| | - Jane Koziol-McLain
- Centre for Interdisciplinary Trauma Research, Auckland University of Technology, Auckland, New Zealand
| | - Nancy Glass
- School of Nursing & Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, Carlton, Australia
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19
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Schonnesson LN, Bowen AM, Williams ML. Project SMART: Preliminary Results From a Test of the Efficacy of a Swedish Internet-Based HIV Risk-Reduction Intervention for Men Who Have Sex With Men. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1501-1511. [PMID: 26545912 DOI: 10.1007/s10508-015-0608-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/30/2015] [Accepted: 08/17/2015] [Indexed: 06/05/2023]
Abstract
In Sweden, 57 % of HIV transmission occurs among MSM, and other sexually transmitted infections are increasing, supporting the need for innovative interventions. The Internet is a potentially useful HIV-prevention platform, but there is a lack of such programs in Sweden. The purpose of this exploratory study was to test the efficacy of the Internet-based SMART intervention to decrease HIV sexual risks in Swedish MSM. The intervention was adapted from the Wyoming Rural AIDS Prevention Project to the Swedish context, which was guided by the Information-Motivation-Behavioral (IMB) skills model and consisted of six sessions. A total of 112 men responded to a pretest questionnaire and were randomly assigned to the SMART intervention or to a waitlist group. Fifty-four men dropped out, leaving a final sample of 58 participants. Twenty-five were assigned to the SMART intervention and 33 to a waitlist group. One month post intervention, the number of casual anal sex partners significantly decreased (t = 2.19, p = .04). Compared with the waitlist group, men in the intervention group increased their HIV knowledge (β = 0.70, p = .01), their belief of condom use as an act of responsibility (β = 1.19, p = .04), their willingness to use a condom with every new partner all the time (β = 1.39, p = .03), and their confidence in using condoms in challenging situations (β = 1.65, p = .02). Condom use was not analyzed due to the small sample size. Despite the small sample, high drop-out, and short follow-up, the study provides support for the efficacy of the Internet interventions, the SMART intervention specifically, for reducing the proportion of casual anal sex partners and improving the three cognitive components of the IMB model for Swedish MSM.
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Affiliation(s)
- Lena Nilsson Schonnesson
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset AB, 118 83, Stockholm, Sweden.
| | - Anne M Bowen
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Mark L Williams
- Health Policy and Management, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
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20
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Tang W, Han L, Best J, Zhang Y, Mollan K, Kim J, Liu F, Hudgens M, Bayus B, Terris-Prestholt F, Galler S, Yang L, Peeling R, Volberding P, Ma B, Xu H, Yang B, Huang S, Fenton K, Wei C, Tucker JD. Crowdsourcing HIV Test Promotion Videos: A Noninferiority Randomized Controlled Trial in China. Clin Infect Dis 2016; 62:1436-1442. [PMID: 27129465 PMCID: PMC4872295 DOI: 10.1093/cid/ciw171] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 12/04/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Crowdsourcing, the process of shifting individual tasks to a large group, may enhance human immunodeficiency virus (HIV) testing interventions. We conducted a noninferiority, randomized controlled trial to compare first-time HIV testing rates among men who have sex with men (MSM) and transgender individuals who received a crowdsourced or a health marketing HIV test promotion video. METHODS Seven hundred twenty-one MSM and transgender participants (≥16 years old, never before tested for HIV) were recruited through 3 Chinese MSM Web portals and randomly assigned to 1 of 2 videos. The crowdsourced video was developed using an open contest and formal transparent judging while the evidence-based health marketing video was designed by experts. Study objectives were to measure HIV test uptake within 3 weeks of watching either HIV test promotion video and cost per new HIV test and diagnosis. RESULTS Overall, 624 of 721 (87%) participants from 31 provinces in 217 Chinese cities completed the study. HIV test uptake was similar between the crowdsourced arm (37% [114/307]) and the health marketing arm (35% [111/317]). The estimated difference between the interventions was 2.1% (95% confidence interval, -5.4% to 9.7%). Among those tested, 31% (69/225) reported a new HIV diagnosis. The crowdsourced intervention cost substantially less than the health marketing intervention per first-time HIV test (US$131 vs US$238 per person) and per new HIV diagnosis (US$415 vs US$799 per person). CONCLUSIONS Our nationwide study demonstrates that crowdsourcing may be an effective tool for improving HIV testing messaging campaigns and could increase community engagement in health campaigns. CLINICAL TRIALS REGISTRATION NCT02248558.
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Affiliation(s)
- Weiming Tang
- University of North Carolina Project-China
- Guangdong Provincial Center for Skin Diseases and STI Control
- Social Entrepreneurship for Sexual Health (SESH) Global, Guangzhou, China
- School of Medicine
| | - Larry Han
- University of North Carolina Project-China
- Guangdong Provincial Center for Skin Diseases and STI Control
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - John Best
- University of North Carolina Project-China
- Social Entrepreneurship for Sexual Health (SESH) Global, Guangzhou, China
- School of Medicine, University of California, San Francisco
| | - Ye Zhang
- University of North Carolina Project-China
- Guangdong Provincial Center for Skin Diseases and STI Control
- Social Entrepreneurship for Sexual Health (SESH) Global, Guangzhou, China
| | - Katie Mollan
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Julie Kim
- Social Entrepreneurship for Sexual Health (SESH) Global, Guangzhou, China
| | - Fengying Liu
- Guangdong Provincial Center for Skin Diseases and STI Control
- Social Entrepreneurship for Sexual Health (SESH) Global, Guangzhou, China
| | - Michael Hudgens
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Barry Bayus
- Business School, University of North Carolina at Chapel Hill
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine
| | - Sam Galler
- University of North Carolina Project-China
- University of Oxford, United Kingdom
| | - Ligang Yang
- Guangdong Provincial Center for Skin Diseases and STI Control
| | - Rosanna Peeling
- Social Entrepreneurship for Sexual Health (SESH) Global, Guangzhou, China
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine
| | | | | | - Huifang Xu
- Department of HIV/AIDS Prevention and Control, Guangzhou Center for Disease Control and Prevention, Baiyun, China
| | - Bin Yang
- Guangdong Provincial Center for Skin Diseases and STI Control
- Social Entrepreneurship for Sexual Health (SESH) Global, Guangzhou, China
| | - Shujie Huang
- Guangdong Provincial Center for Skin Diseases and STI Control
- Social Entrepreneurship for Sexual Health (SESH) Global, Guangzhou, China
| | | | - Chongyi Wei
- School of Medicine, University of California, San Francisco
| | - Joseph D Tucker
- University of North Carolina Project-China
- Guangdong Provincial Center for Skin Diseases and STI Control
- Social Entrepreneurship for Sexual Health (SESH) Global, Guangzhou, China
- School of Medicine
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Grov C, Cain D, Whitfield THF, Rendina HJ, Pawson M, Ventuneac A, Parsons JT. Recruiting a U.S. national sample of HIV-negative gay and bisexual men to complete at-home self-administered HIV/STI testing and surveys: Challenges and Opportunities. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2016; 13:1-21. [PMID: 26858776 PMCID: PMC4743043 DOI: 10.1007/s13178-015-0212-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
We describe enrollment for the One Thousand Strong panel, present characteristics of the panel relative to other large U.S. national studies of gay and bisexual men (GBM), and examine demographic and behavioral characteristics that were associated with passing enrollment milestones. A U.S. national sample of HIV-negative men were enrolled via an established online panel of over 22,000 GBM. Participants (n = 1071) passed three milestones to join our panel. Milestone 1 was screening eligible and providing informed consent. Milestone 2 involved completing an hour-long at-home computer-assisted self-interview (CASI) survey. Milestone 3 involved completing at-home self-administered rapid HIV testing and collecting/returning urine and rectal samples for gonorrhea and chlamydia testing. Compared to those who completed milestones: those not passing milestone 1 were more likely to be non-White and older; those not passing milestone 2 were less likely to have insurance or a primary care physician; and those not passing milestone 3 were less educated, more likely to be bisexual as opposed to gay, more likely to live in the Midwest, had fewer male partners in the past year, and less likely to have tested for HIV in the past year. Effect sizes for significant findings were small. We successfully enrolled a national sample of HIV-negative GBM who completed at-home CASI assessments and at-home self-administered HIV and urine and rectal STI testing. This indicates high feasibility and acceptability of incorporating self-administered biological assays into otherwise fully online studies. Differences in completion of study milestones indicate a need for further investigation into the reasons for lower engagement by certain groups.
