Using ADAPT-ITT to Modify a Telephone-Based HIV Prevention Intervention for SMS Delivery: Formative Study

Abstract

Background African American adolescent females are disproportionately affected by sexually transmitted infections (STIs) and HIV. Given the elevated risk of STIs and HIV in African American women, there is an urgent need to identify innovative strategies to enhance the adoption and maintenance of STI and HIV preventive behaviors. Texting is a promising technology for creating preventive maintenance interventions (PMIs) that extend the efficacy of the original intervention. However, little guidance in public health literature is available for developing this type of application. Objective This paper describes a formative pilot study that incorporates user experience methods to design and test PMI texts for Afiya, an original evidence-based intervention (EBI) specifically designed for African American adolescent females. This study aims to describe the adaptation process of health educator–led phone calling to text-based communication. Methods The formative process followed the assessment, decision, adaptation, production, topical experts-integration, training, testing (ADAPT-ITT) framework for adapting EBIs and using them in a new setting, for a new target population or a modified intervention strategy. This study presents the details of how the phases of the ADAPT-ITT framework were applied to the design of the adaptation. An advisory board was constituted from the target population, consisting of 6 African American women aged 18-24 years, participating in formative activities for 12 weeks, and involving components of the PMI design. As Afiya included a telephone-based PMI, developers of the original Afiya phone scripts crafted the initial design of the SMS-based texts and texting protocol. The advisory board participated in the 1-day Afiya workshop, followed by 4 weeks of texting PMI messages and a midcourse focus group, followed by 4 more weeks of texting PMI messages, ultimately ending with a final focus group. At the advisory board’s request, this phase included an optional, additional week of text-based PMI messages. Results The methods provided a rich source of data and insights into the fundamental issues involved when constructing SMS-based PMI for this target population and for this EBI. Prior contact and context are essential as the health educator was identified as a key persona in the process and the messages were situated in the original (workshop) context. Narrative adaptations for personas emerged from advisory board discussions. Suggestions on how to expand the PMI to current, specific social contexts indicated that the use of narrative analysis is warranted. Conclusions The use of existing EBIs incorporating telephone-based PMI scripts facilitated the initial design of the texts, with a subsequent narrative analysis of the advisory board data providing additional adjustments given the actual context. Additional examination of the advisory board feedback revealed that personas would offer insight into and opportunities for a persona-specific modification of texting narratives.

Adaptation of a Problem-solving Program (Friendship Bench) to Treat Common Mental Disorders Among People Living With HIV and AIDS and on Methadone Maintenance Treatment in Vietnam: Formative Study

“…The application of the ADAPT-ITT framework for the systematic adaptation of EIP can vary depending on the program, population, and resources [ 28 , 30 , 39 ]. A key strength of this study is that it used a linear approach to adapt the ADAPT-ITT framework on a small scale [ 28 ].…”

“…The application of the ADAPT-ITT framework for the systematic adaptation of EIP can vary depending on the program, population, and resources [ 28 , 30 , 39 ]. A key strength of this study is that it used a linear approach to adapt the ADAPT-ITT framework on a small scale [ 28 ]. Results of the previous phases provided informative contributions for the next phase [ 40 ] in terms of the program procedures and content of the program manual.…”

“…The adaptation method ADAPT-ITT of the Centers for Disease Control and Prevention (CDC) was developed by Wingood and DiClemente in 2008 as a framework to guide the adaptation of a proven EIP to the specific goals and study participants of HIV prevention [ 25 ]. The ADAPT-ITT model has been used to adapt HIV prevention EIP for HIV key populations such as African American couples in the United States [ 26 ], people living with HIV in Zimbabwe [ 27 ], African American women in the United States [ 28 ], and men who have sex with men in Thailand [ 29 ] and to address mental and sexual health for young people living with HIV in sub-Saharan Africa [ 30 ].…”

IMPAACT 2016: Operationalizing HIV Intervention Adaptations to Inform the Science and Outcomes of Implementation

“…The ADAPT-ITT framework is instrumental in systematically adapting interventions, and application of the framework can vary depending on the intervention, population, and resources (24)(25)(26). Significant advancements have been made in developing guidelines on how to apply the ADAPT-ITT framework on a small scale (24,25), and there is growing interest for further advancing the application of the ADAPT-ITT framework to a larger scale.…”

“…The ADAPT-ITT framework is instrumental in systematically adapting interventions, and application of the framework can vary depending on the intervention, population, and resources (24)(25)(26). Significant advancements have been made in developing guidelines on how to apply the ADAPT-ITT framework on a small scale (24,25), and there is growing interest for further advancing the application of the ADAPT-ITT framework to a larger scale. Supplementing the general guidelines of the ADAPT-ITT framework with specific operationalization plans outlining systematic processes for each adaptation step offers a robust strategy (20,25) to tailor the framework and replicate for future scale-up of various types of interventions.…”