A multilevel mHealth drug abuse and STI/HIV preventive intervention for clinic settings in the United States: A feasibility and acceptability study

Abstract

Background Drug abuse and sexually transmitted infections (STIs), including the human immunodeficiency virus (HIV), remain significant public health concerns in the United States. Youth are at disproportionate risk of drug use and STIs/HIV, yet interventions aimed at improving STI and HIV testing and reducing STI/HIV risk behaviors through technology-based engagement in clinic settings are limited. The purpose of this study was to examine the feasibility and acceptability of Storytelling 4 Empowerment (S4E), a multilevel mobile-health drug abuse and STI/HIV preventive application (app) for clinic settings. We also explored uptake of STI/HIV testing among youth immediately post-intervention. Method Employing community-based participatory research principles and a multi-method research design, we developed a clinician-facing app, and examined the feasibility and acceptability of S4E among clinicians (n = 6) and youth (n = 20) in an urban youth-centered community health clinic. S4E aimed to improve clinician–youth risk communication and youths’ drug use and STI/HIV knowledge, self-efficacy, and refusal skills. We also explored youths’ uptake of STI and HIV testing. Quantitative data were analyzed by computing mean scores and proportions, and qualitative analyses followed the tenets of content analysis. Results Among eligible participants, 86.9% of youth and 85.7% of clinicians enrolled in the study, suggesting the feasibility of recruiting participants from the targeted clinic. Most clinicians identified as non-Hispanic white (83%) and female (66.7%). Among the youth, 70% identified as non-Hispanic white, followed by 30% African American, and 50% identified as female with a mean age of 19.6 (SD = 1.5, Range = 16–21). The quantitative findings suggest that the acceptability of S4E is high, as indicated by the Client Satisfaction Questionnaire (mean score = 25.2, SD: 4.8). Immediately post-intervention, all youth who reported past 90-day condomless sex or having never been tested for STIs or HIV in their lifetime, were tested for both STIs and HIV. Qualitative themes revealed four overarching themes, including S4E: (1) faciliated timely, targeted, and tailored prevention and risk reduction strategies; (2) shaped clinician and youth communication and interaction during the clinic visit; (3) may have improved uptake of STI/HIV testing and increased STI/HIV knowledge and self-efficacy; and (4) had high feasibiliy and acceptability among youth and clninicans. Conclusions Findings suggest the feasibility and acceptability of S4E in an urban community-based health clinic setting. A next important step is to examine the efficacy of S4E in a randomized controlled trial design.

Global Mapping of Interventions to Improve the Quality of Life of People Living with HIV/AIDS: Implications for Priority Settings

“…Moreover, our study also found a recent rise in researches on the application of e-health interventions in improving QOL of those suffering HIV/AIDS (Topic 4). The use of e-health applications in chronic disease 62 and HIV management 63 has long been discussed and adopted, however, in this context of QOL enhancement, ehealth applications are being used to deliver multilevel interventions, leveraging on their portability, ease of usage, and capacity in population reaching 64 . Again, these emerging themes highlight the transformation in the nature of HIV/AIDS, with new requirements for multifaceted interventions and disease management regime while also reflect the multidimensional characteristics of QOL.…”

Efficacy of a Digital Health Preventive Intervention for Adolescents With HIV or Sexually Transmitted Infections and Substance Use Disorder: Protocol for a Randomized Controlled Trial

“…With respect to participant race, ethnicity, and age, we will recruit a sample that is representative of the clinical population. As in our previous studies [ 28 - 30 ], we expect the majority of participants to be racial minority youths and be sexually active (50/70, 71% report past 90-day oral, vaginal, or anal sexual intercourse) [ 20 , 28 ].…”

“…These elements aim to increase HIV testing and prevent or reduce condomless sex and drug use behaviors among at-risk youths. Our formative research with youths (defined hereon as adolescents and young adults aged 14-21 years) and clinicians demonstrated that youths in the targeted health care clinic (1) routinely visit the clinic for reproductive and other health care, (2) are at increased risk of HIV/STIs, and (3) found S4E to be feasible and acceptable but also want access to S4E outside of the health clinic to continue participating in intervention activities [ 18 - 21 , 28 - 30 ].…”