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Cook F, Seymour M, Giallo R, Cann W, Nicholson JM, Green J, Hiscock H. Comparison of methods for recruiting and engaging parents in online interventions: study protocol for the Cry Baby infant sleep and settling program. BMC Pediatr 2015; 15:174. [PMID: 26556032 PMCID: PMC4640160 DOI: 10.1186/s12887-015-0502-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anticipatory guidance around the management of sleep and crying problems in early infancy has been shown to improve both infant behaviour and parent symptoms of postnatal depression. Digital technology offers platforms for making such programs widely available in a cost-efficient manner. However, it remains unclear who accesses online parenting advice and in particular, whether the parents who would most benefit are represented amongst users. It is also unknown whether the uptake of online programs can be improved by health professional recommendations, or whether parents require additional prompts and reminders to use the program. In this study we aim to: (1) determine whether weekly email prompts increase engagement with and use of a brief online program about infant sleeping and crying, (2) determine whether encouragement from a maternal and child health nurse promotes greater engagement with and use of the program, (3) examine who uses a brief online program about infant sleeping and crying; and, (4) examine the psychosocial characteristics of participants. METHODS/DESIGN This study is a randomised, parallel group, superiority trial, with all participating primary carers of infants aged 2 to 12 weeks, receiving access to the online program. Two modes of recruitment will be compared: recruitment via an online notice published on a non-commercial, highly credible and evidence-based website for parents and carers and via the parent's Maternal and Child Health nurse. After baseline assessment, parents will be randomised to one of two support conditions: online program alone or online program plus weekly email prompts. Follow up data will be collected at 4 months of infant age. DISCUSSION Results from this trial will indicate whether involvement from a health professional, and/or ongoing email contact is necessary to engage parents in a brief online intervention, and promote parental use of strategies suggested within the program. Results of this trial will inform the development of recruitment and engagement strategies for other online interventions. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12613001098729. Registered 01 October 2013.
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Affiliation(s)
- Fallon Cook
- Parenting Research Centre, 5/232 Victoria Parade, East Melbourne, 3002, VIC, Australia. .,Murdoch Childrens Research Institute, Royal Children's Hospital, Flemington Road, Parkville, 3052, VIC, Australia.
| | - Monique Seymour
- Parenting Research Centre, 5/232 Victoria Parade, East Melbourne, 3002, VIC, Australia. .,Murdoch Childrens Research Institute, Royal Children's Hospital, Flemington Road, Parkville, 3052, VIC, Australia.
| | - Rebecca Giallo
- Parenting Research Centre, 5/232 Victoria Parade, East Melbourne, 3002, VIC, Australia. .,Murdoch Childrens Research Institute, Royal Children's Hospital, Flemington Road, Parkville, 3052, VIC, Australia.
| | - Warren Cann
- Parenting Research Centre, 5/232 Victoria Parade, East Melbourne, 3002, VIC, Australia.
| | - Jan M Nicholson
- Parenting Research Centre, 5/232 Victoria Parade, East Melbourne, 3002, VIC, Australia. .,Murdoch Childrens Research Institute, Royal Children's Hospital, Flemington Road, Parkville, 3052, VIC, Australia. .,Judith Lumley Centre, La Trobe University, 215 Franklin St, Melbourne, 3000, VIC, Australia.
| | - Julie Green
- Parenting Research Centre, 5/232 Victoria Parade, East Melbourne, 3002, VIC, Australia. .,Murdoch Childrens Research Institute, Royal Children's Hospital, Flemington Road, Parkville, 3052, VIC, Australia. .,Department of Paediatrics, University of Melbourne, Melbourne, Australia.
| | - Harriet Hiscock
- Murdoch Childrens Research Institute, Royal Children's Hospital, Flemington Road, Parkville, 3052, VIC, Australia. .,Centre for Community Child Health, The Royal Children's Hospital, Flemington Road, Parkville, 3052, VIC, Australia. .,Department of Paediatrics, University of Melbourne, Melbourne, Australia.
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Bailey J, Mann S, Wayal S, Hunter R, Free C, Abraham C, Murray E. Sexual health promotion for young people delivered via digital media: a scoping review. PUBLIC HEALTH RESEARCH 2015. [DOI: 10.3310/phr03130] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundYoung people are at risk of poor sexual health and are, therefore, in need of comprehensive, effective sexual health education. Young people are confident and constant users of digital technology, such as the internet and mobile phones, and there are many innovative possibilities for sexual health education involving these technologies.ObjectivesTo summarise evidence on effectiveness, cost-effectiveness and mechanism of action of interactive digital interventions (IDIs) for sexual health; optimal practice for intervention development; contexts for successful implementation; research methods for digital intervention evaluation; and the future potential of sexual health promotion via digital media.DesignLiterature review of evidence on digital interventions for sexual health for young people, integrating the findings with the views of young people, parents and experts in digital media/sexual health. IDIs are defined as digital media programmes that provide health information and tailored decision support, behaviour-change support and/or emotional support. We focus on sexual well-being for young people aged 13–24 years in the UK.ResultsThere are many imaginative IDIs for sexual health promotion, but few interventions address issues that are important to young people, such as sexual pleasure and relationships. It is vital to collaborate with young people and to use Behaviour-Change Theory in designing interventions. We located 19 randomised controlled trials of IDIs for sexual health promotion for young people, finding a moderate effect on sexual health knowledge [standardised mean difference (SMD) 0.54, 95% confidence interval (CI) 0.17 to 0.92], a small effect on confidence (self-efficacy) (SMD 0.11, 95% CI 0.02 to 0.20) and a positive effect on sexual behaviour (odds ratio 1.28, 95% CI 1.01 to 1.61), but no significant effects on safer sex intention or biological outcomes. One study suggests that IDIs may be as good as face-to-face interventions for sexual health knowledge and safer sex intention. There are no existing data on the cost-effectiveness of IDIs for sexual health promotion. The impact of an IDI will be determined by the proportion of the target population reached, intervention efficacy, adoption in a setting, how well it is delivered and maintenance/sustainability. All of these elements must be addressed for IDIs to be successful. More collaboration is needed to capitalise on the knowledge of users and stakeholders, the design and software skills of the commercial sector and the theoretical expertise and evaluation skills of academia.ConclusionsIDIs are effective for knowledge acquisition and sexual behaviour, and could usefully contribute to sexual health education in schools, in clinic settings and online; however, there are obstacles to overcome, such as access to information technology and ensuring the quality and safety of interventions.Future workMore evidence is needed on the best designs for interventions (e.g. choice of behaviour-change mechanisms and interactive features) and the best models of delivery (e.g. setting, modes of delivery, methods of facilitation and support for engagement) to improve sexual behaviour, biological outcomes and sexual well-being in a cost-effective way.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Julia Bailey
- e-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sue Mann
- Camberwell Sexual Health Centre, King’s College Hospital, London, UK
| | - Sonali Wayal
- e-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Rachael Hunter
- PRIMENT Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Caroline Free
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Elizabeth Murray
- e-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
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Grey JA, Konstan J, Iantaffi A, Wilkerson JM, Galos D, Rosser BRS. An updated protocol to detect invalid entries in an online survey of men who have sex with men (MSM): how do valid and invalid submissions compare? AIDS Behav 2015; 19:1928-37. [PMID: 25805443 DOI: 10.1007/s10461-015-1033-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Researchers use protocols to screen for suspicious survey submissions in online studies. We evaluated how well a de-duplication and cross-validation process detected invalid entries. Data were from the Sexually Explicit Media Study, an Internet-based HIV prevention survey of men who have sex with men. Using our protocol, 146 (11.6 %) of 1254 entries were identified as invalid. Most indicated changes to the screening questionnaire to gain entry (n = 109, 74.7 %), matched other submissions' payment profiles (n = 56, 41.8 %), or featured an IP address that was recorded previously (n = 43, 29.5 %). We found few demographic or behavioral differences between valid and invalid samples, however. Invalid submissions had lower odds of reporting HIV testing in the past year (OR 0.63), and higher odds of requesting no payment compared to check payments (OR 2.75). Thus, rates of HIV testing would have been underestimated if invalid submissions had not been removed, and payment may not be the only incentive for invalid participation.
