Redeveloping a Digital Sexual Health Intervention for Adolescents to Allow for Broader Dissemination: Implications for HIV and STD Prevention

2021 ◽  
Vol 33 (2) ◽  
pp. 89-102
Author(s):  
Hannah Javidi ◽  
Laura Widman ◽  
Nikolette Lipsey ◽  
Julia Brasileiro ◽  
Farhad Javidi ◽  
...  
Keyword(s):  
Sexual Health ◽  
Open Source ◽  
Behavioral Interventions ◽  
Digital Health ◽  
The United States ◽  
Health Intervention ◽  
Health Interventions ◽  
Digital Platforms ◽  
Program Costs ◽  
Sex Knowledge

HIV/STDs and unintended pregnancy persist among adolescents in the United States; thus, effective sexual health interventions that can be broadly disseminated are necessary. Digital health interventions are highly promising because they allow for customization and widespread reach. The current project involved redeveloping and expanding HEART (Health Education and Relationship Training)—a brief, digital sexual health intervention efficacious at improving safer sex knowledge, self-efficacy, and behavior—onto an open-source platform to allow for greater interactivity and accessibility while reducing long-term program costs. The authors describe the process of adapting, reprogramming, and evaluating the new program, which may serve as a guide for investigators seeking to adapt behavioral interventions onto digital platforms. The final product is an open-source intervention that can be easily adapted for new populations. Among 233 adolescents (Mage = 15.06; 64% girls), HEART was highly acceptable and generally feasible to administer, with no differences in acceptability by gender or sexual identity.

scholarly journals Effectiveness, Acceptability, and Feasibility of Digital Health Interventions for LGBTIQ+ Young People: Systematic Review

10.2196/20158 ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. e20158
Author(s):  
Dylan Gilbey ◽  
Helen Morgan ◽  
Ashleigh Lin ◽  
Yael Perry
Keyword(s):  
Young People ◽  
Sexual Health ◽  
Digital Health ◽  
Health Interventions ◽  
Health Concern ◽  
Sufficient Evidence ◽  
Future Research ◽  
Evidence Based ◽  
Bisexual Men ◽  
Targeted Interventions

Background Young people (aged 12-25 years) with diverse sexuality, gender, or bodily characteristics, such as those who identify as lesbian, gay, bisexual, transgender, intersex, or queer (LGBTIQ+), are at substantially greater risk of a range of mental, physical, and sexual health difficulties compared with their peers. Digital health interventions have been identified as a potential way to reduce these health disparities. Objective This review aims to summarize the characteristics of existing evidence-based digital health interventions for LGBTIQ+ young people and to describe the evidence for their effectiveness, acceptability, and feasibility. Methods A systematic literature search was conducted using internet databases and gray literature sources, and the results were screened for inclusion. The included studies were synthesized qualitatively. Results The search identified 38 studies of 24 unique interventions seeking to address mental, physical, or sexual health–related concerns in LGBTIQ+ young people. Substantially more evidence-based interventions existed for gay and bisexual men than for any other population group, and there were more interventions related to risk reduction of sexually transmitted infections than to any other health concern. There was some evidence for the effectiveness, feasibility, and acceptability of these interventions overall; however, the quality of evidence is often lacking. Conclusions There is sufficient evidence to suggest that targeted digital health interventions are an important focus for future research aimed at addressing health difficulties in LGBTIQ+ young people. Additional digital health interventions are needed for a wider range of health difficulties, particularly in terms of mental and physical health concerns, as well as more targeted interventions for same gender–attracted women, trans and gender-diverse people, and people with intersex variations. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020128164; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=128164

scholarly journals The development of ‘Make One Small Change’: an e-health intervention for the workplace developed using the Person-Based Approach

2019 ◽  
Vol 5 ◽  
pp. 205520761985285
Author(s):  
Ana Howarth ◽  
Jose Quesada ◽  
Todd Donnelly ◽  
Peter R Mills
Keyword(s):  
Digital Health ◽  
Intervention Development ◽  
Health Intervention ◽  
Health Interventions ◽  
Self Monitoring ◽  
User Input ◽  
Online Behaviour ◽  
Guiding Principles ◽  
Small Change ◽  
Evidenced Based

