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Li DH, Macapagal K, Mongrella M, Saber R, Mustanski B. "Your Package Could Not Be Delivered": The State of Digital HIV Intervention Implementation in the US. Curr HIV/AIDS Rep 2024; 21:152-167. [PMID: 38502421 DOI: 10.1007/s11904-024-00693-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE OF REVIEW Despite continuous innovations and federal investment to create digital interventions addressing the HIV prevention and care continua, these interventions have not reached people in the U.S. at scale. This article reviews what is known about U.S. implementation of digital HIV interventions and presents a strategy to cross the research-to-practice chasm for these types of interventions. RECENT FINDINGS We conducted a narrative review of U.S.-based original research on implementation of digital HIV interventions and identified few studies reporting on implementation determinants, strategies, processes, or outcomes, particularly outside the context of effectiveness trials. To supplement the literature, in 2023, we surveyed 47 investigators representing 64 unique interventions about their experiences with implementation after their research trials. Respondents placed high importance on intervention implementation, but major barriers included lack of funding and clear implementation models, technology costs, and difficulty identifying partners equipped to deliver digital interventions. They felt that responsibility for implementation should be shared between intervention developers, deliverers (e.g., clinics), and a government entity. If an implementation center were to exist, most respondents wanted to be available for guidance or technical assistance but largely wanted less involvement. Numerous evidence-based, effective digital interventions exist to address HIV prevention and care. However, they remain "on the shelf" absent a concrete and sustainable model for real-world dissemination and implementation. Based on our findings, we call for the creation of national implementation centers, analogous to those in other health systems, to facilitate digital HIV intervention delivery and accelerate progress toward ending the U.S. epidemic.
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Affiliation(s)
- Dennis H Li
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Center for Dissemination and Implementation Science, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kathryn Macapagal
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Melissa Mongrella
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Rana Saber
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Brian Mustanski
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Smith AU, Khawly GM, Jann J, Zetina APM, Padilla J, Schnall R. A Review of Serious Gaming as an Intervention for HIV Prevention. Curr HIV/AIDS Rep 2023; 20:181-205. [PMID: 37213045 PMCID: PMC11177625 DOI: 10.1007/s11904-023-00659-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 05/23/2023]
Abstract
PURPOSEOF REVIEW Young people face the highest number of new HIV infections globally. With today's increasing access to smartphones, serious games have been viewed as an effective means of improving knowledge and behavioral outcomes. This systematic review describes current HIV prevention serious games and their relationship with HIV-related knowledge and behavioral outcomes. RECENT FINDINGS A search of HIV prevention serious games was conducted using PubMed, CINAL, IEEE, Web of Science, and Google Scholar. A total of 31 papers were identified, which consist of 20 studies and 11 protocols. Results for knowledge, attitudes, intentions, and behaviors were mixed. Two interventions reported improvement in PrEP usage and optimal dosing. Gaming appears to be a viable and engaging method to improve knowledge, attitudes, and behavioral outcomes to promote HIV prevention among diverse groups of adolescents and young adults globally. However, additional research is needed to understand how to implement this modality effectively.
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Affiliation(s)
- Ariel U Smith
- College of Nursing - Population Health Systems Science, University of Illinois at Chicago, Chicago, IL, USA.
| | - Gabriella M Khawly
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Janna Jann
- College of Nursing - Population Health Systems Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Ana Paola Mata Zetina
- Division of Scholarship and Research, Columbia University School of Nursing, New York, NY, USA
| | - Janeth Padilla
- Division of Scholarship and Research, Columbia University School of Nursing, New York, NY, USA
| | - Rebecca Schnall
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Becker ER, Shegog R, Savas LS, Frost EL, Coan SP, Healy CM, Spinner SW, Vernon SW. Parents' Experience With a Mobile Health Intervention to Influence Human Papillomavirus Vaccination Decision Making: Mixed Methods Study. JMIR Pediatr Parent 2022; 5:e30340. [PMID: 35188469 PMCID: PMC8902654 DOI: 10.2196/30340] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/25/2021] [Accepted: 11/17/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV)-attributed cancers are preventable, yet HPV vaccination rates severely lag behind other adolescent vaccinations. HPVcancerFree (HPVCF) is a mobile health (mHealth) intervention developed to influence parental HPV vaccination decision making by raising awareness of HPV, reducing HPV vaccination barriers, and enabling HPV vaccination scheduling and reminders through a smartphone app. Evaluating the user experience of mHealth interventions is a vital component in assessing their quality and success but tends to be underreported in mHealth intervention evaluation. OBJECTIVE We aimed to evaluate the user experience of HPVCF, an HPV cancer prevention app designed for a pediatric clinic network, using mixed methods data collected from log files, survey measures, and qualitative feedback. METHODS Study data were evaluated from parents in a large US pediatric clinic network using HPVCF in the treatment study condition of a group randomized controlled trial. Log data captured HPVCF retention and use. Postintervention rating scales and items assessed HPVCF utility, usefulness, understandability, appeal, credibility, and perceived impact. Overall quality was evaluated using the user version of the Mobile Application Rating Scale (uMars). Open-ended responses assessed parent recommendations for HPVCF enhancement. RESULTS The 98 parents were mainly female (n=94, 96%), 41 (5.67) years of age, college educated (n=55, 56%), and White and non-Hispanic (n=55, 56%) and had private health insurance for their children (n=75, 77%). Parents used HPVCF 197 times, with the average visit duration approximating 3.5 minutes. The uMARS app quality score was positively skewed (4.2/5.0). Mean ratings were highest for information (4.46 [SD 0.53]) and lowest for engagement (3.74 [SD 0.69]). In addition, of 95 parents, 45 (47%) rated HPVCF as helpful in HPV vaccination decision making and 16 (17%) attributed HPV vaccine initiation to HPVCF. Parents reported that HPVCF increased their awareness (84/95, 88%), knowledge (84/95, 88%), and HPV vaccination intentions (64/95, 67%). Most of the 98 parents rated the 4 HPVCF components as useful (72-92 [73%-94%]). Parents also agreed that HPVCF is clear (86/95, 91%), accurate (86/95, 91%), and more helpful than other HPV vaccine information they had received (89/95, 94%) and that they would recommend it to others (81/95, 85%). In addition, parents suggested ways to increase awareness and engagement with the app, along with opportunities to enhance the content and functionality. CONCLUSIONS HPVCF was well received by parents and performed well on indicators of quality, usefulness, utility, credibility, and perceived impact. This study contributes a multimethod and multimeasure evaluation to the growing body of literature focused on assessing the user experience of patient-focused technology-mediated applications for HPV education.