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Affiliation(s)
- Jeremy A Grey
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA.
| | - Joseph Konstan
- Department of Computer Science & Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Alex Iantaffi
- Department of Family Medicine & Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Michael Wilkerson
- Division of Health Promotion & Behavioral Sciences, The University of Texas Health Sciences Center (UTHealth) at Houston, Houston, TX, USA
| | - Dylan Galos
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - B R Simon Rosser
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Villanti AC, Jacobs MA, Zawistowski G, Brookover J, Stanton CA, Graham AL. Impact of Baseline Assessment Modality on Enrollment and Retention in a Facebook Smoking Cessation Study. J Med Internet Res 2015; 17:e179. [PMID: 26183789 PMCID: PMC4527002 DOI: 10.2196/jmir.4341] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/11/2015] [Accepted: 04/28/2015] [Indexed: 01/16/2023] Open
Abstract
Background Few studies have addressed enrollment and retention methods in online smoking cessation interventions. Fully automated Web-based trials can yield large numbers of participants rapidly but suffer from high rates of attrition. Personal contact with participants can increase recruitment of smokers into cessation trials and improve participant retention. Objective To compare the impact of Web-based (WEB) and phone (PH) baseline assessments on enrollment and retention metrics in the context of a Facebook smoking cessation study. Methods Participants were recruited via Facebook and Google ads which were randomly displayed to adult smokers in the United States over 27 days from August to September 2013. On each platform, two identical ads were randomly displayed to users who fit the advertising parameters. Clicking on one of the ads resulted in randomization to WEB, and clicking on the other ad resulted in randomization to PH. Following online eligibility screening and informed consent, participants in the WEB arm completed the baseline survey online whereas PH participants completed the baseline survey by phone with a research assistant. All participants were contacted at 30 days to complete a follow-up survey that assessed use of the cessation intervention and smoking outcomes. Participants were paid $15 for follow-up survey completion. Results A total of 4445 people clicked on the WEB ad and 4001 clicked on the PH ad: 12.04% (n=535) of WEB participants and 8.30% (n=332) of PH participants accepted the online study invitation (P<.001). Among the 726 participants who completed online eligibility screening, an equivalent proportion in both arms was eligible and an equivalent proportion of the eligible participants in both arms provided informed consent. There was significant drop-off between consent and completion of the baseline survey in the PH arm, resulting in enrollment rates of 32.7% (35/107) for the PH arm and 67.9% (114/168) for the WEB arm (P<.001). The overall enrollment rate among everyone who clicked on a study ad was 2%. There were no between group differences in the proportion that installed the Facebook app (66/114, 57.9% WEB vs 17/35, 49% PH) or that completed the 30-day follow-up survey (49/114, 43.0% WEB vs 16/35, 46% PH). A total of $6074 was spent on ads, generating 3,834,289 impressions and resulting in 8446 clicks (average cost $0.72 per click). Per participant enrollment costs for advertising alone were $27 WEB and $87 PH. Conclusions A more intensive phone baseline assessment protocol yielded a lower rate of enrollment, equivalent follow-up rates, and higher enrollment costs compared to a Web-based assessment protocol. Future research should focus on honing mixed-mode assessment protocols to further optimize enrollment and retention.
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Affiliation(s)
- Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, United States.
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Sanchez TH, Sineath RC, Kahle EM, Tregear SJ, Sullivan PS. The Annual American Men's Internet Survey of Behaviors of Men Who Have Sex With Men in the United States: Protocol and Key Indicators Report 2013. JMIR Public Health Surveill 2015; 1:e3. [PMID: 27227126 PMCID: PMC4869242 DOI: 10.2196/publichealth.4314] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/17/2015] [Accepted: 03/17/2015] [Indexed: 02/06/2023] Open
Abstract
Background Men who have sex with men (MSM) are disproportionately affected by human immunodeficiency virus (HIV) and there is evidence that this population is participating in increasingly risky sexual behavior. These changes are occurring in the context of new modes of online social interaction—many MSM now report first meeting their sex partners on the Internet. Better monitoring of key behavioral indicators among MSM requires the use of surveillance strategies that capitalize on these new modes of interaction. Therefore, we developed an annual cross-sectional behavioral survey of MSM in the United States, the American Men's Internet Survey (AMIS). Objective The purpose of this paper was to provide a description of AMIS methods. In addition we report on the first cycle of data collection (December 2013 through May 2014; AMIS-2013) on the same key indicators used for national HIV behavioral surveillance. Methods AMIS-2013 recruited MSM from a variety of websites using banner advertisements or email blasts. Adult men currently residing in the United States were eligible to participate if they had ever had sex with a man. We examined demographic and recruitment characteristics using multivariable regression modeling (P<.05) stratified by the participants' self-reported HIV status. Results In the AMIS-2013 round, 79,635 persons landed on the study page and 14,899 were eligible, resulting in 10,377 completed surveys from MSM representing every US state. Participants were mainly white, 40 years or older, living in the US South, living in urban areas, and recruited from a general social networking website. Self-reported HIV prevalence was 10.73% (n=1113). Compared to HIV-negative/unknown status participants, HIV-positive participants were more likely to have had anal sex without a condom with any male partner in the past 12 months (72.24% versus 61.24%, respectively; P<.001) and more likely to have had anal sex without a condom with their last male sex partner who was discordant/unknown HIV status (42.95% versus 13.62%, respectively; P<.001). Illicit substance use in the past 12 months was more likely to be reported by HIV-positive participants than HIV-negative/unknown status participants (39.17% versus 26.85%, respectively; P<.001). The vast majority of HIV-negative/unknown status participants (84.05%) had been previously HIV tested, but less than half (44.20%) had been tested in the past 12 months. Participants 18-24 years of age were more likely than those 40 years or older to have had anal sex without a condom with a discordant/unknown HIV status partner, were more likely to report substance use, and were less likely to have been HIV tested. Compared to general social networking, those from a geospatial social networking website were more likely to have reported all risk behaviors but were more likely to have been HIV tested. Conclusions The first round of AMIS generated useful behavioral measures from more than 10,000 MSM Internet users. Preliminary findings identified some subgroups of MSM Internet users that are at potentially higher risk of HIV acquisition/transmission. AMIS will provide an ongoing data source for examining trends in sexual risk behavior of MSM. This will help to plan and monitor the impact of programs to improve this population's health.
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A web-based personally controlled health management system increases sexually transmitted infection screening rates in young people: a randomized controlled trial. J Am Med Inform Assoc 2015; 22:805-14. [DOI: 10.1093/jamia/ocu052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/29/2014] [Indexed: 01/19/2023] Open
Abstract
Abstract
Objective To determine if a web-based personally controlled health management system (PCHMS) could increase the uptake of sexually transmitted infections (STI) screening among a young university population.
Methods A non-blinded parallel-group randomized controlled trial was conducted. Participants aged 18–29 years were recruited from a university environment between April and August 2013, and randomized 1:1 to either the intervention group (immediate online PCHMS access) or control group (no PCHMS access). The study outcome was self-reported STI testing, measured by an online follow-up survey in October 2013.
Results Of the 369 participants allocated to the PCHMS, 150 completed the follow-up survey, and of the 378 in the control group, 225 completed the follow-up survey. The proportion of the PCHMS group who underwent an STI test during the study period was 15.3% (23/150) compared with 7.6% (17/225) in the control group (P = .017). The difference in STI testing rates within the subgroup of sexually active participants (20.4% (23/113) of the PCHMS group compared with 9.6% (15/157) of the control group) was significantly higher (P = .027) than among non-sexually active participants.
Discussion Access to the PCHMS was associated with a significant increase in participants undergoing STI testing. This is also the first study to demonstrate efficacy of a PCHMS targeting a health concern where susceptibility is generally perceived as low and the majority of infections are asymptomatic.
Conclusion PCHMS interventions may provide an effective means of increasing the demand for STI testing which, combined with increased opportunistic testing by clinicians, could reduce the high and sustained rates of STIs in young people.
