A Sexual Health Promotion App for Transgender Women (Trans Women Connected): Development and Usability Study

Abstract

Background HIV severely impacts the transgender communities in the United States, and transgender women have the highest HIV incidence rates among any identified risk group. Guided by formative research with transgender women and by an expert advisory panel of transgender women, we designed a prototype mobile app to promote HIV prevention among transgender women. Objective This study aimed to develop and test the usability and acceptability of the prototype Trans Women Connected mobile app. Methods We engaged in a 3-phase prototype development process. After conducting formative research about the health needs of this population, we outlined a theory-based app framework and developed three prototype activities (ie, a vision board, a pre-exposure prophylaxis [PrEP] education activity, and an interactive map). We then tested the usability and acceptability of the mobile app and activities with 16 transgender women using pre- and posttests, think-aloud protocols, and open-ended questions. Results Participants reported high acceptability for the mobile app; the mean rating across all usability and likability questions was 5.9 out of 7. Service utilization intention, goal setting, and social support increased at posttest compared with pretest. Increases in self-efficacy in finding lesbian, gay, bisexual, transgender, and queer–friendly services; intention to seek online social support; and PrEP knowledge were statistically significant. Participants described the app as attractive and useful and perceived all three activities positively. Conclusions This study describes the development and usability and acceptability evaluation of a prototype mobile app designed for and with transgender women for HIV prevention. The usability testing findings provided important insights toward refining and the further development of the Trans Women Connected mobile app. The results suggest that a mobile health intervention can support positive changes. The remaining development and efficacy randomized trial of the Trans Women Connected mobile app is currently underway.

Need for Inclusive Consideration of Transgender and Gender Diverse People in E-Health Services: A Systematic Review

“…According to the MMAT, the six included mixed methods studies [16,[44][45][46]62,66] addressed the application aspects for mixed methods appropriately. The MMAT is a short instrument with five questions each to access the qualitative and quantitative parts of the study design and the quality of their integration.…”

“…Measured against this, the researchers addressed their rationale adequately, combined the different methodological approaches appropriately, and integrated them comprehensibly in the presentation of results. All mixed methods studies had a pilot character, and five of them were non-randomized studies [16,44,45,62,66], each with different objectives and scopes. The evidence quality of the mixed methods studies should be evaluated cautiously and classified as preliminary results.…”

“…Four other studies provided app-based content for knowledge gains related to HIV and PrEP and increased test readiness. This was true for the US MOTIVES [70,71], evaluated in a quasi-experimental randomized pilot study of 218 service users (largely MSM sample, including 30.2% and 36.7% trans women in the intervention groups with mean ages of 34.8 and 35.2 years, respectively), the Indonesian RUMAH SELA [72] non-randomized study project with 168 participants (largely MSM and drug user sample, of which 29.17% were trans women with a mean age of 25.6 years), and the US TGD-specific non-randomized usability study project Trans Women Connected [45] with 16 trans women and non-binary individuals (mean age 34.5 years). Two US studies focused on increasing the utilization of HIV-related health care, namely, weCare [39] (process evaluation with 32 participants, average age 25.2 years and including 27.78% trans women), and an unnamed eNavigation [73] addressed to 120 participants (largely MSM sample, including 14.17% trans women with an average age of 27.75 years).…”

“…For the videoconferencing services, service users had to have access to an internet-enabled device with a microphone and camera (e.g., laptop). While another 6 studies [39,45,[70][71][72][73] dealt with mobile health apps, as mentioned above, for the remaining 10 included studies [38,46,58,59,61,[63][64][65][66][67], web-accessible computers were in the foreground due to concepts such as games, educational programs, or forums.…”

A Uniquely Targeted, Mobile App-Based HIV Prevention Intervention for Young Transgender Women: Adaptation and Usability Study (Preprint)

“…LifeSkills Mobile is among the first mHealth interventions that have been developed to meet the specific and unique needs of YTW to reduce sexual risk for HIV acquisition and transmission. It joins other such mHealth initiatives, focusing on transgender women, which are in the development or testing phases [57][58][59][60].…”