Sexual Health Behaviors and Knowledge Among Ugandan Adolescent Girls: Implications for Advancing Comprehensive Sexual Health Education Technology.

Background: Adolescent girls in Uganda have four-fold HIV infections than adolescent boys. Several barriers to accessing comprehensive sexual health education exist for adolescent girls in Uganda, including unequal, social, and economic statuses, limited access to education and health care services, discrimination, and violence. Objective: This study qualitatively examines sexual health behaviors and literacy among Ugandan adolescent girls and explores how technology may be leveraged to improve sexual and reproductive health outcomes in this population. Methods: Four focus group discussions (FGDs) were conducted among 32 adolescent girls aged 14-17 years enrolled in Suubi mHealth. Participants were randomly selected from four secondary schools participating in a randomized clinical trial known as Suubi4Her (N = 1260). FGDs were conducted in the local language, audio-recorded, transcribed verbatim, and translated. Translated transcripts were imported into Dedoose for data management and coding. Emerging themes included Influences for Sex/Relationships, HIV Knowledge, and Sources of Sexual Health Information. Results: Participants reported common influences for sexual engagement included seeking resource security, limited parental communication, and peer influences. Participants also demonstrated knowledge gaps, requesting information such as how to prevent unplanned pregnancies and HIV, endorsing sexual health myths, and describing limitations to accessing sexual health information. Conclusions: Noticeable inconsistencies and limited access to information and resources regarding basic sexual health knowledge were reported, which inevitably increases adolescent girls' risks for adverse sexual and reproductive health outcomes. Developing culturally appropriate interventions may help advance the sexual and reproductive health needs of Ugandan adolescent girls.

Development, Refinement, and Acceptability of Digital Gaming to Improve HIV Testing Among Adolescents and Young Adults at Risk for HIV.

Objective: Adolescents and young adults (AYAs) account for >20% of new HIV diagnoses in the United States, yet >50% are unaware of their infection. Digital gaming is widespread among youth and has proven efficacious in other disease areas; thus, we sought to determine whether a life-and-dating simulation game to increase HIV testing would be acceptable among AYAs. Materials and Methods: Focus groups and surveys were administered to health care providers and AYAs in Washington, DC. AYAs were shown a life-and-dating simulation game that incorporated the Centers for Disease Control and Prevention Risk Estimator tool to demonstrate the potential HIV risk of selected behaviors and a zipcode-level HIV testing locator. Thematic analysis was used to identify general gaming themes and game acceptance. Descriptive statistics were used to summarize response frequencies and Likert scales were used to evaluate game acceptability. Results: Providers, some of whom (38%, n = 5/13) had significant experience caring for youth living with or at increased risk for HIV, advised against the game forcing youth to disclose sexual identity or labeling youth "at risk." AYAs (n = 46) found the initial and revised versions of the game to be highly acceptable: youth thought the game was interesting [mean (standard deviation, SD) = 4.8/5 (0.4)]; liked playing games about HIV-related behaviors [mean (SD) = 4.8/5 (0.5)]; and would share the game to help friends get tested for HIV [mean = 4.6/5 (0.8)]. Conclusions: This study suggests that a digital game to improve HIV testing is acceptable among youth. An efficacy trial is planned to determine the impact of the game on improving HIV testing.

Digital Gaming to Improve Adherence Among Adolescents and Young Adults Living With HIV: Mixed-Methods Study to Test Feasibility and Acceptability.

BACKGROUND: An estimated 50% of adolescents and young adults (AYA) living with HIV are failing to adhere to prescribed antiretroviral treatment (ART). Digital games are effective in chronic disease management; however, research on gaming to improve ART adherence among AYA is limited. OBJECTIVE: We assessed the feasibility and acceptability of video gaming to improve AYA ART adherence. METHODS: Focus group discussions and surveys were administered to health care providers and AYA aged 13 to 24 years living with HIV at a pediatric HIV program in Washington, DC. During focus group discussions, AYA viewed demonstrations of 3 game prototypes linked to portable Wisepill medication dispensers. Content analysis strategies and thematic coding were used to identify adherence themes and gaming acceptance and feasibility. Likert scale and descriptive statistics were used to summarize response frequencies. RESULTS: Providers (n=10) identified common adherence barriers and strategies, including use of gaming analogies to improve AYA ART adherence. Providers supported exploration of digital gaming as an adherence intervention. In 6 focus group discussions, 12 AYA participants identified disclosure of HIV status and irregular daily schedules as major barriers to ART and use of alarms and pillboxes as reminders. Most AYA were very or somewhat likely to use the demonstrated game prototypes to help with ART adherence and desired challenging, individually tailored, user-friendly games with in-game incentives. Game prototypes were modified accordingly. CONCLUSIONS: AYA and their providers supported the use of digital games for ART adherence support. Individualization and in-game incentives were preferable and informed the design of an interactive technology-based adherence intervention among AYA living with HIV.

Measuring Sense of Community Responsibility in Community-Based Prevention Coalitions: An Item Response Theory Analysis.

Research on sense of community (SOC) has traditionally been approached from a resource perspective. Recently, however, research on the experience of SOC has evolved to include a related but distinct construct of sense of community responsibility (SOC-R), or feelings of accountability for the well-being of a community. This study applied item response theory to examine the psychometric properties of a SOC-R scale used in an evaluation of community-based substance abuse prevention coalitions. Data were collected in 2017 from coalition members (analytic sample = 309) in the northeastern United States. Findings indicate that the scale was reliable, unidimensional, and functioned well, particularly at low and moderate levels of the construct. The addition of two items intended to capture higher levels of the construct improved the scale's functioning at higher levels of SOC-R. The adapted SOC-R scale was also shown to have moderately strong relationships with conceptually relevant variables, including SOC, coalition participation, number of roles performed in the coalition, and engagement in community action activities. These findings provide empirical evidence to support the reliability and validity of the SOC-R scale, and have critical implications for our conceptualization of the SOC construct, its measurement, and for the evaluation of community-based prevention interventions.