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Affiliation(s)
- Elisabeth Rb Becker
- University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Ross Shegog
- University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Lara S Savas
- University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Erica L Frost
- University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Sharon P Coan
- University of Texas Health Science Center at Houston, Houston, TX, United States
| | - C Mary Healy
- Baylor College of Medicine, Houston, TX, United States
| | | | - Sally W Vernon
- University of Texas Health Science Center at Houston, Houston, TX, United States
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Sacca L, Craig Rushing S, Markham C, Shegog R, Peskin M, Hernandez B, Gaston A, Singer M, Trevino N, Correa CC, Jessen C, Williamson J, Thomas J. Assessment of the Reach, Usability, and Perceived Impact of " Talking Is Power": A Parental Sexual Health Text-Messaging Service and Web-Based Resource to Empower Sensitive Conversations with American Indian and Alaska Native Teens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9126. [PMID: 34501715 PMCID: PMC8431363 DOI: 10.3390/ijerph18179126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Early sexual debut among American Indian and Alaska Native (AI/AN) adolescents has been associated with an increased risk of teenage pregnancies and sexually transmitted infections, along with an increased risk of having multiple lifetime sexual partners, and engaging in greater frequency of sex, substance abuse, and lack of condom use. A major protective factor against early sexual debut among AI/AN youth is the familial system. Interventions aiming to improve parent-child communication and parental warmth toward adolescent sexual health topics were reported to contribute to positive youth sexual health outcomes, specifically among minority youth. Healthy Native Youth thus developed the Talking is Power text-messaging service to guide parents and caring adults on how to initiate sensitive topics with youth and how to support them in making informed decisions regarding sex and healthy relationships. METHODS Descriptive statistics were used to demonstrate website analytics and reach per views and time spent on each page, and for displaying participants' responses to the questions on the usability of the Talking is Power text-messaging series. To assess the perceived impact of the series, the differences in mean percentage scores of the question assessing parental comfort in engaging in sexual health topics with youth between pre- and post-intervention were calculated using two-sample t-tests of equal variances. Descriptive content analysis was adopted to highlight emerging themes from open-ended items. RESULTS When looking at reach, 862 entrances were recorded during the specified time period (5.8% of total entrances to HNY website), while the bounce rate was set at 73.1% (22.6% greater than the industry average), and the exit rate was 54.3% (15.2% greater than the industry average). Series usability was highly ranked on the 5-Likert scale in terms of signing up for a similar series on a different topic, quality of images, texts, and links, relating to prompts, and change in sparking sensitive conversations with youth. High likelihood of recommending the series to a friend or colleague was also reported by participants (0-10). No significant difference in parental comfort levels was reported (p = 0.78 > 0.05). Main themes provided suggestions for improving the series mode of delivery, while others included positive feedback about the material, with the possibility of expanding the series to other adolescent health topics. CONCLUSION Lessons learned during the design, dissemination, and evaluation of the resource's usability, reach, and perceived impact may be of interest to other Indigenous communities who are in the process of adapting and/or implementing similar approaches.
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Affiliation(s)
- Lea Sacca
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (C.M.); (R.S.); (M.P.); (C.C.C.)
| | - Stephanie Craig Rushing
- Northwest Portland Area Indian Health Board, Portland, OR 97201, USA; (A.G.); (M.S.); (N.T.)
| | - Christine Markham
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (C.M.); (R.S.); (M.P.); (C.C.C.)
| | - Ross Shegog
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (C.M.); (R.S.); (M.P.); (C.C.C.)
| | - Melissa Peskin
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (C.M.); (R.S.); (M.P.); (C.C.C.)
| | - Belinda Hernandez
- School of Public Health, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA;
| | - Amanda Gaston
- Northwest Portland Area Indian Health Board, Portland, OR 97201, USA; (A.G.); (M.S.); (N.T.)
| | - Michelle Singer
- Northwest Portland Area Indian Health Board, Portland, OR 97201, USA; (A.G.); (M.S.); (N.T.)
| | - Nicole Trevino
- Northwest Portland Area Indian Health Board, Portland, OR 97201, USA; (A.G.); (M.S.); (N.T.)
| | - Chrystial C. Correa
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (C.M.); (R.S.); (M.P.); (C.C.C.)
| | - Cornelia Jessen
- Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA; (C.J.); (J.W.)
| | - Jennifer Williamson
- Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA; (C.J.); (J.W.)
| | - Jerri Thomas
- Inter Tribal Council of Arizona, Inc., Phoenix, AZ 85004, USA;
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Ilskens K, Wrona KJ, Dockweiler C, Fischer F. Evidence map on serious games in preventing sexually transmitted infections among adolescents: Systematic review about outcome categories investigated in primary studies (Preprint). JMIR Serious Games 2021; 10:e30526. [PMID: 35107438 PMCID: PMC8851332 DOI: 10.2196/30526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/01/2021] [Accepted: 10/23/2021] [Indexed: 11/26/2022] Open
Abstract
Background Sexually transmitted infections (STIs) represent a global health risk. Adolescents are at increased risk of infection for several reasons such as lack of knowledge, risky sexual behaviors, and lack of behavioral sills (eg, to negotiate safer sex). Given the fact that adolescents often use digital media and that serious games are considered to have the potential to change knowledge, attitudes and behavior, serious games represent an opportunity for the prevention of STIs. Objective The aim of this systematic review was to identify and systematically summarize the dimensions that have been investigated in primary studies on serious games targeting STI prevention among adolescents. Methods A systematic review was conducted in PubMed and Web of Science. Studies published from 2009 to 2021 were included that assessed the effectiveness of serious games on adolescent sexual health. A total of 18 studies met the inclusion criteria and were categorized according to dimensions of effectiveness and user experience. Results Various dimensions of effectiveness and aspects of user experience were investigated in the primary studies. In total, 9 dimensions of effectiveness were observed: sexual behavior, behavioral intentions, knowledge, attitudes and beliefs, self-efficacy and personal limitations, character traits and future orientation, environmental and individual risk factors, risk perception and risk assessment, as well as normative beliefs and (social) norms. Furthermore, several dimensions related to user experience were investigated in primary studies, that is, motivation, acceptability, trustworthiness, comprehensibility, handling and control, perceived effectiveness, as well as satisfaction. Conclusions This review provides an overview of serious games interventions that are vastly different in approach, content, and even platform. In previous studies, knowledge has already been comprehensively assessed, and a positive influence of serious games on knowledge about sexual topics is evident. The results clearly show that adolescents’ sexual knowledge has been increased by the serious games interventions. However, methodological and content differences in the surveys make it difficult to draw conclusions about the effectiveness related to changes in attitudes and behavior.