Background The application of digital health interventions is widespread and many employers are implementing employee e-health programs. Intended to enhance productivity by increasing wellbeing, workplace interventions often lack evidence of effectiveness and have low rates of retention. Use of the person-based approach (PBA) is one solution, which offers a systematic framework for developing effective digital health interventions. This paper describes the application of the PBA to the development of ‘Make one small change’ (Cigna MSC™), an online behaviour change system for lifestyle habits focused on resilience, movement, eating and sleep. Method and results The development of Cigna MSC™ took place over four stages with colleagues ( n = 79) across Cigna globally. Application of the PBA entailed using high amounts of qualitative data to inform development and a cyclical process of ‘listening, applying and delivering’ was adhered to throughout. Early stages involved review of current literature and the collection of feedback in relation to existing interventions. Combined, results revealed key intervention development issues that were then used to form guiding principles. Guiding principles ensured intervention objectives translated into relevant design features. The final stages of evaluation included testing images, text and content approaches. Feedback dictated that the intervention should be fun, easy to use and include milestones for self-monitoring. The resulting version was finalised and made ready to pilot so future analysis can be made in relation to real-world engagement and the embedded evaluative content can be used to provide evidence of intervention effectiveness. Conclusions Using the PBA, which was evolved specifically to improve development of digital interventions, resulted in a workplace intervention embedded with in-depth user input combined with evidenced-based theory. This paper illustrates how using a rigorous methodology can drive the creation of an effective digital health intervention that uniquely allows for refinement at each stage.

Exploring How Trauma Is Addressed in Sexual Education Interventions for Youth: A Scoping Review

2020 ◽  
Vol 47 (6) ◽  
pp. 880-893
Author(s):  
Lisa S. Panisch ◽  
Monica Faulkner ◽  
Sofia B. Fernandez ◽  
Nicole M. Fava
Keyword(s):  
Sexual Health ◽  
Scoping Review ◽  
The United States ◽  
Health Interventions ◽  
Traumatic Experiences ◽  
Sexually Transmitted ◽  
Trauma Informed ◽  
Education Interventions ◽  
Intervention Content ◽  
The Impact

Traumatic experiences are common among adolescents and can negatively affect learning and increase the risk of early pregnancy, parenthood, and sexually transmitted infections. Little is known about how current sexual health interventions address trauma. A scoping review was conducted to gain insight into how trauma is addressed in adolescent sexual health interventions. Peer-reviewed studies from the United States published between 2008 and 2018 describing a sexual health intervention for youth were considered. Studies were analyzed to determine if and how trauma was addressed in the interventions. Out of 169 articles initially screened, 29 met inclusion criteria and 23% ( n = 6) addressed trauma. Four interventions addressed trauma in the intervention content, while two studies evaluated trauma in outcome measures. Educators can broaden this reach by developing trauma-informed content that is compatible with existing curricula. Ongoing study is recommended to evaluate the impact of trauma-informed content on the sexual knowledge, attitudes, and behaviors of youth.

scholarly journals Social Cognitive Theories and Electronic Health Design: Scoping Review (Preprint)

2018 ◽  
Author(s):  
Patricia Grace-Farfaglia
Keyword(s):  
Scoping Review ◽  
Social Cognitive ◽  
Digital Health ◽  
Health Intervention ◽  
Health Interventions ◽  
Design Features ◽  
Social Design ◽  
Web Based ◽  
Cognitive Theories ◽  
Social Cognitive Theories

BACKGROUND There are several social cognitive theories (SCTs) and models that support platform design in electronic health (eHealth) promotion trials. The rationale for this scoping review was to determine how social design features (informational aid, expressive support, gaming, and tailored content) are used to promote self-efficacy, engagement, knowledge, and behavior change. OBJECTIVE This study aimed to review a broad spectrum of digital health interventions in the literature seeking trials that use SCTs for the design of eHealth applications. METHODS The author conducted a systematic scoping review of 161 Web-based health interventions from published randomized clinical trials using 1 or more tools to address the social cognitive determinants in their website design from January 2006 to April 2016. An iterative approach was used in the selection of studies and data extraction. The studies were analyzed for quality and coded for type of social design features employed. RESULTS Expressive interaction tools were found in 48.6% (54/111) of studies categorized as a strong recommendation by the Joanna Briggs Institute criteria. Overall, less than half of the studies addressed participant social support and motivational needs (43.8%). The vast majority of studies (100%) relied on the use of the Web for delivery of informational aid and tailored content for the individual participant (75.9%). CONCLUSIONS This review fills a research gap by linking social theory to Web strategy to improve the impact and sustainability of eHealth interventions. A Digital Health Intervention Model was developed to provide a framework to enhance future Web-based health intervention design and execution.

scholarly journals Black American and Latinx Parent/Caregiver Participation in Digital Health Obesity Interventions for Children: A Systematic Review

