Uncovering a Role for Electronic Personal Health Records in Reducing Disparities in Sexually Transmitted Infection Rates Among Students at a Predominantly African American University: Mixed-Methods Study (Preprint)

Abstract

Uncovering a role for electronic personal health records (PHRs) in reducing disparities in sexually transmitted infection rates: A mixed-methods study among students at a predominantly Black university. AbstractBackground: Young Black adults continue to bear an overwhelming proportion of the United States sexually transmitted infection (STI) burden, including HIV. Several studies on web-and mobile-based (mHealth) STI interventions have been conducted and are currently ongoing that focus on improving outcomes related to testing, risk communication, reducing stigma, increasing condom use, and improving adherence to biomedical prevention and treatment among men who have sex with men (MSM), substance using, and adolescent populations. The Electronic Sexual Health Information Notification and Education (eSHINE) Study was an exploratory mixedmethods study among students at a historically Black university, exploring perceptions on facilitating STI testing conversations with partners using electronic personal health records (PHRs). Objectives: The purpose of this paper is to use eSHINE Study results to describe perceived impacts of PHRs on facilitating risk discussion events. Methods: Focus groups and individual in-depth interviews were conducted on a qualitative research sample (n=35) to explore attitudes and practices related to talking with partners about STI testing and of incorporating PHRs into dyadic discussion events. An online survey was developed to measure qualitative findings on a larger sample of Black students (n=354) and to determine whether any significant differences exist between male and female participants. Results: Multiple contextual barriers were described that inhibit the utility of PHRs for facilitating discussions about STI testing and test results with partners. PHRs were believed to facilitate participants' ability to initiate conversations and confidence in STI screening information shared by partners. With PHR access, the proportion of online survey participants who reported willingness to discuss STI testing within dyadic partnerships prior to sex increased from 40.4% to 61.0%. Conclusions: Findings suggest that subpopulations of young Black adults having access to PHR may improve both motivation and personal agency for initiating dyadic talks about STI testing. This study builds on mHealth interventions research to suggest that PHRs also offer promise as a STI prevention strategy to reduce health disparities. Future eSHINE Study analyses will determine factors associated with willingness to utilize PHR for delivery of STI results as well as willingness to utilize these results to facilitate risk discussions.