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Tang W, Huan X, Zhang Y, Mahapatra T, Li J, Liu X, Mahapatra S, Yan H, Fu G, Zhao J, Gu C, Detels R. Factors associated with loss-to-follow-up during behavioral interventions and HIV testing cohort among men who have sex with men in Nanjing, China. PLoS One 2015; 10:e115691. [PMID: 25559678 PMCID: PMC4283967 DOI: 10.1371/journal.pone.0115691] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 11/24/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Behavioral interventions (BIs) remained the cornerstone of HIV prevention in resource-limited settings. One of the major concerns for such efforts is the loss-to-follow-up (LTFU) that threatens almost every HIV control program involving high-risk population groups. METHODS To evaluate the factors associated with LTFU during BIs and HIV testing among men who have sex with men (MSM), 410 HIV sero-negatives MSM were recruited using respondent driven sampling (RDS) in Nanjing, China during 2008, they were further followed for 18 months. At baseline and each follow-up visits, each participant was counseled about various HIV risk-reductions BIs at a designated sexually transmitted infection (STI) clinic. RESULTS Among 410 participants recruited at baseline, altogether 221 (53.9%) were LTFU at the 18-month follow-up visit. Overall, 46 participants were found to be positive for syphilis infection at baseline while 13 participants were HIV sero-converted during the follow-up period. Increasing age was less (Adjusted Odds Ratio(aOR) of 0.90, 95% confidence Interval (CI) 0.86-0.94) and official residency of provinces other than Nanjing (AOR of 2.49, 95%CI 1.32-4.71), lower level of education (AOR of 2.01, 95%CI 1.10-3.66) and small social network size (AOR of 1.75, 95%CI 1.09-2.80) were more likely to be associated with higher odds of LTFU. CONCLUSION To improve retention in the programs for HIV control, counseling and testing among MSM in Nanjing, focused intensified intervention targeting those who were more likely to be LTFU, especially the young, less educated, unofficial residents of Nanjing who had smaller social network size, might be helpful.
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Affiliation(s)
- Weiming Tang
- Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, Guangdong, 510095, China
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
- University of North Carolina Project-China, Number 2 Lujing Road, Guangzhou, 510095, China
| | - Xiping Huan
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
| | - Ye Zhang
- Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, Guangdong, 510095, China
| | - Tanmay Mahapatra
- Department of Epidemiology, School National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Jianjun Li
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
| | - Xiaoyan Liu
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
| | - Sanchita Mahapatra
- Department of Epidemiology, School National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Hongjing Yan
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
| | - Gengfeng Fu
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
| | - Jinkou Zhao
- Strategy, Investment and Impact Division, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Chenghua Gu
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
- * E-mail: (CG); (RD)
| | - Roger Detels
- Department of Epidemiology, School National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
- * E-mail: (CG); (RD)
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Hui A, Wong PWC, Fu KW. Evaluation of an Online Campaign for Promoting Help-Seeking Attitudes for Depression Using a Facebook Advertisement: An Online Randomized Controlled Experiment. JMIR Ment Health 2015; 2:e5. [PMID: 26543911 PMCID: PMC4607380 DOI: 10.2196/mental.3649] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 12/30/2014] [Accepted: 02/17/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND A depression-awareness campaign delivered through the Internet has been recommended as a public health approach that would enhance mental health literacy and encourage help-seeking attitudes. However, the outcomes of such a campaign remain understudied. OBJECTIVE The main aim of this study was to evaluate the effectiveness of an online depression awareness campaign, which was informed by the theory of planned behavior, to encourage help-seeking attitudes for depression and to enhance mental health literacy in Hong Kong. The second aim was to examine click-through behaviors by varying the affective facial expressions of people in the Facebook advertisements. METHODS Potential participants were recruited through Facebook advertisements, using either a happy or sad face illustration. Volunteer participants registered for the study by clicking on the advertisement and were invited to leave their personal email addresses to receive educational content about depression. The participants were randomly assigned into two groups (campaign or control), and over a four consecutive week period, received either the campaign material or official information developed by the Hospital Authority in Hong Kong. Pretests and posttests were conducted before and after the campaign to measure the differences in help-seeking attitudes and mental health literacy among the campaign and control groups. RESULTS Of the 199 participants that registered and completed the pretest, 116 (55 campaign and 62 control) completed the campaign and the posttest. At the posttest, we found no significant changes in help-seeking attitudes between the campaign and control groups, but the campaign group participants demonstrated a statistically significant improvement in mental health literacy (P=.031) and a higher willingness to access additional information (P<.001) than the control group. Moreover, the happy face Facebook advertisement attracted more click-throughs by users into the website than did the sad face advertisement (P=.03). CONCLUSIONS The present study provides evidence that an online campaign can enhance people's mental health literacy. It also demonstrates the practicality and effectiveness of an online depression awareness campaign using a Facebook-based recruitment strategy and distribution of educational materials through emails. It is important for future studies to take advantage of the popularity of online social media and conduct evaluative research on mental health promotion campaigns.
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Affiliation(s)
- Alison Hui
- Journalism and Media Studies Centre The University of Hong Kong Hong Kong China (Hong Kong)
| | - Paul Wai-Ching Wong
- Department of Social Work and Social Administration The University of Hong Kong Hong Kong China (Hong Kong)
| | - King-Wa Fu
- Journalism and Media Studies Centre The University of Hong Kong Hong Kong China (Hong Kong)
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Asare Bempong G, Ramamurthi HC, McCuller J, Williams JK, Harawa NT. Recruiting Black Men Who Have Sex with Men and Women (BMSMW) in an Urban Setting for HIV Prevention Research. JOURNAL OF AIDS & CLINICAL RESEARCH 2014; 6:408. [PMID: 25984392 PMCID: PMC4433157 DOI: 10.4172/2155-6113.1000408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Concerns related to stigma and confidentiality limit HIV-related study recruitment and retention of Black men who have sex with men and women (MSMW). This paper examines lessons learned from recruitment strategies utilized in enrolling 437 participants between 2007 and 2011 for a randomized controlled trial to test a culturally specific HIV risk-reduction intervention for Black MSMW. METHODS Interested respondents completed a brief screener and participants completed surveys at baseline and at post, 3 and 6 months follow-up. Recruitment patterns were assessed by examining the source of study information reported when respondents were asked how they learned about the study. Chi-square tests were then conducted to examine differences in the distribution of participants by self-reported HIV status, age group and socio-economic status (SES) for each type of study information source. RESULTS Regardless of HIV or SES, study respondents were more likely to have received information about the study through a service agency than from other sources. Participants ages 30-49 and 50+ years were most likely to have learned about the study from an agency (34.9% and 27.0%, respectively) or another participant/friend (20.1%, 23.1%) and least likely to have found out from bus (0.8%, 0.0%) or radio (1.3%, 0.0%) advertisements; whereas younger participants were more likely to have heard about the study through a friend/participant (23.4%) than an agency (15.4%). Although, 14.1% of participants' ages less than 30 years reported the Internet as their source of study information, this compared to just 2.7% and 4.8% for participants in the 30-49 and 50-plus age groups. CONCLUSIONS While agencies and referrals from personal networks appear to be the most significant recruitment source for potential HIV research participants, there is evidence that Internet based tools may enhance recruitment, particularly among younger Black MSMW.
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Affiliation(s)
| | - Hema C. Ramamurthi
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Jason McCuller
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - John K Williams
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Nina T Harawa
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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Usher D, Frye V, Shinnick J, Greene E, Baez E, Benitez J, Solomon L, Shouse RL, Sobieszczyk ME, Koblin BA. Recruitment by a geospatial networking application for research and practice: the New York City experience. J Acquir Immune Defic Syndr 2014; 67:e143-5. [PMID: 25247432 PMCID: PMC4229397 DOI: 10.1097/qai.0000000000000366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- DaShawn Usher
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY
| | - Victoria Frye
- Laboratory of Social and Behavioral Science, New York Blood Center, New York, NY
| | - Julianna Shinnick
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY
| | - Emily Greene
- Laboratory of Social and Behavioral Science, New York Blood Center, New York, NY
| | - Eduardo Baez
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY
| | - Jorge Benitez
- Department of Medicine, Columbia University, New York, NY
| | | | - R. Luke Shouse
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
| | | | - Beryl A. Koblin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY
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Social media technologies for HIV prevention study retention among minority men who have sex with men (MSM). AIDS Behav 2014; 18:1625-9. [PMID: 24062015 DOI: 10.1007/s10461-013-0604-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This brief report describes results on study retention among minority men who have sex with men (MSM) from a 12-week, social networking-based, HIV prevention trial with 1-year follow-up. Participants, primarily minority MSM, were recruited using online and offline methods and randomly assigned to a Facebook (intervention or control) group. Participants completed a baseline survey and were asked to complete two follow-up surveys (12-week follow-up and 1-year post-intervention). 94 % of participants completed the first two surveys and over 82 % completed the baseline and both post-intervention surveys. Participants who spent a greater frequency of time online had almost twice the odds of completing all surveys. HIV negative participants, compared to those who were HIV positive, had over 25 times the odds of completing all surveys. HIV prevention studies on social networking sites can yield high participant retention rates.