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Affiliation(s)
- Karina Ilskens
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Kamil J Wrona
- School of Public Health, Bielefeld University, Bielefeld, Germany
- Faculty of Health, University of Applied Sciences Bielefeld, Bielefeld, Germany
| | - Christoph Dockweiler
- Department of Digital Public Health and Biomedicine, School of Life Sciences, University of Siegen, Siegen, Germany
| | - Florian Fischer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Institute of Gerontological Health Services and Nursing Research, Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany
- Bavarian Research Center for Digital Health and Social Care, Kempten University of Applied Sciences, Kempten, Germany
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Shegog R, Armistead L, Markham C, Dube S, Song HY, Chaudhary P, Spencer A, Peskin M, Santa Maria D, Wilkerson JM, Addy R, Tortolero Emery S, McLaughlin J. A Web-Based Game for Young Adolescents to Improve Parental Communication and Prevent Unintended Pregnancy and Sexually Transmitted Infections (The Secret of Seven Stones): Development and Feasibility Study. JMIR Serious Games 2021; 9:e23088. [PMID: 33502323 PMCID: PMC7875699 DOI: 10.2196/23088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/03/2020] [Accepted: 11/26/2020] [Indexed: 12/02/2022] Open
Abstract
Background Early adolescent unintended pregnancy and sexually transmitted infection prevention are significant public health challenges in the United States. Parental influence can help adolescents make responsible and informed sexual health decisions toward delayed sexual debut; yet parents often feel ill equipped to communicate about sex-related topics. Intergenerational games offer a potential strategy to provide life skills training to young adolescents (aged 11-14 years) while engaging them and their parents in communication about sexual health. Objective This study aims to describe the development of a web-based online sexual health intergenerational adventure game, the Secret of Seven Stones (SSS), using an intervention mapping (IM) approach for developing theory- and evidence-based interventions. Methods We followed the IM development steps to describe a theoretical and empirical model for young adolescent sexual health behavior, define target behaviors and change objectives, identify theory-based methods and practical applications to inform design and function, develop and test a prototype of 2 game levels to assess feasibility before developing the complete 18-level game, draft an implementation plan that includes a commercial dissemination strategy, and draft an evaluation plan including a study design for a randomized controlled trial efficacy trial of SSS. Results SSS comprised an adventure game for young adolescent skills training delivered via a desktop computer, a text-based notification system to provide progress updates for parents and cues to initiate dialogue with their 11- to 14-year-old child, and a website for parent skills training and progress monitoring. Formative prototype testing demonstrated feasibility for in-home use and positive usability ratings. Conclusions The SSS intergenerational game provides a unique addition to the limited cadre of home-based programs that facilitate parent involvement in influencing young adolescent behaviors and reducing adolescent sexual risk taking. The IM framework provided a logical and thorough approach to development and testing, attentive to the need for theoretical and empirical foundations in serious games for health.
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Affiliation(s)
- Ross Shegog
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center Houston, Houston, TX, United States
| | | | - Christine Markham
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Sara Dube
- The Widen Lab, University of Texas at Austin, Austin, TX, United States
| | - Hsing-Yi Song
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Pooja Chaudhary
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Angela Spencer
- Special Supplemental Nutrition Program for Women, Infants and Children (WIC), Washington, DC, United States
| | - Melissa Peskin
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Diane Santa Maria
- School of Nursing, University of Texas Health Science Center Houston, Houston, TX, United States
| | - J Michael Wilkerson
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Robert Addy
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Susan Tortolero Emery
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center Houston, Houston, TX, United States
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Teadt S, Burns JC, Montgomery TM, Darbes L. African American Adolescents and Young Adults, New Media, and Sexual Health: Scoping Review. JMIR Mhealth Uhealth 2020; 8:e19459. [PMID: 33016890 PMCID: PMC7573696 DOI: 10.2196/19459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/20/2020] [Accepted: 08/03/2020] [Indexed: 12/28/2022] Open
Abstract
Background Rates of sexually transmitted infections and unintended pregnancies are disproportionately high among African American adolescents and young adults (AYA). New media platforms such as social networking sites, microblogs, online video sites, and mobile phone applications may be a promising approach in promoting safe sex and preventing sexually transmitted infections. Objective The purpose of this scoping review was to address promising approaches in new media that may serve as valuable tools in health promotion, prevention, education, and intervention development aimed at African American AYA. Methods An electronic search was conducted using Google Scholar, Scopus, Cumulative Index to Nursing and Allied Health (CINHAL), and PubMed online databases. Concept blocks and MeSH terminology were used to identify articles around African American youth and new media. Results The search yielded 1169 articles, and 16 publications met the criteria. Studies from the review found themes in new media that included feasibility, changing attitudes, and improving knowledge related to sexual health behavior among youth of color. Conclusions New media is a promising and feasible platform for improving the sexual health of African American AYA. Further research is suggested to better understand the benefits of new media as a sexual health promotion tool among this specific population.
