The acceptability and feasibility of a pilot study examining the impact of a mobile technology-based intervention informed by behavioral economics to improve HIV knowledge and testing frequency among Latinx sexual minority men and transgender women

Abstract

Background We developed a novel intervention that uses behavioral economics incentives and mobile-health text messages to increase HIV knowledge and testing frequency among Latinx sexual minority men and Latinx transgender women. Here we provide a theoretically-grounded assessment regarding the intervention’s acceptability and feasibility. Methods We conducted 30-min exit interviews with a stratified sample of participants (n = 26 Latinx sexual minority men, 15 Latinx transgender women), supplemented with insights from study staff (n = 6). All interviews were recorded, transcribed, and translated for a content analysis using Dedoose. Cohen’s Kappa was 89.4% across coded excerpts. We evaluated acceptability based on how participants cognitively and emotionally reacted to the intervention and whether they considered it to be appropriate. We measured feasibility based on resource, scientific and process assessments (e.g., functionality of text messaging service, feedback on study recruitment procedures and surveys). Results Regarding acceptability, most participants clearly understood the intervention as a program to receive information about HIV prevention methods through text messages. Participants who did not complete the intervention shared they did not fully understand what it entailed at their initial enrollment, and thought it was a one-time engagement and not an ongoing program. Though some participants with a higher level of education felt the information was simplistic, most appreciated moving beyond a narrow focus on HIV to include general information on sexually transmitted infections; drug use and impaired sexual decision-making; and differential risks associated with sexual positions and practices. Latinx transgender women in particular appreciated receiving information about Pre-Exposure Prophylaxis. While participants didn’t fully understand the exact chances of winning a prize in the quiz component, most enjoyed the quizzes and chance of winning a prize. Participants appreciated that the intervention required a minimal time investment. Participants shared that the intervention was generally culturally appropriate. Regarding feasibility, most participants reported the text message platform worked well though inactive participants consistently said technical difficulties led to their disengagement. Staff shared that clients had varying reactions to being approached while being tested for HIV, with some unwilling to enroll and others being very open and curious about the program. Both staff and participants relayed concerns regarding the length of the recruitment process and study surveys. Conclusions Our theoretically-grounded assessment shows the intervention is both acceptable and feasible. Trial registration The trial was registered on May 5, 2017 with the ClinicalTrials.gov registry [NCT03144336].

Evidence and implication of interventions across various socioecological levels to address HIV testing uptake among men who have sex with men in the United States: A systematic review

“… 26 , 43 , 51 , 52 , 57 , 58 , 64 , 71 , 76 , 78 , 79 Most studies were implemented after 2000. 20 – 26 , 34 – 37 , 39 – 79 , 81 …”

“…Evaluation of acceptability and feasibility was mostly conducted in technology-delivered interventions. 23 , 36 , 38 , 41 , 46 , 47 , 51 , 63 , 70 Participants generally had positive attitudes toward the interventions delivered by website, video or text messages, for example, “I liked the whole goal of the program (Guy2Guy intervention),” and expressed high satisfaction with the program. 38 , 41 , 46 , 51 Mobile app interventions were also shown to be acceptable based on the high System Usability Scale score.…”

“…app crashing or slow responsiveness) and problems with user control and freedom. 23 , 46 , 56 , 63 When pilot testing the Status Update Project mobile app, some participants appreciated its simplicity and reminders while others thought that it was too simple and repetitive. 23 Formative studies and pilot tests are required to learn participants’ preference and test the usability of the online interventions.…”

“…First, there might be a mismatch between the complexity of HIV information content and participants’ health literacy. For example, participants with high health literacy thought that the health information was “simplistic” and they “did not fully get the opportunity to learn anything new.” 47 , 63 Possible solution could be the development of intervention content tailored to participants’ educational level and health literacy. Second, we observed diminished effect of the intervention across study periods.…”

Effects of Behavioral Economics–Based Messaging on Appointment Scheduling Through Patient Portals and Appointment Completion: Observational Study

“…Over the past decade, these tenets of behavioral economics have been increasingly utilized in health care for both patients (cancer screenings [ 14 ], hospital appointment no-show rates [ 7 ], medication adherence for behavioral health [ 15 ], HIV testing rates [ 16 ], obesity and binge eating [ 17 ]) and clinicians (prescribing behavior [ 18 , 19 ], overtreatment of diabetes [ 20 ]), with 83 publications in the top 3 highest impact general medicine journals (Journal of the American Medical Association, The Lancet, The New England Journal of Medicine) from 1998 to 2018 [ 21 ]. A systematic review [ 22 ] found patient portal interventions to be effective in improving a few psychological outcomes, medication adherence, and preventive service use.…”