2021 ◽  
Vol 3 ◽  
Author(s):  
Jennifer Sanchez-Flack ◽  
Joanna Buscemi ◽  
Alexander O'Donnell ◽  
Margaret H. Clark Withington ◽  
Marian Fitzgibbon
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Obesity Prevention ◽  
Weight Status ◽  
Digital Health ◽  
Health Intervention ◽  
Health Interventions ◽  
Black American ◽  
Eligibility Criteria ◽  
Prevention Interventions

Parents/caregivers are consistently described as integral targets given their influential role in supporting and managing behaviors such as diet and physical activity. Identifying effective obesity prevention interventions to enhance and sustain parent participation is needed. Digital obesity prevention interventions are a promising strategy to improve parent/caregiver participation. Digital health interventions demonstrate acceptable participation and retention among parents/caregivers. However, our understanding of digital obesity prevention interventions targeting Black American and Latinx parents/caregivers is limited. This systematic review aims to identify Black American and Latinx parents'/caregivers' level of participation in digital obesity prevention and treatment interventions and determine the relationship between parent/caregiver participation and behavioral and weight status outcomes. This review adheres to PRISMA guidelines and is registered in PROSPERO. Eligibility criteria include: intervention delivered by digital technology, targeted Black American and Latinx parents/caregivers of young children (2–12 years), reported parent/caregiver participation outcomes, targeted diet or physical activity behaviors, and randomized controlled trial study design. Searches were conducted in September 2020 in ERIC, PsychInfo, PubMed, and Web of Science. Initial searches returned 499 results. Four reviewers screened records against eligibility criteria and 12 studies met inclusion criteria. Across all studies, parent/caregiver participation ranged from low to high. Only half of the included studies reported significant improvements in behavioral or weight status outcomes for parents/caregivers and/or children. Of these studies, three reported high parental/caregiver participation rates, and three reported high satisfaction rates. These findings suggest that participation and satisfaction may impact behavior change and weight status. The small number of studies indicates that additional research is needed to determine whether engagement or other factors predict responsiveness to the digital health intervention. Our results lay the groundwork for developing and testing future digital health interventions with the explicit goal of parental/caregiver participation and considers the need to expand our digital health intervention research methodologies to address obesity inequities among diverse families better.

scholarly journals Associations Between Digital Health Intervention Engagement, Physical Activity, and Sedentary Behavior: Systematic Review and Meta-analysis

10.2196/23180 ◽  
2021 ◽  
Vol 23 (2) ◽  
pp. e23180
Author(s):  
Matthew Mclaughlin ◽  
Tessa Delaney ◽  
Alix Hall ◽  
Judith Byaruhanga ◽  
Paul Mackie ◽  
...  
Keyword(s):  
Physical Activity ◽  
Sedentary Behavior ◽  
Subjective Experience ◽  
Digital Health ◽  
Meta Analysis ◽  
Grey Literature ◽  
Positive Association ◽  
Health Intervention ◽  
Health Interventions ◽  
Vote Counting

Background The effectiveness of digital health interventions is commonly assumed to be related to the level of user engagement with the digital health intervention, including measures of both digital health intervention use and users’ subjective experience. However, little is known about the relationships between the measures of digital health intervention engagement and physical activity or sedentary behavior. Objective This study aims to describe the direction and strength of the association between engagement with digital health interventions and physical activity or sedentary behavior in adults and explore whether the direction of association of digital health intervention engagement with physical activity or sedentary behavior varies with the type of engagement with the digital health intervention (ie, subjective experience, activities completed, time, and logins). Methods Four databases were searched from inception to December 2019. Grey literature and reference lists of key systematic reviews and journals were also searched. Studies were eligible for inclusion if they examined a quantitative association between a measure of engagement with a digital health intervention targeting physical activity and a measure of physical activity or sedentary behavior in adults (aged ≥18 years). Studies that purposely sampled or recruited individuals on the basis of pre-existing health-related conditions were excluded. In addition, studies were excluded if the individual engaging with the digital health intervention was not the target of the physical activity intervention, the study had a non–digital health intervention component, or the digital health interventions targeted multiple health behaviors. A random effects meta-analysis and direction of association vote counting (for studies not included in meta-analysis) were used to address objective 1. Objective 2 used vote counting on the direction of the association. Results Overall, 10,653 unique citations were identified and 375 full texts were reviewed. Of these, 19 studies (26 associations) were included in the review, with no studies reporting a measure of sedentary behavior. A meta-analysis of 11 studies indicated a small statistically significant positive association between digital health engagement (based on all usage measures) and physical activity (0.08, 95% CI 0.01-0.14, SD 0.11). Heterogeneity was high, with 77% of the variation in the point estimates explained by the between-study heterogeneity. Vote counting indicated that the relationship between physical activity and digital health intervention engagement was consistently positive for three measures: subjective experience measures (2 of 3 associations), activities completed (5 of 8 associations), and logins (6 of 10 associations). However, the direction of associations between physical activity and time-based measures of usage (time spent using the intervention) were mixed (2 of 5 associations supported the hypothesis, 2 were inconclusive, and 1 rejected the hypothesis). Conclusions The findings indicate a weak but consistent positive association between engagement with a physical activity digital health intervention and physical activity outcomes. No studies have targeted sedentary behavior outcomes. The findings were consistent across most constructs of engagement; however, the associations were weak.

