Developing and validating a new scale to measure the acceptability of health apps among adolescents

Background The acceptability of health interventions is centrally important to achieving their desired health outcomes. The construct of acceptability of mobile health interventions among adolescents is neither well-defined nor consistently operationalized. Objectives Building on the theoretical framework of acceptability, these two studies developed and assessed the reliability and validity of a new scale to measure the acceptability of mobile health applications (“apps”) among adolescents. Methods We followed a structured scale development process including exploratory factor analyses (EFAs), confirmatory factor analyses (CFAs), and employed structural equation modeling (SEM) to assess the relationship between the scale and app usage. Adolescent participants used the Fooducate healthy eating app and completed the acceptability scale at baseline and one-week follow-up. Results EFA (n = 182) determined that the acceptability of health apps was a multidimensional construct with six latent factors: affective attitude, burden, ethicality, intervention coherence, perceived effectiveness, and self-efficacy. CFA (n = 161) from the second sample affirmed the six-factor structure and the unidimensional structures for each of the six subscales. However, CFA did not confirm the higher-order latent factor model suggesting that the six subscales reflect unique aspects of acceptability. SEM indicated that two of the subscales—ethicality and self-efficacy—were predictive of health app usage at one-week follow-up. Conclusions These results highlight the importance of ethicality and self-efficacy for health app acceptability. Future research testing and adapting this new acceptability scale will enhance measurement tools in the fields of mobile health and adolescent health

Challenges in language services: Identifying and responding to patients\u27 needs

Objective: Identify characteristics of hospitalbased language services (LS), and describe practices of identifying patients with limited English proficiency (LEP) and interpreter training. Participants: Seventy-one hospitals applied to participate in a national initiative. Applicants were non-federal, acute care hospitals with substantial LEP populations, at least 10,000 discharges, and in-person interpreters. Methods: Descriptive statistics were generated on language, collection of language data, LEP volume and service utilization, staffing and training requirements and organizational structure. The relationship between admissions and encounters was analyzed. Results Ninety percent of hospitals collect primary language data. Spanish is the most common language (93% of hospitals). We found no statistically significant correlation between admissions and encounters. Eighty-four percent require training. Eightynine percent have a designated LS department but no clear organizational home. Conclusions: Hospital-based LS programs are facing challenges identifying patients with language needs, staffing and training a workforce, and creating an organizational identity. Need is not associated with utilization, suggesting that LS are not reaching patients

Advances in HIV Prevention for Serodiscordant Couples

Serodiscordant couples play an important role in maintaining the global HIV epidemic. This review summarizes biobehavioral and biomedical HIV prevention options for serodiscordant couples focusing on advances in 2013 and 2014, including World Health Organization guidelines and best-evidence for couples counseling, couples-based interventions, and the use of antiviral agents for prevention. In the past few years marked advances have been made in HIV prevention for serodiscordant couples and numerous ongoing studies are continuously expanding HIV prevention tools, especially in the area of pre-exposure prophylaxis. Uptake and adherence to antiviral therapy remains a key challenge. Additional research is needed to develop evidence-based interventions for couples, and especially for male-male couples. Randomized trials have demonstrated the prevention benefits of antiretroviral-based approaches among serodiscordant couples; however, residual transmission observed in recognized serodiscordant couples represents an important and resolvable challenge in HIV prevention

Networking Activities and Perceptions of HIV Risk Among Male Migrant Market Vendors in China

HIV research among internal migrants in China has not fully explored the contexts and perceptions of “risk”. In 2011, urban markets in Liuzhou, China were mapped, and sixty male vendors, age 22 to 56, were selected for in-depth interviews on migration, social and family life, and perceptions and practices of sexual risk behavior. Participants were evenly divided among higher income shop and small stall vendors. All men were sexually active. Only the shop vendors reported non-marital sexual partners, including concurrent partners (n=15), commercial partners (n=10), and other sexual relationships (n=11). Shop vendors engaged in networking activities that facilitated commercial and non-commercial high-risk sex. Perceptions of HIV risk from commercial sex led some men to doubt the protective ability of condoms and rely on local (unproven) self-protection techniques. Networking activities played a role in high-risk sex and shaping migrants' risk perceptions and health practices. The networks created through these processes could also be used to facilitate health promotion activities

Unpacking the ‘structural’ in a structural approach for HIV prevention among female sex workers: A case study from China

Interventions for HIV prevention among female sex workers (FSWs) in China focus on HIV/sexually transmitted infection (STI) and individual behaviour change. An occupational health framework facilitates intervention across an array of health issues FSWs face including HIV/STI, violence, reproductive health, stigma and substance use. Through a case study of a community-based Jiaozhou (JZ) FSW programme, we developed a conceptual framework incorporating global discussions of structural approaches to HIV prevention with the specific social and structural contexts identified among FSWs in China. Based on ethnographic fieldwork between August 2010 and May 2013, we describe the evolution of this programme to its current occupational health focus and unpack the intervention strategies. We describe the critical features of the programme that have fostered success among FSWs including high-quality clinical services provided within a welcoming setting, responsive outreach work through staff and trained FSW peers, interpersonal and community-level engagement aimed at changing the local social and structural environments of sex work and tailored health education materials. This intervention differs from other projects in China by adopting a more holistic approach to FSW health that incorporates social issues. It also demonstrates the feasibility of structural interventions among FSWs even within an environment that has strong anti-prostitution policies

