Abstract
BackgroundAfrican American adolescent females are disproportionately affected by sexually transmitted infections (STIs) and HIV. Given the elevated risk of STIs and HIV in African American women, there is an urgent need to identify innovative strategies to enhance the adoption and maintenance of STI and HIV preventive behaviors. Texting is a promising technology for creating preventive maintenance interventions (PMIs) that extend the efficacy of the original intervention. However, little guidance in public health literature is available for developing this type of application.ObjectiveThis paper describes a formative pilot study that incorporates user experience methods to design and test PMI texts for Afiya, an original evidence-based intervention (EBI) specifically designed for African American adolescent females. This study aims to describe the adaptation process of health educator–led phone calling to text-based communication.MethodsThe formative process followed the assessment, decision, adaptation, production, topical experts-integration, training, testing (ADAPT-ITT) framework for adapting EBIs and using them in a new setting, for a new target population or a modified intervention strategy. This study presents the details of how the phases of the ADAPT-ITT framework were applied to the design of the adaptation. An advisory board was constituted from the target population, consisting of 6 African American women aged 18-24 years, participating in formative activities for 12 weeks, and involving components of the PMI design. As Afiya included a telephone-based PMI, developers of the original Afiya phone scripts crafted the initial design of the SMS-based texts and texting protocol. The advisory board participated in the 1-day Afiya workshop, followed by 4 weeks of texting PMI messages and a midcourse focus group, followed by 4 more weeks of texting PMI messages, ultimately ending with a final focus group. At the advisory board’s request, this phase included an optional, additional week of text-based PMI messages.ResultsThe methods provided a rich source of data and insights into the fundamental issues involved when constructing SMS-based PMI for this target population and for this EBI. Prior contact and context are essential as the health educator was identified as a key persona in the process and the messages were situated in the original (workshop) context. Narrative adaptations for personas emerged from advisory board discussions. Suggestions on how to expand the PMI to current, specific social contexts indicated that the use of narrative analysis is warranted.ConclusionsThe use of existing EBIs incorporating telephone-based PMI scripts facilitated the initial design of the texts, with a subsequent narrative analysis of the advisory board data providing additional adjustments given the actual context. Additional examination of the advisory board feedback revealed that personas would offer insight into and opportunities for a persona-specific modification of texting narratives.
Highlights
Young people in the United States have never known a world without HIV [1]
The methods provided a rich source of data and insights into the fundamental issues involved when constructing SMS-based preventive maintenance intervention (PMI) for this target population and for this evidence-based intervention (EBI)
The use of existing EBIs incorporating telephone-based PMI scripts facilitated the initial design of the texts, with a subsequent narrative analysis of the advisory board data providing additional adjustments given the actual context
Summary
Young people in the United States have never known a world without HIV [1]. The National HIV and AIDS Strategy has consistently identified African Americans as a population at increased risk for HIV to which prevention efforts and resources should be directed (President Donald Trump closed the Office of National AIDS Policy in 2017) [2]. African American females comprised approximately 13% of females in the United States but accounted for 58% of new HIV diagnoses among females, with 92% of infections attributed to heterosexual contact. The infection rate for African American females (21.3 per 100,000 population) was 13 times the rate for White females (1.7 per 100,000). These data underscore the HIV disparities disproportionately burdening African American women. Given the elevated risk of STIs and HIV in African American women, there is an urgent need to identify innovative strategies to enhance the adoption and maintenance of STI and HIV preventive behaviors. Little guidance in public health literature is available for developing this type of application
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