Participatory Design of a Web-Based HIV Oral Self-Testing Infographic Experiment (HOTIE) for Emerging Adult Sexual Minority Men of Color: A Mixed Methods Randomized Control Trial

S Raquel Ramos, David T Lardier Jr, Keosha T Bond, Donte T Boyd, Olivia M O'Hare, LaRon E Nelson, Barbara J Guthrie, Trace Kershaw, S Raquel Ramos, David T Lardier Jr, Keosha T Bond, Donte T Boyd, Olivia M O'Hare, LaRon E Nelson, Barbara J Guthrie, Trace Kershaw

Abstract

Health communication is a key health promotion approach for translating research findings into actionable information. The purpose of this study was to use participatory design to create and then test the usability and comprehension of an HIV self-testing infographic in a sample of 322 emerging adult, sexual minority men of color. Our study objectives addressed three challenges to HIV self-testing: (1) correct usage of the test stick, (2) understanding the number of minutes to wait before reading the result, and (3) how to correctly interpret a negative or a positive HIV result. This study was a two-phase, sequential, mixed methods, pilot, online, randomized controlled trial. Results suggested a significant mean difference between the control and intervention groups on HIV self-testing knowledge, with the control group outperforming the intervention group. However, two-thirds or better of the participants in the intervention group were able to comprehend the three critical steps to HIV self-testing. This was a promising finding that has resulted in the authors' development of additional recommendations for using participatory design for visual aid development in HIV prevention research. Participatory design of an HIV self-testing infographic is a rigorous approach, as a health communication strategy, to address public health priorities.

Keywords: HIV; consumer health informatics; health communication; health literacy; participatory design; sexual and gender minorities.

Conflict of interest statement

The authors declare no potential competing interests.

Figures

Figure 1
Figure 1
HIV self-testing infographic.
Figure 2
Figure 2
Percentage distribution of accuracy of oral HIV self-testing knowledge (in percentages) between experimental (n = 161) and control groups (n = 161).
Figure 3
Figure 3
Bar chart display of experimental group participant responses on the feasibility and acceptability on the oral HIV self-testing infographic questionnaire (n = 161).