HIV test uptake among MSM in China: Implications for enhanced HIV test promotion campaigns among key populations

Despite global efforts to increase HIV test uptake among men who have sex with men (MSM), social stigma and negative attitudes toward homosexuality hinder the effectiveness of traditional test promotion campaigns. Increasing HIV test uptake requires greater understanding of the conditions that facilitate decisions to get tested. We conducted an online survey hosted by two of the most highly frequented MSM web portals in China. A generalised ordered logistic regression analysis was conducted to determine factors associated with HIV testing behaviour. Compared to men who had never tested for HIV, men who had tested in the past year were more likely to have never engaged in sex with women, have multiple male sex partners in the past 3 months and have disclosed their sexual orientation to others. MSM found testing at local Chinese Centers for Disease Control and Prevention (80.7%), gay men’s community-based organisations (80.2%) and public hospitals (70.9%) to be acceptable, while saunas (50.5%) and gay bars (41.8%) were found to be unacceptable testing venues. Our study shows that MSM in China prefer to test at venues that guarantee confidentiality, quality and quick results. Our study also suggests that self-testing may be a feasible approach to increase test uptake

More than just tracking time: Complex measures of user engagement with an internet-based health promotion intervention

BACKGROUND: There has been a rise in internet-based health interventions without a concomitant focus on new methods to measure user engagement and its effect on outcomes. We describe current user tracking methods for internet-based health interventions and offer suggestions for improvement based on the design and pilot testing of healthMpowerment.org (HMP). METHODS: HMP is a multi-component online intervention for young Black men and transgender women who have sex with men (YBMSM/TW) to reduce risky sexual behaviors, promote healthy living and build social support. The intervention is non-directive, incorporates interactive features, and utilizes a point-based reward system. Fifteen YBMSM/TW (age 20-30) participated in a one-month pilot study to test the usability and efficacy of HMP. Engagement with the intervention was tracked using a customized data capture system and validated with Google Analytics. Usage was measured in time spent (total and across sections) and points earned. RESULTS: Average total time spent on HMP was five hours per person (range 0-13). Total time spent was correlated with total points earned and overall site satisfaction. CONCLUSION: Measuring engagement in internet-based interventions is crucial to determining efficacy. Multiple methods of tracking helped derive more comprehensive user profiles. Results highlighted the limitations of measures to capture user activity and the elusiveness of the concept of engagement

Sexual Health Knowledge and Health Practices of Female Sex Workers in Liuzhou, China, Differ by Size of Venue

We conducted qualitative interviews with 48 female sex workers (FSW) recruited from entertainment venues in Liuzhou, China. Analyses found that HIV knowledge and sexual health seeking strategies differed by size of venue: (1) Women in smaller venues said they douched before/after sex and used condoms with all but their regular partners and clients. Most found the brochures distributed by Chinese CDC workers “irrelevant” or “boring” and relied on friends for health advice. (2) FSW in middle and large venues were less concerned about prevention, claiming their clients were “healthy.” They relied more on the Internet for health information and were less concerned about the cost of seeing a doctor. (3) Pregnancies and abortions were frequent, especially among the younger women in large venues. This research documents the need to develop tailored HIV-related messages and prevention strategies with the help of FSW to address differences among FSW working in venues of different sizes

Microenterprise Development Interventions for Sexual Risk Reduction: A Systematic Review

Comprehensive interventions that address both individual and structural determinants associated with HIV/STI risk are gaining increasing attention over the past decade. Microenterprise development offers an appealing model for HIV prevention by addressing poverty and gender equality. This study systematically reviewed the effects of microenterprise development interventions on HIV/STI incidence and sexual risk behaviors. Microenterprise development was defined as developing small business capacity among individuals to alleviate poverty. Seven eligible research studies representing five interventions were identified and included in this review. All of the studies targeted women, and three focused on sex workers. None measured biomarker outcomes. All three sex worker studies showed significant reduction in sexual risk behaviors when compared to the control group. Non-sex worker studies showed limited changes in sexual risk behavior. This review indicates the potential utility of microenterprise development in HIV risk reduction programs. More research is needed to determine how microenterprise development can be effectively incorporated in comprehensive HIV control strategies

Advancing the Prevention Agenda for HIV and Other Sexually Transmitted Infections in South China: Social Science Research to Inform Effective Public Health Interventions

Despite widespread biomedical advances in treatment, HIV and other sexually transmitted infections (STI) continue to affect a large portion of the world's population. The profoundly social nature of behaviorally driven epidemics and disparities across socioeconomic divides in the distribution of HIV/STI and care outcomes emphasize the need for innovative, multilevel interventions. Interdisciplinary approaches to HIV/STI control are needed to combine insights from the social and biological sciences and public health fields. In this concluding essay to a Special Issue on HIV/STI in south China, we describe the evolution of China's HIV/STI epidemics and the government response; then synthesize findings from the 11 studies presented in this issues to extend seven recommendations for future HIV/STI prevention and care research in China. We discuss lessons learned from forging international collaborations between social science and public health to inform a shared research agenda to better meet the needs of those most affected by HIV and other STI