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

Abstract

BACKGROUND African American adolescent females are disproportionately affected by STIs and HIV. Given the elevated risk of STIs and HIV for African American women, there is an urgent need to identify innovative strategies to enhance 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 the public health literature is available for developing this type of application. OBJECTIVE We describe a formative pilot study that incorporates user experience (UX) methods to design and test PMI texts for Afiya, an original evidence-based intervention (EBI) specifically designed for African American adolescent females. The purpose of this study is to describe the adaptation process of the health educator-lead phone calling to text-based communication. METHODS The formative process followed the ADAPT-ITT framework for adapting EBI 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 (AB) from the target population was constituted, consisting of six African American women ages 18 – 24 years, participating in formative activities for 12 weeks, involving components of the PMI design. As Afiya included a telephone-based PMI, developers of the original Afiya consultation scripts crafted the initial design of the SMS-based text and texting protocol. The AB participated in the one-day Afiya workshop, followed by 4 weeks of texting PMI messages, a mid-course focus group, followed by 4 more weeks of texting PMI messages, 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 issue 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 AB discussions. Suggestions on how to expand the PMI to current, specific social contexts indicated the use of narrative analysis is warranted. CONCLUSIONS The use of existing EBI incorporating telephone-based PMI scripts facilitated the initial design of the texts, with subsequent narrative analysis of the AB data providing additional adjustments given the actual context. Post-analysis revealed that personas would offer insight and opportunities for persona-specific modification of texting narratives. CLINICALTRIAL None.