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Affiliation(s)
- Sierra Teadt
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Jade C Burns
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Tiffany M Montgomery
- College of Nursing & Health Professions, Drexel University, Philadelphia, PA, United States
| | - Lynae Darbes
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
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Kamke K, Widman L, Desmarais SL. Evaluation of an Online Sexual Health Program among Adolescent Girls with Emotional and Behavioral Difficulties. JOURNAL OF CHILD AND FAMILY STUDIES 2020; 29:1044-1054. [PMID: 33456296 PMCID: PMC7810243 DOI: 10.1007/s10826-019-01685-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Adolescent girls with emotional and behavioral difficulties (EBDs) have a heightened risk of negative sexual health, including HIV, other sexually transmitted infections (STIs), and unplanned pregnancy. Few evidence-based sexual health interventions are available for adolescent girls with EBDs. This study tested the feasibility, acceptability, and efficacy of a brief, online sexual health program called HEART (Health Education and Relationship Training). METHODS Forty-seven participants (M-age = 15.79; SD = 1.71; 62% Black, 23% Hispanic) recruited from community-based organizations in the southeastern U.S. were compared to a non-equivalent comparison group who received an attention-matched intervention. RESULTS Findings support the feasibility of participant recruitment and program administration in community-based settings. Participants completed HEART in 44 minutes and experienced few technological difficulties. HEART was highly acceptable: most participants liked, learned from, and were engaged with the program. Further, 92% would recommend HEART to a friend and 98% would use what they learned in the future. At posttest, intervention participants had significantly higher communication intentions, communication skills, STI/HIV knowledge, sexual self-efficacy, condom attitudes, and condom norms than the comparison group (ps < .003; effect size ds = .38-1.65). Significant improvement in condom intentions was observed when comparing pretest to posttest scores among intervention participants only, t(46) = -3.21, d = 0.47. CONCLUSIONS Findings support the feasibility, acceptability, and efficacy of HEART among adolescent girls with EBDs in community-based settings. This study also addresses the growing need for research into the transferability of sexual health interventions to facilitate evidence-based decision-making about program dissemination and implementation.
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Affiliation(s)
- K Kamke
- North Carolina State University, Raleigh, NC
| | - L Widman
- North Carolina State University, Raleigh, NC
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Erguera XA, Johnson MO, Neilands TB, Ruel T, Berrean B, Thomas S, Saberi P. WYZ: a pilot study protocol for designing and developing a mobile health application for engagement in HIV care and medication adherence in youth and young adults living with HIV. BMJ Open 2019; 9:e030473. [PMID: 31061063 PMCID: PMC6501960 DOI: 10.1136/bmjopen-2019-030473] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Youth and young adults bear a disproportionate share of the HIV burden and there is a critical need for interventions to curb health disparities experienced among these age groups. The purpose of our research is to build on our theory-guided model and formative research to develop a mobile health application, called WYZ, for improved engagement in HIV care and antiretroviral therapy adherence, and pilot test it among youth and young adults living with HIV (YLWH). In this paper, we explain the design and development of WYZ for YLWH, describe the design of a forthcoming pilot trial for evaluating the feasibility and acceptability of WYZ and compare WYZ with other mobile health applications being developed to improve engagement in HIV care and antiretroviral medication adherence. METHODS AND ANALYSIS We used an agile methodology, shown to be useful in software development, and elicited feedback during beta testing to develop WYZ. WYZ is a modular, adaptive and personalised intervention delivered via a mobile phone. It is grounded in the information, motivation, behaviouralskills model which has been valuable for understanding and guiding the development of interventions for complex health behaviours. WYZ was created in collaboration with YLWH aged 18-29 years using a human-centred design approach that emphasises understanding the perspective of the users of the technology. WYZ is intended to improve engagement in HIV care by: (1) enhancing medication adherence self-efficacy, (2) increasing awareness and use of community resources, (3) reducing barriers to communication between youth and their healthcare team, and (4) providing a secure platform for the formation of a private online community of YLWH. We will conduct a 6-month single-arm pilot study to examine feasibility and acceptability of WYZ among 76 YLWH who live or receive care in the San Francisco Bay Area. All study activities, including recruitment, screening, enrolment, study assessments, provision of incentives and exit interviews, will be conducted remotely. We will explore feasibility and acceptability outcomes of the intervention using quantitative and qualitative methods. ETHICS AND DISSEMINATION Study staff will obtain written consent for study participation from all participants. This study and its protocols have been approved by the University of California San Francisco (UCSF) Institutional Review Board. Study staff will work with the UCSF Center for AIDS Prevention Studies' Community Engagement Core and the Youth Advisory Panel to disseminate results to the participants and the community using presentations, community forums, journal publications and/or social media. TRIAL REGISTRATION NUMBER NCT03587857; Pre-results.
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Affiliation(s)
- Xavier A. Erguera
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Mallory O. Johnson
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Torsten B. Neilands
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Theodore Ruel
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Beth Berrean
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sean Thomas
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Parya Saberi
- Medicine, University of California San Francisco, San Francisco, California, USA
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Morales A, Espada JP, Orgilés M, Escribano S, Johnson BT, Lightfoot M. Interventions to reduce risk for sexually transmitted infections in adolescents: A meta-analysis of trials, 2008-2016. PLoS One 2018; 13:e0199421. [PMID: 29953546 PMCID: PMC6023153 DOI: 10.1371/journal.pone.0199421] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/07/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Numerous studies have evaluated the efficacy of interventions to reduce risk for sexually transmitted infections in adolescents in recent years, but their global effects remain unknown since 2008, the last date of a comprehensive review of prior studies. AIMS This study aims at evaluating the efficacy of interventions to promote sexual health, reduce STIs and unplanned pregnancies targeted to adolescents available after 2008; and analyzing the moderators of their global efficacy. METHODS We searched electronic databases and manual searches of some journals focused on STIs in May 2016. The studies evaluated the efficacy of interventions to reduce sexual risk in adolescents (age range: 11-19) anywhere in the world. Effect size of the relevant outcomes for sexual risk was calculated for every study. Analyses incorporated random-effect assumptions for each outcome. The homogeneity in the results was examined with the I2 statistic and its associated 95% confident interval. RESULTS Data from 63 studies (59,795 participants) were analyzed for behavioral and non-behavioral outcomes. In the short term, interventions had a positive impact in sexual health-related knowledge (Hedges'g = 1.01), attitudes (g = 0.29), self-efficacy toward condom use (g = 0.22), intention to refuse sex (g = 0.56), condom use intention (g = 0.46), and condom use (g = 0.38). In the medium term, positive effects observed at the short-term were maintained, although effect size significantly decreased in all variables. In the long term, interventions improved condom use (g = 0.47). Moderators of the efficacy are discussed. CONCLUSIONS Sexual health promotion interventions are effective to promote sexual health through increasing condom use. Effects on non-behavioral variables tend to decrease over time, while condom use increased in the long-term. Interventions should focus on the long-term efficacy, especially in behavioral and biological measures.
