The mHealth Development of an Evidence-Based HIV Risk-Reduction Intervention for Young African American Women in the US South (Preprint)

Abstract

\n BACKGROUND\n Young African American women have higher rates of sexually transmitted infections, including HIV, compared with young women of other racial and ethnic groups. Gender-, culturally-, and age-specific interventions are needed to end the HIV epidemic. The Women’s CoOp (WC) is an HIV risk-reduction intervention that has proven efficacious in various face-to-face formats.\n \n \n OBJECTIVE\n We aimed to adapt the delivery method of an evidence-based intervention, the Young Women’s CoOp, from an in-person format to a self-guided mobile health (mHealth) delivery format while ensuring that core elements were maintained for intervention comparability and fidelity.\n \n \n METHODS\n Several adaptation phases were conducted using the Personal Health Informatics and Intervention Toolkit (PHIT) as a guiding point to create the mobile app version of the WC. Throughout these 5 phases, we established the implementation groundwork for the app; conducted formative research activities to test the initial draft of the app and obtain feedback; applied the PHIT toolkit programming structure to produce the mHealth version of the WC intervention; conducted usability and pretesting with interested parties, followed by in-house testing by WC interventionists and PHIT developers; and deployed the app to tablets and distributed it to study participants. The app underwent regular maintenance updates during the study.\n \n \n RESULTS\n The team converted the 7 elements of the WC as accurately as possible for comparability to determine efficacy in a mobile app format while changing little about the basic delivery methods. For instance, “cue card” presentation of the materials delivered by intervention staff were presented within the app but with voice-over narration and in a self-guided format rather than being led by a staff member. Other aspects of the intervention did not lend themselves to such straightforward adaptation, such as hands-on condom proficiency practice and one-on-one goal setting activities. In these cases, the subject-matter experts and app developers worked together to find comparable analogues to employ within the app. Once developed, tested, and finalized, the mHealth Young Women’s CoOp app was deployed to 226 participants over the course of 32 months.\n \n \n CONCLUSIONS\n The adaptation process created an accurate mHealth equivalent of an existing, research-based, in-person behavioral health intervention and yielded successful results. Participant reception of the app was positive overall and evidence showed that the intervention content was absorbed. However, intervention completion rates for those working with the Young Women’s CoOp app were lower than desired. This outcome could be caused by the implementation decision to make as close an equivalent to the in-person intervention as possible. Employing more of the natural capabilities of a mobile app—such as further gamification, different types of interactivity, and integrated notifications and messaging—could be helpful for maintaining participant adherence to the intervention schedule in future iterations.\n \n \n CLINICALTRIAL\n ClinicalTrials.gov\nNCT02965014; https://clinicaltrials.gov/ct2/show/NCT02965014\n