Health Behavior Theory to Enhance eHealth Intervention Research in HIV: Rationale and Review

Abstract

Purpose of Review Optimal design and evaluation of eHealth interventions requires the specification of behavioral targets and hypothesized mechanisms of action – both of which can be enhanced with the use of established health behavior theories (HBTs). In this paper, we describe the major HBTs and examine their use in studies of eHealth interventions for HIV prevention and treatment, and assess the contribution of HBT in developing and evaluating eHealth interventions. Recent Finding Based on our review of the literature, we argue the field can benefit from more systematic selection, application and reporting of HBT. We highlight theories specifically designed for eHealth and describe ways that HBT can be used by researchers and practitioners to improve the rigor and impact of eHealth interventions for individuals living with or at risk for HIV. Summary This brief overview of HBTs and their application to eHealth intervention in HIV research has underscored the importance of a theoretically intentional approach. The theory should be used to inform the design of the eHealth intervention; the intervention should not determine the theory. A theory-driven iterative model of eHealth intervention development may not only improve our repertoire of effective strategies but also has the potential to expand our theoretical and empirical knowledge of health behavior change.

Mapping Canadian Men’s Recent and Intended Health Behavior Changes Through the Don’t Change Much Electronic Health Program

“…This study’s findings confirm the potential of men’s eHealth programs as previously described in a range of contexts and diverse studies [ 7 , 14 - 25 ]. Adding to the literature focused on understanding men’s eHealth acceptability, engagement, and behavior change, this study contributes some important empirical insights and supports calls for future research to more fully investigate dose-response relationships with randomized controlled trials [ 25 , 26 ]. Although careful not to overstate the current findings or imply attribution, some explanations and potential implications for the statistically significant associations between men’s DCM exposure levels and their recent and intended health behavior changes are offered as a means to scoping adjustments for DCM, and making broader recommendations for the men’s eHealth field.…”

“…Klein et al’s [ 24 ] quasi-experimental, 2-arm study evaluated Real Talk (an eHealth harm reduction intervention targeting black men who have sex with men) reported end user’s HIV knowledge gains (although there were no significant differences between Real Talk and the control participant’s actual condom use or other risk reduction strategies). Although the aforementioned and many other men’s eHealth evaluation studies have been limited by small samples, attrition, and/or a lack of control groups, the results are encouraging [ 25 , 26 ]. In sum, acceptability and evaluation studies confirm the strong potential of men’s eHealth programs amid calls for more evidence to efficiently guide future work and confidently claim sustained health behavior change effects.…”

“…The second issue relates to incorporating theory to map men’s health behavior changes and their relationships to tailored eHealth programs. Simoni et al [ 26 ] argued the need for health promotion theory in men’s eHealth to build a translatable empirical base and advance the design and evaluation of gender-sensitized interventions. Among many health promotion theories, the transtheoretical (or stages of change) model [ 27 , 28 ] has guided eHealth program designs and helped contextualize barriers and facilitators to men’s health behavior changes in a range of contexts [ 29 - 31 ].…”

Using Digital Communication Technology to Increase HIV Testing Among Men Who Have Sex With Men and Transgender Women: Systematic Review and Meta-Analysis

“…In addition, grounding in theoretical frameworks may also be another indicator of effectiveness, as suggested by the greater uptake of HIV testing reported by theoretically based interventions included in this review. Although the majority of studies in this review reported a theoretical basis for their intervention, the limited number of theory-based, HIV-focused digital interventions have been noted by others [ 85 , 86 ]; this may be attributed to the speed of development and proliferation of digital approaches to improving HIV outcomes. The findings presented here suggest that theoretical grounding is an important component of effective interventions and should be prioritized in future development.…”

Utility of Short Message Service (SMS) for Remote Data Collection for HIV in Low- and Middle-Income Countries

“…A prior review of health behavior theory and its application to eHealth HIV interventions and research advocated for theory to be incorporated in the design [78], and these findings are relevant for SMS approaches for data collection. While SMS may be used solely as an approach to capture data, it can simultaneously be used to serve as an intervention designed to elicit behavior change.…”