A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study

Abstract

BackgroundDespite ongoing prevention efforts, HIV and other sexually transmitted infections (HIV/STIs) and drug use remain public health concerns. Urban adolescents, many of whom are underserved and racial minorities, are disproportionately affected. Recent changes in policy, including the Affordable Care Act, and advances in technology provide HIV/STI and drug abuse prevention scientists with unique opportunities to deliver mobile health (mHealth) preventive interventions in primary care.ObjectivesThe purpose of this community-engaged study was to develop an mHealth version of the Storytelling for Empowerment preventive intervention for primary care (hereinafter referred to as “S4E”).MethodsA total of 29 adolescents were recruited from a youth-centered primary care clinic in Southeast, Michigan, to participate in qualitative interviews. Participants were predominantly African American (n=19, 65.5%) and female (n=21, 72.4%) with a mean age of 16.23 (SD 2.09). The principles of community-based participatory research (CBPR), in conjunction with agile software development and the recommended core prevention principles of the National Institute on Drug Abuse (NIDA) were employed during S4E development. CBPR principles are aimed at improving the effectiveness of research by addressing locally relevant health problems, working with community strengths, and translating basic science into applied research. Complementing this approach, the NIDA prevention principles are derived from decades of drug abuse prevention research aimed at increasing the effectiveness and uptake of programs, through the development of culturally specific interventions and ensuring the structure, content, and delivery of the intervention fit the needs of the community. Data were analyzed using thematic analysis.ResultsA total of 5 themes emerged from the data: (1) acceptability of the mHealth app to adolescents in primary care, (2) inclusion of a risk assessment to improve clinician-adolescent HIV/STI and drug use communication, (3) incorporation of culturally specific HIV/STI and drug use content, (4) incorporation of interactive aspects in the app to engage youth, and (5) perspectives on the appearance of the app.ConclusionsThere is a dearth of mHealth HIV/STI and drug abuse preventive interventions for primary care. Incorporating the principles of CBPR in conjunction with agile software development and NIDA-recommended core prevention principles may be helpful in developing culturally specific mHealth interventions. An important next step in this program of research is to examine the feasibility, acceptability, and efficacy of S4E on adolescent sexual risk and drug use behaviors, and HIV/STI testing. Implications for prevention research and primary care practice are discussed in the context of the Affordable Care Act and technological advances.

Healthcare in the pocket: A qualitative analysis of patients� perspectives of an mHealth application to foster power in everyday living with schizophrenia (Preprint)

“…To guide and direct the interviews, a semi-structured thematic interview guide [40] regarding different sources of power was used. The sources of power, which were inspired from the first phase of the study [31] and aspects of empowerment derived from an empowerment program [41] were: knowledge power, skills power and personal power. …”

Adolescent Experiences of Clinician–Patient HIV/STI Communication in Primary Care

“…Data are from a larger study focused on the development and examination of a mobile-health HIV/STI and drug abuse preventive intervention (Córdova et al, 2015; Córdova et al, 2016). Data collection occurred between December 2013 and October 2014, and was approved by the University of Michigan’s Institutional Review Board.…”

“…Although preliminary analysis indicated that saturation—defined as the point at which no new information or themes related to HIV/STI communication were identified in the data (Bowen, 2008)—was reached, we conducted one additional focus group and two individual interviews. Investigators have reported saturation with three focus group (Krueger & Casey, 2014) and 4–6 individual interviews (Córdova et al, 2015; Guest, Bunce, & Johnson, 2006). Among the 29 participants, 25 participated in focus group interviews that ranged in size from 2–6 participants, and 4 participated in individual interviews.…”

“…Ecodevelopmental theory has been applied to develop a fuller understanding of how parent–adolescent communication shapes HIV/STI risk behaviors (Córdova, Huang, Pantin, & Prado, 2012). The theory may also have great utility for developing a fuller understanding of clinician–adolescent HIV/STI communication, yet research remains limited (Córdova et al, 2015; Córdova et al, 2016). Furthermore, social interaction theory affirms that clinician–adolescent communication does not happen in isolation, but rather occurs in a dynamic and reciprocal manner; therefore, incorporating aspects of interpersonal communication processes into an ecodevelopmental framework may be helpful.…”

Recommendations for the Development of a Mobile HIV Prevention Intervention for Men Who Have Sex With Men and Hijras in Mumbai: Qualitative Study (Preprint)

“…Preferred content often includes information about HIV/STIs, proper condom use, behavioral risk reduction strategies, and partner communication strategies [19,20]. For persons living with HIV/AIDS (PLHA), preferred content includes information about health care providers and treatment, especially regarding linkage and retention into care and medication adherence [21,22].…”