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Affiliation(s)
- Alexandra Morales
- Department of Health Psychology, Miguel Hernández University, Elche, Spain
| | - José P. Espada
- Department of Health Psychology, Miguel Hernández University, Elche, Spain
| | - Mireia Orgilés
- Department of Health Psychology, Miguel Hernández University, Elche, Spain
| | - Silvia Escribano
- Department of Health Psychology, Miguel Hernández University, Elche, Spain
| | - Blair T. Johnson
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, Connecticut, United States of America
| | - Marguerita Lightfoot
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
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11
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Eleftheriou A, Bullock S, Graham CA, Ingham R. Using Computer Simulations for Investigating a Sex Education Intervention: An Exploratory Study. JMIR Serious Games 2017; 5:e9. [PMID: 28468747 PMCID: PMC5438447 DOI: 10.2196/games.6598] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/04/2016] [Accepted: 02/08/2017] [Indexed: 11/29/2022] Open
Abstract
Background Sexually transmitted infections (STIs) are ongoing concerns. The best method for preventing the transmission of these infections is the correct and consistent use of condoms. Few studies have explored the use of games in interventions for increasing condom use by challenging the false sense of security associated with judging the presence of an STI based on attractiveness. Objectives The primary purpose of this study was to explore the potential use of computer simulation as a serious game for sex education. Specific aims were to (1) study the influence of a newly designed serious game on self-rated confidence for assessing STI risk and (2) examine whether this varied by gender, age, and scores on sexuality-related personality trait measures. Methods This paper undertook a Web-based questionnaire study employing between and within subject analyses. A Web-based platform hosted in the United Kingdom was used to deliver male and female stimuli (facial photographs) and collect data. A convenience sample group of 66 participants (64%, 42/66) male, mean age 22.5 years) completed the Term on the Tides, a computer simulation developed for this study. Participants also completed questionnaires on demographics, sexual preferences, sexual risk evaluations, the Sexual Sensation Seeking Scale (SSS), and the Sexual Inhibition Subscale 2 (SIS2) of the Sexual Inhibition/Sexual Excitation Scales-Short Form (SIS/SES - SF). Results The overall confidence of participants to evaluate sexual risks reduced after playing the game (P<.005). Age and personality trait measures did not predict the change in confidence of evaluating risk. Women demonstrated larger shifts in confidence than did men (P=.03). Conclusions This study extends the literature by investigating the potential of computer simulations as a serious game for sex education. Engaging in the Term on the Tides game had an impact on participants’ confidence in evaluating sexual risks.
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Affiliation(s)
- Anastasia Eleftheriou
- Institute for Complex Systems Simulation, Electronics and Computer Science, University of Southampton, Southampton, United Kingdom
| | - Seth Bullock
- Department of Computer Science, University of Bristol, Bristol, United Kingdom
| | - Cynthia A Graham
- Centre for Sexual Health Research, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Roger Ingham
- Centre for Sexual Health Research, Department of Psychology, University of Southampton, Southampton, United Kingdom
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12
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Shegog R, Craig Rushing S, Gorman G, Jessen C, Torres J, Lane TL, Gaston A, Revels TK, Williamson J, Peskin MF, D'Cruz J, Tortolero S, Markham CM. NATIVE-It's Your Game: Adapting a Technology-Based Sexual Health Curriculum for American Indian and Alaska Native youth. J Prim Prev 2017; 38:27-48. [PMID: 27520459 DOI: 10.1007/s10935-016-0440-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sexually transmitted infection (STI) and birth rates among American Indian/Alaska Native (AI/AN) youth indicate a need for effective middle school HIV/STI and pregnancy prevention curricula to delay, or mitigate, the consequences of early sexual activity. While effective curricula exist, there is a dearth of curricula with content salient to AI/AN youth. Further, there is a lack of sexual health curricula that take advantage of the motivational appeal, reach, and fidelity of communication technology for this population, who are sophisticated technology users. We describe the adaptation process used to develop Native It's Your Game, a stand-alone 13-lesson Internet-based sexual health life-skills curriculum adapted from an existing promising sexual health curriculum, It's Your Game-Tech (IYG-Tech). The adaptation included three phases: (1) pre-adaptation needs assessment and IYG-Tech usability testing; (2) adaptation, including design document development, prototype programming, and alpha testing; and (3) post-adaption usability testing. Laboratory- and school-based tests with AI/AN middle school youth demonstrated high ratings on usability parameters. Youth rated the Native IYG lessons favorably in meeting the needs of AI/AN youth (54-86 % agreement across lessons) and in comparison to other learning channels (57-100 %) and rated the lessons as helpful in making better health choices (73-100 %). Tribal stakeholders rated Native IYG favorably, and suggested it was culturally appropriate for AI/AN youth and suitable for implementation in tribal settings. Further efficacy testing is indicated for Native IYG, as a potential strategy to deliver HIV/STI and pregnancy prevention to traditionally underserved AI/AN middle school youth.