scholarly journals Predictors of Internet Health Information–Seeking Behaviors Among Young Adults Living With HIV Across the United States: Longitudinal Observational Study (Preprint)

2020 ◽  
Author(s):  
Warren Scott Comulada ◽  
Mary Step ◽  
Jesse B Fletcher ◽  
Amanda E Tanner ◽  
Nadia L Dowshen ◽  
...  
Keyword(s):  
Young Adults ◽  
Health Information ◽  
Information Seeking ◽  
General Health ◽  
Digital Health ◽  
The United States ◽  
Health Interventions ◽  
Health Information Seeking ◽  
Internet Health Information ◽  
Living With Hiv

BACKGROUND Consistent with young adults’ penchant for digital communication, young adults living with HIV use digital communication media to seek out health information. Understanding the types of health information sought online and the characteristics of these information-seeking young adults is vital when designing digital health interventions for them. OBJECTIVE This study aims to describe characteristics of young adults living with HIV who seek health information through the internet. Results will be relevant to digital health interventions and patient education. METHODS Young adults with HIV (aged 18-34 years) self-reported internet use during an evaluation of digital HIV care interventions across 10 demonstration projects in the United States (N=716). Lasso (least absolute shrinkage and selection operator) models were used to select characteristics that predicted whether participants reported seeking general health and sexual and reproductive health (SRH) information on the internet during the past 6 months. RESULTS Almost a third (211/716, 29.5%) and a fifth (155/716, 21.6%) of participants reported searching for general health and SRH information, respectively; 26.7% (36/135) of transgender young adults with HIV searched for gender-affirming care topics. Areas under the curve (>0.70) indicated success in building models to predict internet health information seeking. Consistent with prior studies, higher education and income predicted health information seeking. Higher self-reported antiretroviral therapy adherence, substance use, and not reporting transgender gender identity also predicted health information seeking. Reporting a sexual orientation other than gay, lesbian, bisexual, or straight predicted SRH information seeking. CONCLUSIONS Young adults living with HIV commonly seek both general health and SRH information online, particularly those exploring their sexual identity. Providers should discuss the most commonly sought SRH topics and the use of digital technology and be open to discussing information found online to better assist young adults with HIV in finding accurate information. Characteristics associated with health information–seeking behavior may also be used to develop and tailor digital health interventions for these young adults.

scholarly journals Assessing Therapeutic Alliance in the Context of mHealth Interventions for Mental Health Problems: Development of the Mobile Agnew Relationship Measure (mARM) Questionnaire (Preprint)

2017 ◽  
Author(s):  
Katherine Berry ◽  
Amy Salter ◽  
Rohan Morris ◽  
Susannah James ◽  
Sandra Bucci
Keyword(s):  
Mental Health ◽  
Therapeutic Alliance ◽  
Digital Health ◽  
Health Intervention ◽  
Health Interventions ◽  
Health Staff ◽  
Service Users ◽  
Face To Face ◽  
Mental Health Interventions ◽  
Stage 1

