BackgroundDespite ongoing prevention efforts, HIV and other sexually transmitted infections (HIV/STIs) and drug use remain public health concerns. Urban adolescents, many of whom are underserved and racial minorities, are disproportionately affected. Recent changes in policy, including the Affordable Care Act, and advances in technology provide HIV/STI and drug abuse prevention scientists with unique opportunities to deliver mobile health (mHealth) preventive interventions in primary care.ObjectivesThe purpose of this community-engaged study was to develop an mHealth version of the Storytelling for Empowerment preventive intervention for primary care (hereinafter referred to as “S4E”).MethodsA total of 29 adolescents were recruited from a youth-centered primary care clinic in Southeast, Michigan, to participate in qualitative interviews. Participants were predominantly African American (n=19, 65.5%) and female (n=21, 72.4%) with a mean age of 16.23 (SD 2.09). The principles of community-based participatory research (CBPR), in conjunction with agile software development and the recommended core prevention principles of the National Institute on Drug Abuse (NIDA) were employed during S4E development. CBPR principles are aimed at improving the effectiveness of research by addressing locally relevant health problems, working with community strengths, and translating basic science into applied research. Complementing this approach, the NIDA prevention principles are derived from decades of drug abuse prevention research aimed at increasing the effectiveness and uptake of programs, through the development of culturally specific interventions and ensuring the structure, content, and delivery of the intervention fit the needs of the community. Data were analyzed using thematic analysis.ResultsA total of 5 themes emerged from the data: (1) acceptability of the mHealth app to adolescents in primary care, (2) inclusion of a risk assessment to improve clinician-adolescent HIV/STI and drug use communication, (3) incorporation of culturally specific HIV/STI and drug use content, (4) incorporation of interactive aspects in the app to engage youth, and (5) perspectives on the appearance of the app.ConclusionsThere is a dearth of mHealth HIV/STI and drug abuse preventive interventions for primary care. Incorporating the principles of CBPR in conjunction with agile software development and NIDA-recommended core prevention principles may be helpful in developing culturally specific mHealth interventions. An important next step in this program of research is to examine the feasibility, acceptability, and efficacy of S4E on adolescent sexual risk and drug use behaviors, and HIV/STI testing. Implications for prevention research and primary care practice are discussed in the context of the Affordable Care Act and technological advances.

This research used a structured storytelling narrative methodology to capture the lived experience of youth participants to identify effective factors that helped them in three programs in Santa Barbara and Ventura Counties, California. Thirty-nine youth aged 8-17 participated in two storytelling protocols at their home sites; one was a written narrative of a vivid experience in the project, and the second was a group story about a character who had been a participant. Categorical content analysis reported the following themes: positive peer experiences, caring adults, family atmosphere and learning new skills particularly computer literacy. Participants reported changing from being isolated or acting out to succeeding in school.

Although there are effective treatments that promote recovery and improve quality of life for serious mental illness in nonincarcerated populations, more research is needed to understand the recovery process for individuals with a history of incarceration. A qualitative, grounded theory study was conducted with 17 men and women who have serious mental illness (SMI) and a history of incarceration. Findings revealed barriers and facilitators to the recovery process in the areas of identity, treatment, relationships, community, and institutions. The findings suggested that incarceration had harmful effects on the recovery process for individuals with SMI, although these individuals, at times, found ways to turn this challenging experience into an opportunity for personal growth. The clinical implications of these findings include the importance of the prevention of incarceration for people with SMI, as well as the provision of multidisciplinary care, such as medical, mental health, and substance use treatment, during and after incarceration, to reduce barriers and increase recovery outcomes. Additionally, factors related specifically to incarceration should be addressed during delivery of treatment and accessibility of community resources. Advocacy and policy change for prison reform will also be discussed. Impact StatementAlthough incarceration appears to disrupt the recovery process for people with serious mental illness (SMI), this study affirms that individuals with SMI have remarkable resilience navigating barriers to recovery. Additionally, this study identifies the association between personal recovery with institutional, community, relationship, treatment, and identity factors.

Latino adolescents are disproportionately impacted by HIV, but researchers have documented few programs to prevent and reduce HIV risk. The Storytelling for Empowerment (SFE) HIV StoryBook was designed with an innovative ecodevelopment approach combining empowerment, family communication, and positive cultural identity. A mixed method design used both a randomized control group design, as well as grounded theory coding of semi-structured focus group interviews. For the quantitative method, a total of 96 adolescents (85% Latino, M age = 12.2) were randomized to either the SFE HIV StoryBook condition or a control condition and then tested at baseline and at 4 months post-baseline. Study findings indicated that teens who participated in the HIV StoryBook condition maintained sexual abstinence, increased their ability to communicate about sex, increased their intention to stop sexual advances, and increased their HIV prevention knowledge. For the qualitative method, seven focus groups of 38 participants, including staff, madres, teen participants, and graduates created rich description.