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Affiliation(s)
- Ross Shegog
- Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, The University of Texas Health Science Center Houston, 7000 Fannin Street, Suite 2668, Houston, TX, 77030, USA.
| | - Stephanie Craig Rushing
- Northwest Portland Area Indian Health Board, 2121 SW Broadway, Suite 300, Portland, OR, 97201, USA
| | - Gwenda Gorman
- Inter Tribal Council of Arizona, Inc., 2214 North Central Avenue, Suite 100, Phoenix, AZ, 85004, USA
| | - Cornelia Jessen
- Division of Community Health Services, Alaska Native Tribal Health Consortium, 3900 Ambassador Drive, Anchorage, AK, 99508, USA
| | - Jennifer Torres
- Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, The University of Texas Health Science Center Houston, 7000 Fannin Street, Suite 2668, Houston, TX, 77030, USA
| | - Travis L Lane
- Inter Tribal Council of Arizona, Inc., 2214 North Central Avenue, Suite 100, Phoenix, AZ, 85004, USA
| | - Amanda Gaston
- Northwest Portland Area Indian Health Board, 2121 SW Broadway, Suite 300, Portland, OR, 97201, USA
| | - Taija Koogei Revels
- Division of Community Health Services, Alaska Native Tribal Health Consortium, 3900 Ambassador Drive, Anchorage, AK, 99508, USA
| | - Jennifer Williamson
- Division of Community Health Services, Alaska Native Tribal Health Consortium, 3900 Ambassador Drive, Anchorage, AK, 99508, USA
| | - Melissa F Peskin
- Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, The University of Texas Health Science Center Houston, 7000 Fannin Street, Suite 2668, Houston, TX, 77030, USA
| | - Jina D'Cruz
- Center for Disease Control (CDC), Office of Public Health Scientific Services (OPHSS), Center for Surveillance, Epidemiology and Laboratory Services (CSELS), Dekalb County, Atlanta, GA, USA
| | - Susan Tortolero
- Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, The University of Texas Health Science Center Houston, 7000 Fannin Street, Suite 2668, Houston, TX, 77030, USA
| | - Christine M Markham
- Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, The University of Texas Health Science Center Houston, 7000 Fannin Street, Suite 2668, Houston, TX, 77030, USA
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13
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Flanders CE, Pragg L, Dobinson C, Logie C. Young sexual minority women's use of the internet and other digital technologies for sexual health information seeking. CANADIAN JOURNAL OF HUMAN SEXUALITY 2017. [DOI: 10.3138/cjhs.261-a2] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We know little about the online sexual health information seeking practices and needs specific to young sexual minority women. This is problematic as young sexual minority women report heightened negative sexual health outcomes in contrast to their heterosexual peers, which could be partially addressed through being able to access effective, relevant online sexual health information sources. This exploratory qualitative study employed a series of focus groups to understand more about what types of online resources young sexual minority women access, their motivations for using those resources, and what types of sexual health information they need. The focus group data were analyzed from a thematic analysis approach. Results indicate that participants used a wide range of online resources, such as apps, websites, blogs, and YouTube. The type of resource accessed often depended upon the information needed. Participants reported preferring online resources due to experiences or expectations of heteronormativity from their sexual health service providers, convenience and accessibility, the capacity to remain anonymous, and the lack of relevant sexual health information offline. These findings help begin to fill the gap on knowledge of young sexual minority women's sexual health information seeking practices, which can be used for the development of effective online sexual health information resources targeting young sexual minority women.
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Affiliation(s)
- Corey E. Flanders
- Department of Psychology and Education, Mount Holyoke College, South Hadley, MA
| | - Lauren Pragg
- Department of Social and Political Thought, York University, Toronto, ON
| | | | - Carmen Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON
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14
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D'Cruz J, Santa Maria D, Dube S, Markham C, McLaughlin J, Wilkerson JM, Peskin MF, Tortolero S, Shegog R. Promoting Parent-Child Sexual Health Dialogue with an Intergenerational Game: Parent and Youth Perspectives. Games Health J 2017; 4:113-22. [PMID: 26181805 DOI: 10.1089/g4h.2014.0080] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Sexual health discussions between parents and their preadolescent youth can delay sexual debut and increase condom and contraceptive use. However, parents frequently report being uncomfortable talking with their youth about sex, often reporting a lack of self-efficacy and skills to inform and motivate responsible decision making by youth. Intergenerational games may support parent-youth sexual health communication. The purpose of this study was to explore parent and youth perspectives on a proposed intergenerational game designed to increase effective parent-youth sexual health communication and skills training. MATERIALS AND METHODS Eight focus groups were conducted: four with parents (n=20) and four with their 11-14-year-old youth (n=19), to identify similarities and differences in perspectives on gaming context, delivery channel, content, and design (components, features, and function) that might facilitate dyadic sexual health communication. RESULTS Participants concurred that a sex education game could improve communication while being responsive to family time constraints. They affirmed the demand for an immersive story-based educational adventure game using mobile platforms and flexible communication modalities. Emergent themes informed the development of a features inventory (including educational and gaming strategies, communication components, channel, and setting) and upper-level program flow to guide future game development. CONCLUSIONS This study supports the potential of a game to be a viable medium to bring a shared dyadic sexual health educational experience to parents and youth that could engage them in a motivationally appealing way to meaningfully impact their sexual health communication and youth sexual risk behaviors.