References

    1. Neuhauser L. Integrating participatory design and health literacy to improve research and interventions. Inf. Serv. Use. 2017;37:153–176. doi: 10.3233/ISU-170829.
    1. Spinuzzi C. The methodology of participatory design. Tech. Commun. 2005;52:163–174.
    1. Clemensen J., Larsen S.B., Kyng M., Kirkevold M. Participatory design in health sciences: Using cooperative experimental methods in developing health services and computer technology. Qual. Health Res. 2007;17:122–130. doi: 10.1177/1049732306293664.
    1. Bjerkan J., Hedlund M., Hellesø R. Patients’ contribution to the development of a web-based plan for integrated care–a participatory design study. Inform. Health Soc. Care. 2015;40:167–184. doi: 10.3109/17538157.2014.907803.
    1. CDC [(accessed on 3 September 2021)];HIV Surveillance Report. 2019 Volume 32 Available online: .
    1. UNAIDS 90-90-90: An Ambitious Treatment Target to Help End the AIDS Epidemic. [(accessed on 3 September 2021)]. Available online: .
    1. Sidibé M., Loures L., Samb B. The UNAIDS 90–90–90 target: A clear choice for ending AIDS and for sustainable health and development. J. Int. AIDS Soc. 2016;19:21133. doi: 10.7448/IAS.19.1.21133.
    1. Roehr B. FDA approves “instant” HIV home test for use over the counter. BMJ Br. Med J. 2012;345:5. doi: 10.1136/bmj.e4636.
    1. Pai N.P., Balram B., Shivkumar S., Martinez-Cajas J.L., Claessens C., Lambert G., Peeling R.W., Joseph L. Head-to-head comparison of accuracy of a rapid point-of-care HIV test with oral versus whole-blood specimens: A systematic review and meta-analysis. Lancet Infect. Dis. 2012;12:373–380. doi: 10.1016/S1473-3099(11)70368-1.
    1. Wood B.R., Ballenger C., Stekler J.D. Arguments for and against HIV self-testing. HIV/AIDS (Auckland NZ) 2014;6:117.
    1. Estem K.S., Catania J., Klausner J.D. HIV self-testing: A review of current implementation and fidelity. Curr. HIV/AIDS Rep. 2016;13:107–115. doi: 10.1007/s11904-016-0307-y.
    1. Knight L., Makusha T., Lim J., Peck R., Taegtmeyer M., van Rooyen H. “I think it is right”: A qualitative exploration of the acceptability and desired future use of oral swab and finger-prick HIV self-tests by lay users in KwaZulu-Natal, South Africa. BMC Res. Notes. 2017;10:1–8. doi: 10.1186/s13104-017-2810-7.
    1. WHO HIV Treatment and Care: WHO HIV Policy Adoption and Implementation Status in Countries: Factsheet. 2019. [(accessed on 10 October 2019)]. World Health Organization. Available online: .
    1. Bradley H., Hall H.I., Wolitski R.J., Van Handel M.M., Stone A.E., LaFlam M., Skarbinski J., Higa D.H., Prejean J., Frazier E.L. Vital signs: HIV diagnosis, care, and treatment among persons living with HIV—United States, 2011. MMWR Morb. Mortal. Wkly. Rep. 2014;63:1113–1117.
    1. Frye V., Wilton L., Hirshfield S., Chiasson M.A., Usher D., Lucy D., McCrossin J., Greene E., Koblin B., Team A.A.M.S. “Just because it’s out there, people aren’t going to use it”. HIV self-testing among young, black MSM, and transgender women. AIDS Patient Care STDs. 2015;29:617–624. doi: 10.1089/apc.2015.0100.
    1. Levy M.E., Wilton L., Phillips G., Glick S.N., Kuo I., Brewer R.A., Elliott A., Watson C., Magnus M. Understanding structural barriers to accessing HIV testing and prevention services among black men who have sex with men (BMSM) in the United States. AIDS Behav. 2014;18:972–996. doi: 10.1007/s10461-014-0719-x.
    1. Elopre L., Ott C., Lambert C.C., Amico K.R., Sullivan P., Marrazzo J., Mugavero M.J., Turan J.M. Missed prevention opportunities: Why young, black MSM with recent HIV diagnosis did not access HIV pre-exposure prophylaxis services. AIDS Behav. 2021;25:1464–1473. doi: 10.1007/s10461-020-02985-0.
    1. Ramos S.R., Gordon P., Bakken S., Schnall R. Sociotechnical Analysis of Health Information Exchange Consent Processes in an HIV Clinic. J. Assoc. Nurses AIDS Care. 2016;27:792–803. doi: 10.1016/j.jana.2016.08.001.
    1. Ramos S.R., Paintsil E., Ofori-Atta A., Kusah J.T., Amissah K.A., Alhassan A., Ofori I.P., Reynolds N.R. Prototype Development, Usability and Preference of a Culturally-relevant Pictorial Aid to Facilitate Comprehension of Likert-type levels of Agreement in Caregivers of Children Living with HIV in Ghana. Comput. Inform. Nurs. CIN. 2020;38:45. doi: 10.1097/CIN.0000000000000584.