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Grov C, Breslow AS, Newcomb ME, Rosenberger JG, Bauermeister JA. Gay and bisexual men's use of the Internet: research from the 1990s through 2013. JOURNAL OF SEX RESEARCH 2014; 51:390-409. [PMID: 24754360 PMCID: PMC4154140 DOI: 10.1080/00224499.2013.871626] [Citation(s) in RCA: 206] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
We document the historical and cultural shifts in how gay and bisexual men have used the Internet for sexuality between the 1990s and 2013-including shifting technology as well as research methods to study gay and bisexual men online. Gay and bisexual men have rapidly taken to using the Internet for sexual purposes: for health information seeking, finding sex partners, dating, cybersex, and pornography. Men have adapted to the ever-evolving technological advances that have been made in connecting users to the Internet-from logging on via dial-up modem on a desktop computer to geo-social-sexual networking via handheld devices. In kind, researchers have adapted to the Internet to study gay and bisexual men. Studies have carefully considered the ethics, feasibility, and acceptability of using the Internet to conduct research and interventions. Much of this work has been grounded in models of disease prevention, largely as a result of the ongoing HIV/AIDS epidemic. The need to reduce HIV in this population has been a driving force to develop innovative research and Internet-based intervention methodologies. The Internet, and specifically mobile technology, is an environment gay and bisexual men are using for sexual purposes. These innovative technologies represent powerful resources for researchers to study and provide outreach.
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Affiliation(s)
- Christian Grov
- Brooklyn College and the Graduate Center of CUNY, New York, NY. USA
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY. USA
| | - Aaron S. Breslow
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY. USA
| | - Michael E. Newcomb
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Joshua G. Rosenberger
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | - Jose A Bauermeister
- The Center for Sexuality & Health Disparities, University of Michigan, Ann Arbor, MI, USA
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Bailey JV, Pavlou M, Copas A, McCarthy O, Carswell K, Rait G, Hart G, Nazareth I, Free C, French R, Murray E. The Sexunzipped trial: optimizing the design of online randomized controlled trials. J Med Internet Res 2013; 15:e278. [PMID: 24334216 PMCID: PMC3868980 DOI: 10.2196/jmir.2668] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 08/14/2013] [Accepted: 09/06/2013] [Indexed: 11/24/2022] Open
Abstract
Background Sexual health problems such as unwanted pregnancy and sexually transmitted infection are important public health concerns and there is huge potential for health promotion using digital interventions. Evaluations of digital interventions are increasingly conducted online. Trial administration and data collection online offers many advantages, but concerns remain over fraudulent registration to obtain compensation, the quality of self-reported data, and high attrition. Objective This study addresses the feasibility of several dimensions of online trial design—recruitment, online consent, participant identity verification, randomization and concealment of allocation, online data collection, data quality, and retention at 3-month follow-up. Methods Young people aged 16 to 20 years and resident in the United Kingdom were recruited to the “Sexunzipped” online trial between November 2010 and March 2011 (n=2036). Participants filled in baseline demographic and sexual health questionnaires online and were randomized to the Sexunzipped interactive intervention website or to an information-only control website. Participants were also randomly allocated to a postal request (or no request) for a urine sample for genital chlamydia testing and receipt of a lower (£10/US$16) or higher (£20/US$32) value shopping voucher compensation for 3-month outcome data. Results The majority of the 2006 valid participants (90.98%, 1825/2006) were aged between 18 and 20 years at enrolment, from all four countries in the United Kingdom. Most were white (89.98%, 1805/2006), most were in school or training (77.48%, 1545/1994), and 62.81% (1260/2006) of the sample were female. In total, 3.88% (79/2036) of registrations appeared to be invalid and another 4.00% (81/2006) of participants gave inconsistent responses within the questionnaire. The higher value compensation (£20/US$32) increased response rates by 6-10%, boosting retention at 3 months to 77.2% (166/215) for submission of online self-reported sexual health outcomes and 47.4% (118/249) for return of chlamydia urine samples by post. Conclusions It was quick and efficient to recruit young people to this online trial. Our procedures for obtaining online consent, verifying participant identity, automated randomization, and concealment of allocation worked well. The optimal response rate for the online sexual health outcome measurement was comparable to face-to-face trials. Multiple methods of participant contact, requesting online data only, and higher value compensation increased trial retention at 3-month follow-up. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 55651027; http://www.controlled-trials.com/ISRCTN55651027 (Archived by WebCite at http://www.webcitation.org/6LbkxdPKf).
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Affiliation(s)
- Julia V Bailey
- e-Health Unit, Research Department of Primary Care and Population Health, University College London, London, United Kingdom.
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Frew PM, Williams VA, Shapiro ET, Sanchez T, Rosenberg ES, Fenimore VL, Sullivan PS. From (Un)Willingness to InvolveMENt: Development of a Successful Study Brand for Recruitment of Diverse MSM to a Longitudinal HIV Research. INTERNATIONAL JOURNAL OF POPULATION RESEARCH 2013; 2013:624245. [PMID: 24639900 PMCID: PMC3955100 DOI: 10.1155/2013/624245] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND HIV continues to be a major concern among MSM, yet Black MSM have not been enrolled in HIV research studies in proportionate numbers to White MSM. We developed an HIV prevention research brand strategy for MSM. METHODS Questionnaires and focus groups were conducted with 54 participants. Descriptive statistics and chi-square analyses were performed and qualitative data were transcribed and content analyzed to identify common themes. RESULTS Formative research results indicated that younger Black MSM (18-29 years) were less likely to think about joining prevention studies compared to older (≥30 years) Black MSM (x2 = 5.92, P = 0.015). Qualitative and quantitative results indicate four prominent themes related to brand development: (1) communication sources (message deliverer), (2) message (impact of public health messaging on perceptions of HIV research), (3) intended audience (underlying issues that influence personal relevance of HIV research), and (4) communication channels (reaching intended audiences). CONCLUSION The findings highlight the importance of behavioral communication translational research to effectively engage hard-to-reach populations. Despite reservations, MSM in our formative study expressed a need for active involvement and greater education to facilitate their engagement in HIV prevention research. Thus, the brand concept of "InvolveMENt" emerged.
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Affiliation(s)
- Paula M. Frew
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
- Emory Center for AIDS Research, Atlanta, GA 30322, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
- The Hope Clinic of the Emory Vaccine Center, Decatur, GA 30030, USA
| | - Victoria A. Williams
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Eve T. Shapiro
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Travis Sanchez
- Emory Center for AIDS Research, Atlanta, GA 30322, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Eli S. Rosenberg
- Emory Center for AIDS Research, Atlanta, GA 30322, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | | | - Patrick S. Sullivan
- Emory Center for AIDS Research, Atlanta, GA 30322, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
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Christensen JL, Miller LC, Appleby PR, Corsbie-Massay C, Godoy CG, Marsella SC, Read SJ. Reducing shame in a game that predicts HIV risk reduction for young adult MSM: a randomized trial delivered nationally over the Web. J Int AIDS Soc 2013; 16:18716. [PMID: 24242264 PMCID: PMC3833191 DOI: 10.7448/ias.16.3.18716] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 08/23/2013] [Accepted: 08/29/2013] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Men who have sex with men (MSM) often face socially sanctioned disapproval of sexual deviance from the heterosexual "normal." Such sexual stigma can be internalized producing a painful affective state (i.e., shame). Although shame (e.g., addiction) can predict risk-taking (e.g., alcohol abuse), sexual shame's link to sexual risk-taking is unclear. Socially Optimized Learning in Virtual Environments (SOLVE) was designed to reduce MSM's sexual shame, but whether it does so, and if that reduction predicts HIV risk reduction, is unclear. To test if at baseline, MSM's reported past unprotected anal intercourse (UAI) is related to shame; MSM's exposure to SOLVE compared to a wait-list control (WLC) condition reduces MSM's shame; and shame-reduction mediates the link between WLC condition and UAI risk reduction. METHODS HIV-negative, self-identified African American, Latino or White MSM, aged 18-24 years, who had had UAI with a non-primary/casual partner in the past three months were recruited for a national online study. Eligible MSM were computer randomized to either WLC or a web-delivered SOLVE. Retained MSM completed baseline measures (e.g., UAI in the past three months; current level of shame) and, in the SOLVE group, viewed at least one level of the game. At the end of the first session, shame was measured again. MSM completed follow-up UAI measures three months later. All data from 921 retained MSM (WLC condition, 484; SOLVE condition, 437) were analyzed, with missing data multiply imputed. RESULTS At baseline, MSM reporting more risky sexual behaviour reported more shame (r s=0.21; p<0.001). MSM in the SOLVE intervention reported more shame reduction (M=-0.08) than MSM in the control condition (M=0.07; t(919)=4.24; p<0.001). As predicted, the indirect effect was significant (point estimate -0.10, 95% bias-corrected CI [-0.01 to -0.23] such that participants in the SOLVE treatment condition reported greater reductions in shame, which in turn predicted reductions in risky sexual behaviour at follow-up. The direct effect, however, was not significant. CONCLUSIONS SOLVE is the first intervention to: (1) significantly reduce shame for MSM; and (2) demonstrate that shame-reduction, due to an intervention, is predictive of risk (UAI) reduction over time.
