Uptake of and Engagement With an Online Sexual Health Intervention (HOPE eIntervention) Among African American Young Adults: Mixed Methods Study.

BACKGROUND: Regarding health technologies, African American young adults have low rates of uptake, ongoing usage, and engagement, which may widen sexual health inequalities. OBJECTIVE: We aimed to examine rates of uptake and ongoing usage, and factors influencing uptake, ongoing usage, and engagement for a consumer health informatics (CHI) intervention for HIV/sexually transmitted infection (STI) prevention among African American young adults, using the diffusion of innovation theory, trust-centered design framework, and O'Brien and Toms' model of engagement. METHODS: This community-based participatory mixed methods study included surveys at four time points (n=315; 280 African American participants) among young adults aged 18 to 24 years involved in a blended offline/online HIV/STI prevention intervention (HIV Outreach, Prevention, and Education [HOPE] eIntervention), which was described as a "HOPE party." Qualitative interviews were conducted with a subset of participants (n=19) after initial surveys and website server logs indicated low uptake and ongoing usage. A generalized linear mixed-effects model identified predictors of eIntervention uptake, server logs were summarized to describe use over time, and interview transcripts were coded and thematically analyzed to identify factors affecting uptake and engagement. RESULTS: Participants' initial self-reported eIntervention uptake was low, but increased significantly over time, although uptake never reached expectations. The most frequent activity was visiting the website. Demographic factors and HOPE party social network characteristics were not significantly correlated with uptake, although participant education and party network gender homophily approached significance. According to interviews, one factor driving uptake was the desire to share HIV/STI prevention information with others. Survey and interview results showed that technology access, perceived time, and institutional and technological trust were necessary conditions for uptake. Interviews revealed that factors undermining uptake were insufficient promotion and awareness building, and the platform of the intervention, with social media being less appealing due to previous negative experiences concerning discussion of sexuality on social media. During the interaction with the eIntervention, interview data showed that factors driving initial engagement were audience-targeted website esthetics and appealing visuals. Ongoing usage was impeded by insufficiently frequent updates. Similarly, lack of novelty drove disengagement, although a social media contest for sharing intervention content resulted in some re-engagement. CONCLUSIONS: To encourage uptake, CHI interventions for African American young adults can better leverage users' desires to share information about HIV/STI prevention with others. Ensuring implementation through trusted organizations is also important, though vigorous promotion is needed. Visual appeal and targeted content foster engagement at first, but ongoing usage may require continual content changes. A thorough analysis of CHI intervention use can inform the development of future interventions to promote uptake and engagement. To guide future analyses, we present an expanded uptake and engagement model for CHI interventions targeting African American young adults based on our empirical results.

Good or bad, ups and downs, and getting better: Use of personal health data for temporal reflection in chronic illness.

BACKGROUND: Time is a central component of the experience of illness. Yet, little is known about how chronically ill patients and their family members use temporal information (i.e., information that is dependent on some measurement of time) to reflect upon the illness experience. OBJECTIVES: The purpose of this study is to explore what temporal information chronically ill patients and their family members need, where they obtain it, and how they use it, along with related temporal reasoning processes and challenges. METHODS: A series of five qualitative, semi-structured interviews were conducted during a two-year longitudinal study of 38 families (97 individuals) with at least one chronically ill member (HIV/AIDS or type 2 diabetes). RESULTS: Patients and family members had temporal information needs related to identifying: patient status; trends; optimal timing, optimal frequency, cause and effect; and what to expect. They used a wide range of information sources to meet these needs, including clinical test results, at-home health monitoring technologies, patient physical appearance and physical sensations, and information about other patients' experiences. Participants employed several forms of reasoning to reflect on temporal information: criteria reasoning (i.e., comparison to a standard), comparative reasoning (both to oneself in the past and to other people), cause-to-effects, effects-to-cause reasoning, conditional reasoning (i.e., if-then reasoning), and deductive reasoning. They used temporal information to carry out instrumental illness management, and to meet emotional and social needs. Patients and families confronted challenges in selecting relevant data, recognizing patterns in those data, and in drawing conclusions based on inferred patterns. CONCLUSIONS: Patients have six main temporal information needs, and they use a variety of information sources and reasoning strategies to meet these needs. They also confront important challenges in using temporal information. Based on our results, we offer design principles for systems that support patient and family member temporal reflection. We recommend that such technologies: (1) minimize user burden; (2) leverage existing dissemination channels; (3) include both clinical and non-clinical information; (4) meet informational, emotional and social needs; and (5) facilitate collaborative sense-making among patients and family.