Abstract
BackgroundIn the era of potent antiretroviral therapy, a high level of condomless anal intercourse continues to drive increases in HIV incidence in recent years among men who have sex with men. Effective behavior change strategies for promoting HIV-preventive behaviors are warranted. Narrative persuasion is a novel health communication approach that has demonstrated its persuasive advantages in overcoming resistance to counterattitudinal messages. The efficacy of narrative persuasion in promoting health behavior changes has been well documented, but critical research gaps exist for its application to HIV prevention.ObjectiveIn this study, we aimed to (1) capitalize on narrative persuasion to design a web-based multisession intervention for reducing condomless anal intercourse among men who have sex with men in Hong Kong (the HeHe Talks Project) by following a systematic development process; and (2) describe the main components of the narrative intervention that potentially determine its persuasiveness.MethodsPersuasive themes and subtopics related to reducing condomless anal intercourse were initially proposed based on epidemiological evidence. The biographic narrative interview method was used to elicit firsthand experiential stories from a maximum variation sample of local men who have sex with men with diverse backgrounds and experiences related to HIV prevention; different types of role models were established accordingly. Framework analysis was used to aggregate the original quotations from narrators into collective narratives under 6 intervention themes. A dedicated website was finally developed for intervention delivery.ResultsA series of video-based intervention messages in biographic narrative format (firsthand experiential stories shared by men who have sex with men) combined with topic-equivalent argumentative messages were produced and programmed into 6 intervention sessions. The 6-week intervention program can be automatically delivered and monitored online.ConclusionsWe systematically created a web-based HIV prevention intervention derived from peer-generated stories. Strategies used to enhance the efficacy of the narrative intervention have been discussed within basic communication components. This paper describes the methods and experiences of the rigorous development of a narrative communication intervention for HIV prevention, which enables replication of the intervention in the future.
Highlights
Men Who Have Sex With Men as an Important Target for human immunodeficiency virus sexually transmitted infections (STIs) (HIV) Prevention a steadily decreasing trend has been observed for the global human immunodeficiency virus STI (HIV) burden, the epidemic has continued to expand among men who have sex with men [1]
We systematically created a web-based HIV prevention intervention derived from peer-generated stories
Despite biomedical advances in antiretroviral therapy and growing access to care and treatment, there is a paradoxical rise in the HIV incidence rate among men who have sex with men that was found to be significantly associated with an increase in condomless anal intercourse [3,4]
Summary
Men Who Have Sex With Men as an Important Target for HIV Prevention a steadily decreasing trend has been observed for the global HIV burden, the epidemic has continued to expand among men who have sex with men [1]. Despite biomedical advances in antiretroviral therapy and growing access to care and treatment, there is a paradoxical rise in the HIV incidence rate among men who have sex with men that was found to be significantly associated with an increase in condomless anal intercourse [3,4]. More efforts are necessary to develop effective behavior change strategies for the promotion of HIV-preventive behaviors among this vulnerable population. In the era of potent antiretroviral therapy, a high level of condomless anal intercourse continues to drive increases in HIV incidence in recent years among men who have sex with men. Effective behavior change strategies for promoting HIV-preventive behaviors are warranted. The efficacy of narrative persuasion in promoting health behavior changes has been well documented, but critical research gaps exist for its application to HIV prevention
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