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Affiliation(s)
- John L Christensen
- Department of Communication and Center for Health, Intervention, & Prevention, University of Connecticut, Storrs, CT;
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Stein ML, Rump BO, Kretzschmar MEE, van Steenbergen JE. Social Networking Sites as a Tool for Contact Tracing: Urge for Ethical Framework for Normative Guidance. Public Health Ethics 2013. [DOI: 10.1093/phe/pht035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Feasibility, acceptability, and preliminary efficacy of an online HIV prevention program for diverse young men who have sex with men: the keep it up! intervention. AIDS Behav 2013; 17:2999-3012. [PMID: 23673793 DOI: 10.1007/s10461-013-0507-z] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Young men who have sex with men (YMSM) are disproportionately infected with HIV/AIDS and there are few prevention programs with published efficacy for this population. This study evaluated the feasibility, acceptability, and preliminary efficacy of an online, interactive, and highly engaging HIV prevention program called Keep It Up! The intervention was designed to be delivered to diverse YMSM upon receiving an HIV negative text result, with the goal for them to "Keep It Up" and stay negative. In a randomized clinical trial, the intervention was compared to an online didactic HIV knowledge condition. The study sample included 102 sexually active YMSM. Participants reported completing online modules in settings that were private and not distracting. Mixed methods data showed intervention participants felt the program was valuable and acceptable. Compared to the control condition, participants in the intervention arm had a 44 % lower rate of unprotected anal sex acts at the 12-week follow-up (p < 0.05).
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Murray E, White IR, Varagunam M, Godfrey C, Khadjesari Z, McCambridge J. Attrition revisited: adherence and retention in a web-based alcohol trial. J Med Internet Res 2013; 15:e162. [PMID: 23996958 PMCID: PMC3815435 DOI: 10.2196/jmir.2336] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 04/04/2013] [Accepted: 05/08/2013] [Indexed: 11/17/2022] Open
Abstract
Background Attrition is a noted feature of eHealth interventions and trials. In 2005, Eysenbach published a landmark paper calling for a “science of attrition,” suggesting that the 2 forms of attrition—nonusage attrition (low adherence to the intervention) and dropout attrition (poor retention to follow-up)—may be related and that this potential relationship deserved further study. Objective The aim of this paper was to use data from an online alcohol trial to explore Eysenbach’s hypothesis, and to answer 3 research questions: (1) Are adherence and retention related? If so, how, and under which circumstances? (2) Do adherence and retention have similar predictors? Can these predictors adequately explain any relationship between adherence and retention or are there additional, unmeasured predictors impacting on the relationship? (3) If there are additional unmeasured predictors impacting on the relationship, are there data to support Eysenbach’s hypothesis that these are related to overall levels of interest? Methods Secondary analysis of data from an online trial of an online intervention to reduce alcohol consumption among heavy drinkers. The 2 outcomes were adherence to the intervention measured by number of log-ins, and retention to the trial measured by provision of follow-up data at 3 months (the primary outcome point). Dependent variables were demographic and alcohol-related data collected at baseline. Predictors of adherence and retention were modeled using logistic regression models. Results Data were available on 7932 participants. Adherence and retention were related in a complex fashion. Participants in the intervention group were more likely than those in the control group to log in more than once (42% vs 28%, P<.001) and less likely than those in the control group to respond at 3 months (40% vs 49%, P<.001). Within each randomized group, participants who logged in more frequently were more likely to respond than those who logged in less frequently. Response rates in the intervention group for those who logged in once, twice, or ≥3 times were 34%, 46%, and 51%, respectively (P<.001); response rates in the control group for those who logged in once, twice, or ≥3 times were 44%, 60%, and 67%, respectively (P<.001). Relationships between baseline characteristics and adherence and retention were also complex. Where demographic characteristics predicted adherence, they tended also to predict retention. However, characteristics related to alcohol consumption and intention or confidence in reducing alcohol consumption tended to have opposite effects on adherence and retention, with factors that predicted improved adherence tending to predict reduced retention. The complexity of these relationships suggested the existence of an unmeasured confounder. Conclusions In this dataset, adherence and retention were related in a complex fashion. We propose a possible explanatory model for these data. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 31070347; http://www.controlled-trials.com/ISRCTN31070347 (Archived by WebCite at http://www.webcitation.org/6IEmNnlCn).
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Affiliation(s)
- Elizabeth Murray
- e-Health Unit, Research Department of Primary Care and Population Health, University College London, London, United Kingdom.
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Khosropour CM, Johnson BA, Ricca AV, Sullivan PS. Enhancing retention of an Internet-based cohort study of men who have sex with men (MSM) via text messaging: randomized controlled trial. J Med Internet Res 2013; 15:e194. [PMID: 23981905 PMCID: PMC3757960 DOI: 10.2196/jmir.2756] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 07/10/2013] [Accepted: 07/11/2013] [Indexed: 11/16/2022] Open
Abstract
Background Black and Hispanic men who have sex with men (MSM) are disproportionately affected by HIV in the United States. The Internet is a promising vehicle for delivery of HIV prevention interventions to these men, but retention of MSM of color in longitudinal Internet-based studies has been problematic. Text message follow-up may enhance retention in these studies. Objective To compare retention in a 12-month prospective Internet-based study of HIV-negative MSM randomized to receive bimonthly follow-up surveys either through an Internet browser online or through text messages. Methods Internet-using MSM were recruited through banner advertisements on social networking and Internet-dating sites. White, black, and Hispanic men who were ≥18, completed an online baseline survey, and returned an at-home HIV test kit, which tested HIV negative, were eligible. Men were randomized to receive follow-up surveys every 2 months on the Internet or by text message for 12 months (unblinded). We used time-to-event methods to compare the rate of loss-to-follow-up (defined as non-response to a follow-up survey after multiple systematically-delivered contact attempts) in the 2 follow-up groups, overall and by race/ethnicity. Results are reported as hazard ratios (HR) and 95% confidence intervals (CI) of the rate of loss-to-follow-up for men randomized to text message follow-up compared to online follow-up. Results Of 1489 eligible and consenting men who started the online baseline survey, 895 (60%) completed the survey and were sent an at-home HIV test kit. Of these, 710 of the 895 (79%) returned the at-home HIV test kit, tested HIV-negative, and were followed prospectively. The study cohort comprised 66% white men (470/710), 15% (106/710) black men, and 19% (134/710) Hispanic men. At 12 months, 77% (282/366) of men randomized to online follow-up were retained in the study, compared to 70% (241/344) men randomized to text message follow-up (HR=1.30, 95% CI 0.97-1.73). The rate of loss-to-follow-up was non-significantly higher in the text message arm compared to the online arm for both white (HR=1.43, 95% CI 0.97-1.73) and Hispanic men (HR=1.71, 95% CI 0.91-3.23); however, loss-to-follow-up among black men was non-significantly lower among those who received text message follow-up compared to online follow-up (HR=0.78, 95% CI 0.41-1.50). In the online arm, black men were significantly more likely to be lost to follow-up compared to white men (HR=2.25, 95% CI 1.36-3.71), but this was not the case in the text message arm (HR=1.23, 95% CI 0.70-2.16). Conclusions We retained >70% of MSM enrolled in an online study for 12 months; thus, engaging men in online studies for a sufficient time to assess sustained outcomes is possible. Text message follow-up of an online cohort of MSM is feasible, and may result in higher retention among black MSM.
