Effect of a web drama video series on HIV and other sexually transmitted infection testing among gay, bisexual and queer men: study protocol for a community-based, pragmatic randomised controlled trial in Singapore: the People Like Us (PLU) Evaluation Study

Abstract

IntroductionGay, bisexual and queer (GBQ) men are at disproportionately higher risk of acquiring HIV and other sexually transmitted infections (STI). While HIV/STI testing rates among GBQ men are increasing worldwide, they remain suboptimal in a variety of settings.Methods and analysisThe study is a pragmatic randomised controlled trial designed to evaluate an online video series developed by a community-based organisation in Singapore for GBQ men. A total of 300 HIV-negative GBQ men in Singapore aged 18–29 years old will be recruited for this study. Participants will subsequently be randomised into the intervention arm (n=150) and the control arm (n=150). The intervention arm (n=150) will be assigned the intervention along with sexual health information via a pamphlet, while the control group (n=150) will be assigned only the sexual health information via a pamphlet. Participants should also not have watched the video prior to their participation in this study, which will be ascertained through a questionnaire. Primary outcomes for this evaluation are changes in self-reported intention to test for, actual testing for and regularity of testing for HIV, syphilis, chlamydia and gonorrhoea at the 3 and 6 months after intervention. Secondary outcomes include changes in self-reported risk perception for HIV and other STIs, knowledge of HIV, knowledge of risks associated with acquiring STIs, knowledge of HIV pre-exposure prophylaxis, consistent condom use for anal sex with casual partners, incidence of STIs, connectedness to the lesbian, gay, bisexual and transgender community, self-concealment of sexual orientation, perceived homophobia, internalised homophobia, HIV testing self-efficacy and HIV testing social norms.Ethics and disseminationThe study has been approved by the National University of Singapore Institutional Review Board (S-19-059) and registered at ClinicalTrials.gov. The results will be published in peer-reviewed academic journals and disseminated to community-based organisations and policymakers.Trial registration numberNCT04021953

Theories of change for e-health interventions targeting HIV/STIs and sexual risk, substance use and mental ill health amongst men who have sex with men: systematic review and synthesis

“…Furthermore, the Online Mindfulness-Based Cognitive Therapy intervention was modelled on an existing protocol effective for addressing symptoms of depression and anxiety. People Like Us Internet Tan [ 65 ] Sexual health messages incorporated into this web drama series aimed to increase HIV/STI knowledge and risk perception; provide information on HIV/STI testing and its benefits as well as resources for HIV/STI testing and other mental health services; address homophobia and sexual identity disclosure; increase self-efficacy for negotiating safer sex and promote positive attitudes, skills and self-efficacy related to safer sex. Content incorporated modelling of safer sex behaviours.…”

“…Quality varied notably across theory reports and clustered towards low and medium quality, with 14 reports (42%) meeting none or one of the assessed criteria [ 61 , 63 – 65 , 76 , 77 , 79 – 82 , 84 , 86 – 88 ]; 14 (42%) meeting two or three criteria [ 56 , 58 , 59 , 62 , 66 – 68 , 71 – 75 , 78 , 83 ] and only five (15%) meeting four or five criteria [ 55 , 60 , 69 , 70 , 85 ].…”

“…Our grouping of theories of change based inductively on their key constructs resulted in three groups of intervention theories of change. The largest, the ‘cognitive/skills’ theory of change grouping [ 55 , 56 , 59 , 61 , 65 , 67 , 68 , 70 – 73 , 77 – 80 , 83 , 84 , 87 , 88 ], was informed largely by social cognitive theory and the IMB model. The second grouping drew on two theories of change driven primarily by self-monitoring (the ‘self-monitoring’ theory of change grouping) [ 81 , 85 ], and the third drew on two theories of change based on cognitive therapy approaches (the ‘cognitive therapy’ theory of change grouping) [ 58 , 98 ].…”

“…Ten of the 13 theories of change in this grouping referenced social cognitive theory [ 56 , 63 , 66 , 67 , 72 , 73 , 83 , 84 , 87 ] and/or the IMB model [ 55 , 56 , 60 , 61 , 64 , 67 , 68 , 70 , 71 , 77 – 80 , 83 , 87 ], often in combination with other scientific theories. Three referenced the theory of planned behaviour [ 59 , 70 , 88 ] and one referenced no existing scientific theories but shared key constructs with other theories of change in this grouping [ 65 ]. Whilst other interventions also drew on these scientific theories, the theories of change in this grouping shared as core components constructs that are key to these three scientific theories.…”

“…Interventions in this grouping provided information and exercises and incorporated modelling techniques. These activities were theorised to impact on mediators including knowledge, outcome expectancies, attitudes (including internalised homophobia [ 65 , 78 ]), perceived norms, perceived vulnerability/risk (a construct combining via reciprocal translation those of perceived vulnerability [ 64 , 70 , 71 , 77 – 80 ] and risk perceptions [ 59 , 65 , 73 ]) and behavioural skills. Two interventions whose theories of change informed this grouping aimed to impact connectedness to the LGBT community [ 65 , 78 ], portrayed as a mediator in the synthesised diagram though the reports were not explicit about how intervention activities aimed to engender this connectedness or how it might be related to sexual health outcomes.…”