    1. Schnall R., John R.M., Carballo-Dieguez A. Do high-risk young adults use the HIV self-test appropriately? Observations from a think-aloud study. AIDS Behav. 2016;20:939–948. doi: 10.1007/s10461-015-1240-6.
    1. Mathews A., Farley S., Conserve D.F., Knight K., Le’Marus A., Blumberg M., Rennie S., Tucker J. “Meet people where they are”: A qualitative study of community barriers and facilitators to HIV testing and HIV self-testing among African Americans in urban and rural areas in North Carolina. BMC Public Health. 2020;20:494. doi: 10.1186/s12889-020-08582-z.
    1. Peck R.B., Lim J.M., van Rooyen H., Mukoma W., Chepuka L., Bansil P., Knight L.C., Muturi N., Chirwa E., Lee A.M. What should the ideal HIV self-test look like? A usability study of test prototypes in unsupervised HIV self-testing in Kenya, Malawi, and South Africa. AIDS Behav. 2014;18:422–432. doi: 10.1007/s10461-014-0818-8.
    1. Ng O.T., Chow A.L., Lee V.J., Chen M.I., Win M.K., Tan H.H., Chua A., Leo Y.S. Accuracy and user-acceptability of HIV self-testing using an oral fluid-based HIV rapid test. PLoS ONE. 2012;7:e45168. doi: 10.1371/journal.pone.0045168.
    1. Paasche-Orlow M.K., Parker R.M., Gazmararian J.A., Nielsen-Bohlman L.T., Rudd R.R. The prevalence of limited health literacy. J. Gen. Intern. Med. 2005;20:175–184. doi: 10.1111/j.1525-1497.2005.40245.x.
    1. Rudd R.E., Moeykens B.A., Colton T.C. Health and literacy: A review of medical and public health literature. Office of Educational Research and Improvement. 1999. [(accessed on 12 November 2021)]. Available online: .
    1. Figueroa C., Johnson C., Verster A., Baggaley R. Attitudes and acceptability on HIV self-testing among key populations: A literature review. AIDS Behav. 2015;19:1949–1965. doi: 10.1007/s10461-015-1097-8.
    1. Johnson C.C., Kennedy C., Fonner V., Siegfried N., Figueroa C., Dalal S., Sands A., Baggaley R. Examining the effects of HIV self-testing compared to standard HIV testing services: A systematic review and meta-analysis. J. Int. AIDS Soc. 2017;20:21594. doi: 10.7448/IAS.20.1.21594.
    1. Zhang C., Li X., Brecht M.-L., Koniak-Griffin D. Can self-testing increase HIV testing among men who have sex with men: A systematic review and meta-analysis. PLoS ONE. 2017;12:e0188890. doi: 10.1371/journal.pone.0188890.
    1. Houts P.S., Doak C.C., Doak L.G., Loscalzo M.J. The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence. Patient Educ. Couns. 2006;61:173–190. doi: 10.1016/j.pec.2005.05.004.
    1. Deutsch M.B., Green J., Keatley J., Mayer G., Hastings J., Hall A.M., Deutsch M.B., Keatley J., Green J., Allison R. Electronic medical records and the transgender patient: Recommendations from the World Professional Association for Transgender Health EMR Working Group. J. Am. Med Inform. Assoc. 2013;20:700–703. doi: 10.1136/amiajnl-2012-001472.
    1. National Survey of Family Growth (NSFG) Years Survey Included Sexual and Gender Minority (SGM)-Related Questions 2002–Present. [(accessed on 3 September 2021)]; Available online: .
    1. Lund A.M. Measuring usability with the use questionnaire12. Usability Interface. 2001;8:3–6.
    1. Lee S.Y.D., Stucky B.D., Lee J.Y., Rozier R.G., Bender D.E. Short assessment of health literacy—Spanish and English: A comparable test of health literacy for Spanish and English speakers. Health Serv. Res. 2010;45:1105–1120. doi: 10.1111/j.1475-6773.2010.01119.x.
    1. Carey M.P., Schroder K.E. Development and psychometric evaluation of the brief HIV Knowledge Questionnaire. AIDS Educ. Prev. 2002;14:172–182. doi: 10.1521/aeap.14.2.172.23902.
    1. Faul F., Erdfelder E., Buchner A., Lang A.-G. Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behav. Res. Methods. 2009;41:1149–1160. doi: 10.3758/BRM.41.4.1149.
    1. Bursac Z., Gauss C.H., Williams D.K., Hosmer D.W. Purposeful selection of variables in logistic regression. Source Code Biol. Med. 2008;3:17. doi: 10.1186/1751-0473-3-17.
    1. Aneshensel C.S. Theory-Based Data Analysis for the Social Sciences. Sage Publications; Thousand Oaks, CA, USA: 2012.
    1. Simonsen J., Robertson T. Routledge International Handbook of Participatory Design. Routledge; London, UK: 2012.
    1. Bond K.T., Ramos S.R. Utilization of an animated electronic health video to increase knowledge of post-and pre-exposure prophylaxis for HIV among African American women: Nationwide cross-sectional survey. JMIR Form. Res. 2019;3:e9995. doi: 10.2196/formative.9995.