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Affiliation(s)
- Christine M Khosropour
- School of Public Health, Department of Epidemiology, University of Washington, Seattle, WA, USA
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Higa DH, Crepaz N, Marshall KJ, Kay L, Vosburgh HW, Spikes P, Lyles CM, Purcell DW. A systematic review to identify challenges of demonstrating efficacy of HIV behavioral interventions for gay, bisexual, and other men who have sex with men (MSM). AIDS Behav 2013; 17:1231-44. [PMID: 23397183 DOI: 10.1007/s10461-013-0418-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV but few MSM-specific evidence-based interventions (EBIs) have been identified for this vulnerable group. We conducted a systematic review to identify reasons for the small number of EBIs for MSM. We also compared study, intervention and sample characteristics of EBIs versus non-EBIs to better understand the challenges of demonstrating efficacy evidence. Thirty-three MSM-specific studies were evaluated: Nine (27 %) were considered EBIs while 24 (73 %) were non-EBIs. Non-EBIs had multiple methodological limitations; the most common was not finding a significant positive effect. Compared to EBIs, non-EBIs were less likely to use peer intervention deliverers, include sexual communication in their interventions, and intervene at the community level. Incorporating characteristics associated with EBIs may strengthen behavioral interventions for MSM. More EBIs are needed for substance-using MSM, MSM of color, MSM residing in the south and MSM in couples.
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Affiliation(s)
- Darrel H Higa
- Prevention Research Branch, Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Attrition in a longitudinal study with hard-to-reach participants was reduced by ongoing contact. J Clin Epidemiol 2013; 66:575-81. [PMID: 23384589 DOI: 10.1016/j.jclinepi.2012.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 11/18/2012] [Accepted: 12/04/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Minimizing attrition is a key objective in longitudinal research, with possible consequences being additional bias and reduced generalizability. Identifying determinants of attrition is essential in determining attrition prevention strategies. The objective of this study was to investigate a number of these determinants, with an emphasis on contactability. STUDY DESIGN AND SETTING Data were taken from the Passports project, a randomized controlled trial of an intervention to provide postrelease support to ex-prisoners in Queensland, Australia. Measures of contactability included intervention intensity, baseline collaterals, and follow-up telephone calls, with attrition at follow-up being the outcome event. Multivariable modeling was used to assess the independent effects of these measures on attrition. RESULTS Attrition was found to be more likely among those who were not contacted between the release and follow-up (adjusted odds ratio [AOR]: 2.93; 95% confidence interval [CI]: 1.87, 4.60), did not provide collaterals (AOR: 2.58; 95% CI: 1.68, 3.97), and received more than four telephone calls (AOR: 2.42; 95% CI: 1.61, 3.63). Evidence of dose-response relationships between attrition and the measures of collaterals and telephone calls was also seen to exist. CONCLUSION These findings have implications for sample size maintenance, especially those involving hard-to-reach populations. Subject to cost constraints and possible diminishing returns, researchers should endeavor to implement a study protocol that facilitates continued contact during follow-up.
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Recruiting drug using men who have sex with men in behavioral intervention trials: a comparison of internet and field-based strategies. AIDS Behav 2013; 17:688-99. [PMID: 22684657 DOI: 10.1007/s10461-012-0231-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although online and field-based samples of men who have sex with men (MSM) have been compared on a variety of markers, differences in drug use have not been well examined. In addition, generalization from studies comparing recruitment methods is often limited by a focus on either HIV seropositive or seronegative MSM. We compared two New York City-based samples of MSM recruited simultaneously between July 2009 and January 2010-one sample recruited in the field (n = 2,402) and one sample recruited via the Internet (n = 694). All recruitment efforts targeted men without restriction on age or self-reported HIV status. Our results show marked differences in drug and alcohol use between online and field-based samples of MSM. Specifically, men surveyed online were significantly more likely to have tried a variety of drugs, including methamphetamine, cocaine, and ecstasy. Men recruited online were also more likely to report older age, HIV positive serostatus, and "never" using condoms. Internet-based recruitment was found to be more cost-effective in terms of recruitment yield than was field-based recruitment.
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Thériault N, Bi P, Hiller JE, Nor M. Use of web 2.0 to recruit Australian gay men to an online HIV/AIDS survey. J Med Internet Res 2012; 14:e149. [PMID: 23128646 PMCID: PMC3510723 DOI: 10.2196/jmir.1819] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 02/01/2012] [Accepted: 04/07/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Continuous prevention efforts for human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) are recommended among those men who have sex with men (MSM). Creative use of e-technologies coupled with a better understanding of social networks could lead to improved health interventions among this risk population. OBJECTIVE The aims of the study were to (1) compare the impact of various advertising strategies on recruiting MSM participants to an online HIV/AIDS survey, and (2) explore the feasibility of using a social network service (SNS) for study advertising. METHODS A cross-sectional online survey was conducted in 2009. South Australian men over 18 years were invited to participate if they had had sexual intercourse with men in the previous year. A short questionnaire was used to collect demographics and information on sexual behavior, HIV history, use of the Internet for dating purposes, and sources of health information. The survey was promoted in community settings and online, including advertisements through social networks. RESULTS A total of 243 men completed the online survey during the 8-week data collection period. Online advertisements recruited 91.7% (220/240) of the sample. Conversely, traditional advertisements in the community recruited only 5.8% (14/240) of the sample. Ten volunteers were asked to advertise on their personal SNS application, but only 2 effectively did so. Only 18/240 (7.5%) of the respondents reported having learned of our study through the SNS application. In this sample, 19.3% (47/243) of participants had never been tested for HIV. Among the participants who had been tested, 12.8% (25/196) reported being HIV-positive. Regarding Internet use, 82.3% (200/243) of participants had dated online in the previous 6 months. Among the participants who had dated online, most (175/200, 87.5%) had found an Internet sexual partner and two-thirds (132/200, 66.0%) had had anal sex with these partner(s). Among men who had anal sex with an Internet partner, 68.2% (90/132) used a condom during sex. CONCLUSIONS The MSM participants in this study had high-risk profiles for HIV and other sexually transmitted diseases (STDs), which highlights the need for ongoing health interventions among this group. In this study, the SNS marketing strategy did not appear to create a viral effect and it had a relatively poor yield.
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Affiliation(s)
- Nathanaelle Thériault
- Direction régionale de santé publique de la Capitale-Nationale, Agence de la santé et des services sociaux de la Capitale-Nationale, Quebec, QC, Canada
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Wyatt GE, Williams JK, Gupta A, Malebranche D. Are cultural values and beliefs included in U.S. based HIV interventions? Prev Med 2012; 55:362-70. [PMID: 21884721 PMCID: PMC3736836 DOI: 10.1016/j.ypmed.2011.08.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 06/29/2011] [Accepted: 08/09/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the extent to which current United States based human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) prevention and risk reduction interventions address and include aspects of cultural beliefs in definitions, curricula, measures and related theories that may contradict current safer sex messages. METHOD A comprehensive literature review was conducted to determine which published human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) prevention and risk reduction interventions incorporated aspects of cultural beliefs. RESULTS This review of 166 human immunodeficiency virus (HIV) prevention and risk reduction interventions, published between 1988 and 2010, identified 34 interventions that varied in cultural definitions and the integration of cultural concepts. CONCLUSION human immunodeficiency virus (HIV) interventions need to move beyond targeting specific populations based upon race/ethnicity, gender, sexual, drug and/or risk behaviors and incorporate cultural beliefs and experiences pertinent to an individual's risk. Theory based interventions that incorporate cultural beliefs within a contextual framework are needed if prevention and risk reduction messages are to reach targeted at risk populations. Implications for the lack of uniformity of cultural definitions, measures and related theories are discussed and recommendations are made to ensure that cultural beliefs are acknowledged for their potential conflict with safer sex skills and practices.
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Affiliation(s)
- Gail E Wyatt
- University of California, Los Angeles, Department of Psychiatry & Biobehavioral Sciences, Semel Institute of Neuroscience and Human Behavior, Los Angeles, CA 90024-1759, USA.
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Bull SS, Levine DK, Black SR, Schmiege SJ, Santelli J. Social media-delivered sexual health intervention: a cluster randomized controlled trial. Am J Prev Med 2012; 43:467-74. [PMID: 23079168 PMCID: PMC3479665 DOI: 10.1016/j.amepre.2012.07.022] [Citation(s) in RCA: 215] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 04/30/2012] [Accepted: 07/03/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Youth are using social media regularly and represent a group facing substantial risk for sexually transmitted infection (STI). Although there is evidence that the Internet can be used effectively in supporting healthy sexual behavior, this has not yet extended to social networking sites. PURPOSE To determine whether STI prevention messages delivered via Facebook are efficacious in preventing increases in sexual risk behavior at 2 and 6 months. DESIGN Cluster RCT, October 2010-May 2011. SETTING/PARTICIPANTS Individuals (seeds) recruited in multiple settings (online, via newspaper ads and face-to-face) were asked to recruit three friends, who in turn recruited additional friends, extending three waves from the seed. Seeds and waves of friends were considered networks and exposed to either the intervention or control condition. INTERVENTION Exposure to Just/Us, a Facebook page developed with youth input, or to control content on 18-24 News, a Facebook page with current events for 2 months. MAIN OUTCOME MEASURES Condom use at last sex and proportion of sex acts protected by condoms. Repeated measures of nested data were used to model main effects of exposure to Just/Us and time by treatment interaction. RESULTS A total of 1578 participants enrolled, with 14% Latino and 35% African-American; 75% of participants completed at least one study follow-up. Time by treatment effects were observed at 2 months for condom use (intervention 68% vs control 56%, p=0.04) and proportion of sex acts protected by condoms (intervention 63% vs control 57%, p=0.03) where intervention participation reduced the tendency for condom use to decrease over time. No effects were seen at 6 months. CONCLUSIONS Social networking sites may be venues for efficacious health education interventions. More work is needed to understand what elements of social media are compelling, how network membership influences effects, and whether linking social media to clinical and social services can be beneficial. TRIAL REGISTRATION This study is registered at www.clinicaltrials.govNCT00725959.
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Affiliation(s)
- Sheana S Bull
- Department of Community and Behavioral Health, Colorado School of Public Health, Denver, Colorado, USA.
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Mathieu E, McGeechan K, Barratt A, Herbert R. Internet-based randomized controlled trials: a systematic review. J Am Med Inform Assoc 2012; 20:568-76. [PMID: 23065196 DOI: 10.1136/amiajnl-2012-001175] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The internet is increasingly being used to conduct randomized controlled trials (RCTs). Knowledge of the types of interventions evaluated and the methodological quality of these trials could inform decisions about whether to conduct future trials using conventional methods, fully online or a mixture of the two. OBJECTIVE To identify and describe the scope of internet-based RCTs for human health condition interventions and evaluate their methodological quality. METHODS A systematic review of RCTs of any health intervention conducted fully or primarily on the internet was carried out. RESULTS 23 fully and 27 primarily internet-based RCTs were identified. The first was conducted in 2000. The majority of trials evaluated interventions that involved providing health information to participants, but a few evaluated self-administered interventions (eg, valerian, stretching). Methodological quality was variable and the methods were generally poorly reported. The risk of bias was low in only a small number of trials; most had substantial methodological shortcomings. Only one trial was identified as meeting all criteria for adequate methodological quality. A particular problem was high rates of loss to follow-up (fully online: mean 47%; primarily online: mean 36%). CONCLUSIONS It is theoretically possible but perhaps difficult to test the effectiveness of health interventions rigorously with RCTs conducted fully or primarily over the internet. The use of the internet to conduct trials is more suited to pragmatic rather than explanatory trials. The main limitation of these trials is that they typically experience high rates of loss to follow-up. Methodological standards now accepted for traditional RCTs needs to be evident for online RCTs as well, especially in reporting of their methods.
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Affiliation(s)
- Erin Mathieu
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
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Côté J, Godin G, Guéhéneuc YG, Rouleau G, Ramirez-Garcìa P, Otis J, Tremblay C, Fadel G. Evaluation of a real-time virtual intervention to empower persons living with HIV to use therapy self-management: study protocol for an online randomized controlled trial. Trials 2012; 13:187. [PMID: 23039306 PMCID: PMC3519569 DOI: 10.1186/1745-6215-13-187] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 09/21/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Living with HIV makes considerable demands on a person in terms of self-management, especially as regards adherence to treatment and coping with adverse side-effects. The online HIV Treatment, Virtual Nursing Assistance and Education (Virus de I'immunodéficience Humaine-Traitement Assistance Virtuelle Infirmière et Enseignement; VIH-TAVIE™) intervention was developed to provide persons living with HIV (PLHIV) with personalized follow-up and real-time support in managing their medication intake on a daily basis. An online randomized controlled trial (RCT) will be conducted to evaluate the efficacy of this intervention primarily in optimizing adherence to combination anti-retroviral therapy (ART) among PLHIV. METHODS/DESIGN A convenience sample of 232 PLHIV will be split evenly and randomly between an experimental group that will use the web application, and a control group that will be handed a list of websites of interest. Participants must be aged 18 years or older, have been on ART for at least 6 months, and have internet access. The intervention is composed of four interactive computer sessions of 20 to 30 minutes hosted by a virtual nurse who engages the PLHIV in a skills-learning process aimed at improving self-management of medication intake. Adherence constitutes the principal outcome, and is defined as the intake of at least 95% of the prescribed tablets. The following intermediary measures will be assessed: self-efficacy and attitude towards antiretroviral medication, symptom-related discomfort, and emotional support. There will be three measurement times: baseline (T0), after 3 months (T3) and 6 months (T6) of baseline measurement. The principal analyses will focus on comparing the two groups in terms of treatment adherence at the end of follow-up at T6. An intention-to-treat (ITT) analysis will be carried out to evaluate the true value of the intervention in a real context. DISCUSSION Carrying out this online RCT poses various challenges in terms of recruitment, ethics, and data collection, including participant follow-up over an extended period. Collaboration between researchers from clinical disciplines (nursing, medicine), and experts in behavioral sciences information technology and media will be crucial to the development of innovative solutions to supplying and delivering health services. TRIAL REGISTRATION CE 11.184 / NCT 01510340.
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Affiliation(s)
- José Côté
- Research Chair in Innovative Nursing Practices, Research Centre of the Centre Hospitalier de l’Université de Montréal, Quebec, Canada
- Université de Montréal, Quebec, Canada
| | - Gaston Godin
- Canada Research Chair on Behaviour and Health, Université Laval, Quebec, Canada
| | - Yann-Gaël Guéhéneuc
- Canada Research Chair on Software Patterns and Patterns of Software, École Polytechnique Montreal, Quebec, Canada
| | - Geneviève Rouleau
- Research Chair in Innovative Nursing Practices, Research Centre of the Centre Hospitalier de l’Université de Montréal, Quebec, Canada
| | | | - Joanne Otis
- Canada Research Chair in Health Education, Université du Québec à Montréal, Quebec, Canada
| | - Cécile Tremblay
- Université de Montréal, Quebec, Canada
- Research Centre of the Centre Hospitalier de l’Université de Montréal, Quebec, Canada
| | - Ghayas Fadel
- Quebec Coalition Of Community-Based HIV/AIDS Organizations (COCQ-SIDA), Montreal, Quebec, Canada
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An online randomized controlled trial evaluating HIV prevention digital media interventions for men who have sex with men. PLoS One 2012; 7:e46252. [PMID: 23071551 PMCID: PMC3462792 DOI: 10.1371/journal.pone.0046252] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 08/31/2012] [Indexed: 12/02/2022] Open
Abstract
Background As HIV infection continues unabated, there is a need for effective interventions targeting at-risk men who have sex with men (MSM). Engaging MSM online where they meet sexual partners is critical for HIV prevention efforts. Methods A randomized controlled trial (RCT) conducted online among U.S. MSM recruited from several gay sexual networking websites assessed the impact of 2 HIV prevention videos and an HIV prevention webpage compared to a control condition for the study outcomes HIV testing, serostatus disclosure, and unprotected anal intercourse (UAI) at 60-day follow-up. Video conditions were pooled due to reduced power from low retention (53%, n = 1,631). No participant incentives were provided. Principal Findings Follow-up was completed by 1,631 (53%) of 3,092 eligible men. In the 60 days after the intervention, men in the pooled video condition were significantly more likely than men in the control to report full serostatus disclosure (‘asked and told’) with their last sexual partner (OR 1.32, 95% CI 1.01–1.74). Comparing baseline to follow-up, HIV-negative men in the pooled video (OR 0.70, 95% CI 0.54–0.91) and webpage condition (OR 0.43, 95% CI 0.25–0.72) significantly reduced UAI at follow-up. HIV-positive men in the pooled video condition significantly reduced UAI (OR 0.38, 95% CI 0.20–0.67) and serodiscordant UAI (OR 0.53, 95% CI 0.28–0.96) at follow-up. Conclusions/Significance Findings from this online RCT of MSM recruited from sexual networking websites suggest that a low cost, brief digital media intervention designed to engage critical thinking can increase HIV disclosure to sexual partners and decrease sexual risk. Effective, brief HIV prevention interventions featuring digital media that are made widely available may serve as a complementary part of an overall behavioral and biomedical strategy for reducing sexual risk by addressing the specific needs and circumstances of the target population, and by changing individual knowledge, motivations, and community norms. Trial Registration ClinicalTrials.gov NCT00649701
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