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Affiliation(s)
- Jina D'Cruz
- 1 Center for Health Promotion and Prevention Research, University of Texas Health Science Center , Houston, Texas
| | - Diane Santa Maria
- 1 Center for Health Promotion and Prevention Research, University of Texas Health Science Center , Houston, Texas
| | - Sara Dube
- 1 Center for Health Promotion and Prevention Research, University of Texas Health Science Center , Houston, Texas
| | - Christine Markham
- 1 Center for Health Promotion and Prevention Research, University of Texas Health Science Center , Houston, Texas
| | | | - Johnny M Wilkerson
- 1 Center for Health Promotion and Prevention Research, University of Texas Health Science Center , Houston, Texas
| | - Melissa F Peskin
- 1 Center for Health Promotion and Prevention Research, University of Texas Health Science Center , Houston, Texas
| | - Susan Tortolero
- 1 Center for Health Promotion and Prevention Research, University of Texas Health Science Center , Houston, Texas
| | - Ross Shegog
- 1 Center for Health Promotion and Prevention Research, University of Texas Health Science Center , Houston, Texas
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15
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Markham CM, Craig Rushing S, Jessen C, Gorman G, Torres J, Lambert WE, Prokhorov AV, Miller L, Allums-Featherston K, Addy RC, Peskin MF, Shegog R. Internet-Based Delivery of Evidence-Based Health Promotion Programs Among American Indian and Alaska Native Youth: A Case Study. JMIR Res Protoc 2016; 5:e225. [PMID: 27872037 PMCID: PMC5138449 DOI: 10.2196/resprot.6017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 10/15/2016] [Accepted: 10/28/2016] [Indexed: 11/29/2022] Open
Abstract
Background American Indian and Alaska Native (AI/AN) youth face multiple health challenges compared to other racial/ethnic groups, which could potentially be ameliorated by the dissemination of evidence-based adolescent health promotion programs. Previous studies have indicated that limited trained personnel, cultural barriers, and geographic isolation may hinder the reach and implementation of evidence-based health promotion programs among AI/AN youth. Although Internet access is variable in AI/AN communities across the United States, it is swiftly and steadily improving, and it may provide a viable strategy to disseminate evidence-based health promotion programs to this underserved population. Objective We explored the potential of using the Internet to disseminate evidence-based health promotion programs on multiple health topics to AI/AN youth living in diverse communities across 3 geographically dispersed regions of the United States. Specifically, we assessed the Internet’s potential to increase the reach and implementation of evidence-based health promotion programs for AI/AN youth, and to engage AI/AN youth. Methods This randomized controlled trial was conducted in 25 participating sites in Alaska, Arizona, and the Pacific Northwest. Predominantly AI/AN youth, aged 12-14 years, accessed 6 evidence-based health promotion programs delivered via the Internet, which focused on sexual health, hearing loss, alcohol use, tobacco use, drug use, and nutrition and physical activity. Adult site coordinators completed computer-based education inventory surveys, connectivity and bandwidth testing to assess parameters related to program reach (computer access, connectivity, and bandwidth), and implementation logs to assess barriers to implementation (program errors and delivery issues). We assessed youths’ perceptions of program engagement via ratings on ease of use, understandability, credibility, likeability, perceived impact, and motivational appeal, using previously established measures. Results Sites had sufficient computer access and Internet connectivity to implement the 6 programs with adequate fidelity; however, variable bandwidth (ranging from 0.24 to 93.5 megabits per second; mean 25.6) and technical issues led some sites to access programs via back-up modalities (eg, uploading the programs from a Universal Serial Bus drive). The number of youth providing engagement ratings varied by program (n=40-191; 48-60% female, 85-90% self-identified AI/AN). Across programs, youth rated the programs as easy to use (68-91%), trustworthy (61-89%), likeable (59-87%), and impactful (63-91%). Most youth understood the words in the programs (60-83%), although some needed hints to complete the programs (16-49%). Overall, 37-66% of the participants would recommend the programs to a classmate, and 62-87% found the programs enjoyable when compared to other school lessons. Conclusions Findings demonstrate the potential of the Internet to enhance the reach and implementation of evidence-based health promotion programs, and to engage AI/AN youth. Provision of back-up modalities is recommended to address possible connectivity or technical issues. The dissemination of Internet-based health promotion programs may be a promising strategy to address health disparities for this underserved population. Trial Registration Clinicaltrials.gov NCT01303575; https://clinicaltrials.gov/ct2/show/NCT01303575 (Archived by WebCite at http://www.webcitation.org/6m7DO4g7c)
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Affiliation(s)
- Christine M Markham
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | - Cornelia Jessen
- Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Gwenda Gorman
- Inter Tribal Council of Arizona, Inc., Phoenix, AZ, United States
| | - Jennifer Torres
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | | | | | | | - Robert C Addy
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Melissa F Peskin
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Ross Shegog
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
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16
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Hightow-Weidman LB, Muessig KE, Bauermeister J, Zhang C, LeGrand S. Youth, Technology, and HIV: Recent Advances and Future Directions. Curr HIV/AIDS Rep 2016; 12:500-15. [PMID: 26385582 DOI: 10.1007/s11904-015-0280-x] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Technology, including mobile technologies and social media, offers powerful tools to reach, engage, and retain youth and young adults in HIV prevention and care interventions both in the USA and globally. In this report, we focus on HIV, technology, and youth, presenting a synthesis of recently published (Jan 2014-May 2015) observational and experimental studies relevant for understanding and intervening on HIV risk, prevention, and care. We present findings from a selection of the 66 relevant citations identified, highlighting studies that demonstrate a novel approach to technology interventions among youth in regard to content, delivery, target population, or public health impact. We discuss current trends globally and in the USA in how youth are using technology, as well as emergent research issues in this field-including the need for new theories for developing technology-based HIV interventions and new metrics of engagement, exposure, and evaluation.
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Affiliation(s)
- Lisa B Hightow-Weidman
- Department of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Bioinformatics Building CB#7030, Chapel Hill, NC, 27599, USA.
| | - Kathryn E Muessig
- Department of Health Behavior, University of North Carolina at Chapel Hill, 306 Rosenau Hall Campus Box 7440, Chapel Hill, NC, 27599-7440, USA.
| | - Jose Bauermeister
- Department of Health Behavior and Health Education School of Public Health, University of Michigan, 1415 Washington Heights, SPH I, Room 3822, Ann Arbor, MI, 48109-2029, USA.
| | - Chen Zhang
- Department of Health Behavior, University of North Carolina at Chapel Hill, 306 Rosenau Hall Campus Box 7440, Chapel Hill, NC, 27599-7440, USA.
| | - Sara LeGrand
- Center for Health Policy and Inequalities Research Duke Global Health Institute, Duke University, 310 Trent Dr., Room 305, Durham, NC, 27710, USA.