    1. Kalichman S.C., Cherry J., Cain D. Nurse-delivered antiretroviral treatment adherence intervention for people with low literacy skills and living with HIV/AIDS. J. Assoc. Nurses AIDS Care. 2005;16:3–15. doi: 10.1016/j.jana.2005.07.001.
    1. Kalichman S.C., Cherry C., Kalichman M.O., Amaral C., White D., Grebler T., Eaton L.A., Cruess D., Detorio M.A., Caliendo A.M. Randomized clinical trial of HIV treatment adherence counseling interventions for people living with HIV and limited health literacy. J. Acquir. Immune Defic. Syndr. 2013;63:42. doi: 10.1097/QAI.0b013e318286ce49.
    1. Ramos S.R. User-centered Design, Experience, and Usability of an e-Consent User Interface to Facilitate Informed Decision Making in an HIV Clinic. Comput. Inform. Nurs. CIN. 2017;35:556. doi: 10.1097/CIN.0000000000000356.
    1. Krause J., Subklew-Sehume F., Kenyon C., Colebunders R. Acceptability of HIV self-testing: A systematic literature review. BMC Public Health. 2013;13:735. doi: 10.1186/1471-2458-13-735.
    1. Carballo-Diéguez A., Frasca T., Dolezal C., Balan I. Will gay and bisexually active men at high risk of infection use over-the-counter rapid HIV tests to screen sexual partners? J. Sex Res. 2012;49:379–387. doi: 10.1080/00224499.2011.647117.
    1. Gaydos C.A., Hsieh Y.-H., Harvey L., Burah A., Won H., Jett-Goheen M., Barnes M., Agreda P., Arora N., Rothman R.E. Will patients “opt in” to perform their own rapid HIV test in the emergency department? Ann. Emerg. Med. 2011;58:S74–S78. doi: 10.1016/j.annemergmed.2011.03.029.
    1. Choko A.T., Desmond N., Webb E.L., Chavula K., Napierala-Mavedzenge S., Gaydos C.A., Makombe S.D., Chunda T., Squire S.B., French N. The uptake and accuracy of oral kits for HIV self-testing in high HIV prevalence setting: A cross-sectional feasibility study in Blantyre, Malawi. PLoS Med. 2011;8:e1001102. doi: 10.1371/journal.pmed.1001102.
    1. Kurth A.E., Cleland C.M., Chhun N., Sidle J.E., Were E., Naanyu V., Emonyi W., Macharia S.M., Sang E., Siika A.M. Accuracy and acceptability of oral fluid HIV self-testing in a general adult population in Kenya. AIDS Behav. 2016;20:870–879. doi: 10.1007/s10461-015-1213-9.
    1. Marlin R.W., Young S.D., Bristow C.C., Wilson G., Rodriguez J., Ortiz J., Mathew R., Klausner J.D. Piloting an HIV self-test kit voucher program to raise serostatus awareness of high-risk African Americans, Los Angeles. BMC Public Health. 2014;14:1–5. doi: 10.1186/1471-2458-14-1226.
    1. Merchant R., Clark M., Liu T., Rosenberger J., Romanoff J., Bauermeister J., Mayer K. Preferences for oral fluid rapid HIV self-testing among social media-using young black, Hispanic, and white men-who-have-sex-with-men (YMSM): Implications for future interventions. Public Health. 2017;145:7–19. doi: 10.1016/j.puhe.2016.12.002.
    1. Marks S.J., Merchant R.C., Clark M.A., Liu T., Rosenberger J.G., Bauermeister J.A., Mayer K.H. Barriers to HIV Testing and Opportunities for Expansion Using Home-Based HIV Self-Testing: Results of a National Study of Higher HIV Risk Young Men Who Have Sex with Men. SAGE Open. 2021;11:21582440211016835. doi: 10.1177/21582440211016835.
    1. Dai M., Harrington N.G. Intention to behavior: Using the integrative model of behavioral prediction to understand actual control of prep uptake among gay men. Arch. Sex. Behav. 2021;50:1817–1828. doi: 10.1007/s10508-020-01802-y.
    1. Katz D.A., Golden M.R., Hughes J.P., Farquhar C., Stekler J.D. HIV self-testing increases HIV testing frequency in high risk men who have sex with men: A randomized controlled trial. J. Acquir. Immune Defic. Syndr. 2018;78:505. doi: 10.1097/QAI.0000000000001709.
    1. Ramos S.R., Warren R., Shedlin M., Melkus G., Kershaw T., Vorderstrasse A. A framework for using eHealth interventions to overcome medical mistrust among sexual minority men of color living with chronic conditions. Behav. Med. 2019;45:166–176. doi: 10.1080/08964289.2019.1570074.
    1. Warren R., Shedlin M., Alema-Mensah E., Obasaju C., Hodge Sr D.A. Clinical trials participation among African Americans and the ethics of trust: Leadership perspectives. Ethics Med. Public Health. 2019;10:128–138. doi: 10.1016/j.jemep.2019.100405.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren