Game Plan, a Web-Based Intervention to Improve Adherence and Persistence to HIV Pre-exposure Prophylaxis and Reduce Heavy Drinking in Gay, Bisexual, and Other Men Who Have Sex With Men: Usability and User Experience Testing

Abstract

Background Encouraging consistent use of pre-exposure prophylaxis (PrEP) is essential for reducing HIV incidence, particularly among gay, bisexual, and other men who have sex with men (GBM), and especially those who engage in heavy drinking. Although practice guidelines recommend providing adherence counseling to PrEP patients, clinics and providers may not have the resources or expertise to provide it. Internet-facilitated interventions have been shown to improve HIV prevention outcomes, including medication and care adherence. Game Plan is a website we created to help users make a tangible plan for reducing their HIV risk. We designed additional components of Game Plan to address key individual level barriers to PrEP use. Objective The aim of this mixed methods research is to test the usability and user experience of these components with intended users: GBM who drink heavily and are on PrEP. Methods In study 1 (usability), we completed a detailed individual interview in which participants (n=10) walked through a prototype of the website, thinking aloud as they did, and completed a follow-up interview and web-based survey afterward. Study 2 (user experience) involved providing participants (n=40) with a link to the prototype website to explore on their own and asking them to complete the same follow-up survey afterward. Qualitative data were analyzed using thematic analysis, and descriptive statistics were used to analyze quantitative data. Results Users in both studies gave the website excellent ratings for usability, overall satisfaction, and quality, and most often described the site as informative, helpful, and supportive. Users also rated the site’s content and feel as respectful of them and their autonomy, empathetic, and they stated that it conveyed confidence in their ability to change. The study 1 interviews highlighted the importance of the website’s esthetics to the participants’ engagement with it and its credibility in prompting genuine reflection. Conclusions GBM who reported heavy drinking and used PrEP generally found a website focused on helping them to create a plan to use PrEP consistently to be helpful. Adopting user-centered design methods and attending to the esthetics of mobile health interventions are important steps toward encouraging engagement and reducing at-risk behaviors.

Game Plan—a Brief Web-Based Intervention to Improve Uptake and Use of HIV Pre-exposure Prophylaxis (PrEP) and Reduce Alcohol Use Among Gay and Bisexual Men: Content Analysis

“…Research on these new components of Game Plan is currently in its preliminary phases. Initial design research with GBM suggests that Game Plan is generally engaging and that users believe they would use it if they encounter it in the real world [ 56 ]. However, little is known about the effects of these components on PrEP outcomes.…”

“…It was explicitly designed to be brief (approximately 20-30 minutes, on average) so that it is feasible for use in clinics (eg, in waiting rooms) or at home and to more closely resemble how many people access and use health information on the web: during a few brief visits [ 54 , 55 ]. In our formative work, users spent 20 to 40 minutes interacting with the application in a single visit [ 53 , 56 ]. The site was originally developed using a thorough user-centered design research process [ 57 ] conducted among GBM across the United States but concentrated in the northeastern United States.…”

“…These participants completed a baseline survey, received a link to the prototype site, and then completed a follow-up survey to assess their perceptions of the site. The results of these studies have been published elsewhere [ 56 ]. In this paper, we describe each component and its theoretical or empirical basis.…”