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Lopez LM, Bernholc A, Chen M, Tolley EE. School-based interventions for improving contraceptive use in adolescents. Cochrane Database Syst Rev 2016; 2016:CD012249. [PMID: 27353385 PMCID: PMC9239532 DOI: 10.1002/14651858.cd012249] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Young women, especially adolescents, often lack access to modern contraception. Reasons vary by geography and regional politics and culture. The projected 2015 birth rate in 'developing' regions was 56 per 1000 compared with 17 per 1000 for 'developed' regions. OBJECTIVES To identify school-based interventions that improved contraceptive use among adolescents SEARCH METHODS Until 6 June 2016, we searched for eligible trials in PubMed, CENTRAL, ERIC, Web of Science, POPLINE, ClinicalTrials.gov and ICTRP. SELECTION CRITERIA We considered randomized controlled trials (RCTs) that assigned individuals or clusters. The majority of participants must have been 19 years old or younger.The educational strategy must have occurred primarily in a middle school or high school. The intervention had to emphasize one or more effective methods of contraception. Our primary outcomes were pregnancy and contraceptive use. DATA COLLECTION AND ANALYSIS We assessed titles and abstracts identified during the searches. One author extracted and entered the data into RevMan; a second author verified accuracy. We examined studies for methodological quality.For unadjusted dichotomous outcomes, we calculated the Mantel-Haenszel odds ratio (OR) with 95% confidence interval (CI). For cluster randomized trials, we used adjusted measures, e.g. OR, risk ratio, or difference in proportions. For continuous outcomes, we used the adjusted mean difference (MD) or other measures from the models. We did not conduct meta-analysis due to varied interventions and outcome measures. MAIN RESULTS The 11 trials included 10 cluster RCTs and an individually randomized trial. The cluster RCTs had sample sizes from 816 to 10,954; the median number of clusters was 24. Most trials were conducted in the USA and UK; one was from Mexico and one from South Africa.We focus here on the trials with moderate quality evidence and an intervention effect. Three addressed preventing pregnancy and HIV/STI through interactive sessions. One trial provided a multifaceted two-year program. Immediately after year one and 12 months after year two, the intervention group was more likely than the standard-curriculum group to report using effective contraception during last sex (reported adjusted ORs 1.62 ± standard error (SE) 0.22) and 1.76 ± SE 0.29), condom use during last sex (reported adjusted ORs 1.91 ± SE 0.27 and 1.68 ± SE 0.25), and less frequent sex without a condom in the past three months (reported ratios of adjusted means 0.50 ± SE 0.31 and 0.63 ± SE 0.23). Another trial compared multifaceted two-year programs on sexual risk reduction and risk avoidance (abstinence-focused) versus usual health education. At 3 months, the risk reduction group was less likely than the usual-education group to report no condom use at last intercourse (reported adjusted OR 0.67, 95% CI 0.47 to 0.96) and sex without a condom in the last three months (reported adjusted OR 0.59, 95% CI 0.36 to 0.95). At 3 and after 15 months, the risk avoidance group was also less likely than the usual-education group to report no condom use at last intercourse (reported adjusted ORs 0.70, 95% CI 0.52 to 0.93; and 0.61, 95% CI 0.45 to 0.85). At the same time points, the risk reduction group had a higher score than the usual-education group for condom knowledge. The third trial provided a peer-led program with eight interactive sessions. At 17 months, the intervention group was less likely than the teacher-led group to report oral contraceptive use during last sex (OR 0.57, 95% CI 0.36 to 0.91). This difference may not have been significant if the investigators had adjusted for the clustering. At 5 and 17 months, the peer-led group had a greater mean increase in knowledge of HIV and pregnancy prevention compared with the control group. An additional trial showed an effect on knowledge only. The group with an emergency contraception (EC) session was more likely than the group without the EC unit to know the time limits for using hormonal EC (pill) and the non-hormonal IUD as EC. AUTHORS' CONCLUSIONS Since most trials addressed preventing STI/HIV and pregnancy, they emphasized condom use. However, several studies covered a range of contraceptive methods. The overall quality of evidence was low. Main reasons for downgrading the evidence were having limited information on intervention fidelity, analyzing a subsample rather than all those randomized, and having high losses.
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Affiliation(s)
- Laureen M Lopez
- FHI 360Clinical and Epidemiological Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Alissa Bernholc
- FHI 360Biostatistics359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Mario Chen
- FHI 360Biostatistics359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Elizabeth E. Tolley
- FHI 360Social and Behavioral Health Sciences359 Blackwell Street, Suite 200DurhamNorth CarolinaUSA27701
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18
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Peskin MF, Shegog R, Markham CM, Thiel M, Baumler ER, Addy RC, Gabay EK, Emery ST. Efficacy of It's Your Game-Tech: A Computer-Based Sexual Health Education Program for Middle School Youth. J Adolesc Health 2015; 56:515-21. [PMID: 25739520 PMCID: PMC4409535 DOI: 10.1016/j.jadohealth.2015.01.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 01/24/2023]
Abstract
PURPOSE Few computer-based HIV, sexually transmitted infection (STI), and pregnancy prevention programs are available, and even fewer target early adolescents. In this study, we tested the efficacy of It's Your Game (IYG)-Tech, a completely computer-based, middle school sexual health education program. The primary hypothesis was that students who received IYG-Tech would significantly delay sexual initiation by ninth grade. METHODS We evaluated IYG-Tech using a randomized, two-arm nested design among 19 schools in a large, urban school district in southeast Texas (20 schools were originally randomized). The target population was English-speaking eighth-grade students who were followed into the ninth grade. The final analytic sample included 1,374 students. Multilevel logistic regression models were used to test for differences in sexual initiation between intervention and control students, while adjusting for age, gender, ethnicity, time between measures, and family structure. RESULTS There was no significant difference in the delay of sexual activity or in any other sexual behavior between intervention and control students. However, there were significant positive between-group differences for psychosocial variables related to STI and condom knowledge, attitudes about abstinence, condom use self-efficacy, and perceived norms about sex. Post hoc analyses conducted among intervention students revealed some significant associations: "full exposure" (completion of all 13 lessons) and "mid-exposure" (5-8 lessons) students were less likely than "low exposure" (1-4 lessons) students to initiate sex. CONCLUSIONS Collectively, our findings indicate that IYG-Tech impacts some determinants of sexual behavior, and that additional efficacy evaluation with full intervention exposure may be warranted.
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Affiliation(s)
- Melissa F. Peskin
- Address correspondence to: Melissa F. Peskin, Ph.D., Center for Health Promotion and Prevention Research, UTHealth School of Public Health, 7000 Fannin St., Ste. 2658, Houston, TX; Tel.: (713) 500-9759;
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