BACKGROUND Digital health interventions in the form of smartphone apps aim to improve mental health and enable people access to support as and when needed without having to face the stigma they may experience in accessing services. If we are to evaluate mobile health (mHealth) apps and advance scientific understanding, we also need tools to help us understand in what ways mHealth interventions are effective or not. The concept of therapeutic alliance, a measure of the quality of the relationship between a health care provider and a service user, is a key factor in explaining the effects of mental health interventions. The Agnew Relationship Measure (ARM) is a well-validated measure of therapeutic alliance in face-to-face therapy. OBJECTIVE This study presented the first attempt to (1) explore service users’ views of the concept of relationship within mHealth mental health interventions and (2) adapt a well-validated face-to-face measure of therapeutic alliance, the Agnew Relationship Measure (ARM), for use with mHealth interventions. METHODS In stage 1, we interviewed 9 mental health service users about the concept of therapeutic alliance in the context of a digital health intervention and derived key themes from interview transcripts using thematic analysis. In stage 2, we used rating scales and open-ended questions to elicit views from 14 service users and 10 mental health staff about the content and face validity of the scale, which replaced the word “therapist” with the word “app.” In stage 3, we used the findings from stages 1 and 2 to adapt the measure with the support of a decision-making algorithm about which items to drop, retain, or adapt. RESULTS Findings suggested that service users do identify relationship concepts when thinking about mHealth interventions, including forming a bond with an app and the ability to be open with an app. However, there were key differences between relationships with health professionals and relationships with apps. For example, apps were not as tailored and responsive to each person’s unique needs. Furthermore, apps were not capable of portraying uniquely human-like qualities such as friendliness, collaboration, and agreement. We made a number of changes to the ARM that included revising 16 items; removing 4 items due to lack of suitable alternatives; and adding 1 item to capture a key theme derived from stage 1 of the study (“The app is like having a member of my care team in my pocket”). CONCLUSIONS This study introduces the mHealth version of the ARM, the mARM, that has good face and content validity. We encourage researchers to include this easy-to-use tool in digital health intervention studies to gather further data about its psychometric properties and advance our understanding of how therapeutic alliance influences the efficacy of mHealth interventions. CLINICALTRIAL International Standard Randomized Controlled Trial Number (ISRCTN) 34966555; http://www.isrctn.com/ISRCTN34966555 (Archived by WebCite at http://www.webcitation.org/6ymBVwKif)

scholarly journals A Digital Health Intervention for Weight Management for Latino Families Living in Rural Communities: Perspectives and Lessons Learned During Development

10.2196/20679 ◽  
2020 ◽  
Vol 4 (8) ◽  
pp. e20679
Author(s):  
Zenong Yin ◽  
Vanessa L Errisuriz ◽  
Martin Evans ◽  
Devasena Inupakutika ◽  
Sahak Kaghyan ◽  
...  
Keyword(s):  
Health Care ◽  
Weight Management ◽  
Access To Health Care ◽  
Underserved Populations ◽  
Digital Health ◽  
Intervention Strategy ◽  
Health Intervention ◽  
Lessons Learned ◽  
Health Interventions ◽  
Rural Residents

Rural residents face numerous challenges in accessing quality health care for management of chronic diseases (eg, obesity, diabetes), including scarcity of health care services and insufficient public transport. Digital health interventions, which include modalities such as internet, smartphones, and monitoring sensors, may help increase rural residents’ access to health care. While digital health interventions have become an increasingly popular intervention strategy to address obesity, research examining the use of technological tools for obesity management among rural Latino populations is limited. In this paper, we share our experience developing a culturally tailored, interactive health intervention using digital technologies for a family-oriented, weight management program in a rural, primarily Latino community. We describe the formative research that guided the development of the intervention, discuss the process of developing the intervention technologies including issues of privacy and data security, examine the results of a pilot study, and share lessons learned. Our experience can help others design user-centered digital health interventions to engage underserved populations in the uptake of healthy lifestyle and disease management skills.

scholarly journals Evaluating use of web-based interventions: an example of a Dutch sexual health intervention

2021 ◽  
Author(s):  
Gido Metz ◽  
Hanneke Roosjen ◽  
Wessel Zweers ◽  
Rik Crutzen
Keyword(s):  
Sexual Health ◽  
Behavior Change ◽  
Behavioral Interventions ◽  
Real Life ◽  
Health Intervention ◽  
Web Analytics ◽  
Current Increase ◽  
Web Based ◽  
Actual Use ◽  
Intended Use

With the current increase in web-based interventions, the question of how to measure, and consequently improve engagement in such interventions is gaining more importance. Modern day web analytics tools make it easy to monitor use of web-based interventions. However, in this article, we propose that it would be more meaningful to first examine how the developers envisioned the use of the intervention to establish behavior change (i.e. intended use), before looking into how the intervention is ultimately used with web analytics (i.e. actual use). Such an approach responds to the regularly expressed concern that behavioral interventions are often poorly described, leading to less meaningful evaluations as it is not clear what exactly is being evaluated. Using data from a Dutch sexual health intervention (sense.info), we demonstrate the value of acyclic behavior change diagrams (ABCDs) as a method to visualize intended use of an intervention. ABCDs show at a glance how behavior change principles are applied in an intervention and target determinants of behavior. Based on this ABCD, we look into actual use of the intervention, using the web analytics tool Matomo. This real-life example demonstrates the potential of combining ABCDs and Matomo as methods to gain insight into use of web- based interventions.

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