Social Presence and Use of Internet-Delivered Interventions: A Multi-Method Approach

Objective Internet-delivered interventions can effectively change health risk behaviors and their determinants, but adherence to intervention websites once they are accessed is very low. This study tests whether and how social presence elements can increase website use. Methods A website about Hepatitis A, B, and C virus infections was used in a preparatory lab-based eye-tracking study assessing whether social presence elements attract participants\u27 attention, because this is a prerequisite for affecting website use. In the following field study, 482 participants representative of the Dutch population were randomized to either a website with or a website without social presence elements. Participants completed a questionnaire of validated measures regarding user perceptions immediately after exposure to the website. Server registrations were used to assess website use. Results Participants in the experimental condition focused on the social presence elements, both in terms of frequency (F(1, 98) = 40.34, p<.001) and duration (F(1, 88) = 39.99, p<.001), but did not differ in website use in comparison with the control condition; neither in terms of the number of pages visited (t(456) = 1.44, p = .15), nor in terms of time on the website (t(456) = 0.01, p = .99). Conclusions Adding social presence elements did not affect actual use of an intervention website within a public health context. Possible reasons are limited attention for these elements in comparison with the main text and the utilitarian value of intervention websites

Maternal Health Outcomes and Male Partner Involvement Among HIV Infected Women in Rural South Africa

Introduction This study aimed to investigate the association between Male Partner Involvement (MPI) and maternal health outcomes among women attending Prevention of Mother-to-Child Transmission of HIV (PMTCT) services in rural South Africa. The association between Male Partner Participation in the main study (MPP) and maternal health outcomes among these women was also investigated. Methods The study utilized data collected from 535 HIV infected women in a randomized controlled trial between 2015 and 2016. Maternal health outcome data (delivery mode, pregnancy systolic and diastolic blood pressure, pregnancy body mass index, pregnancy CD4 count, and pregnancy viral load) were collected from the women's antenatal record forms accessed from the primary healthcare facilities. Bivariate and multivariable logistic regression models were used to estimate the association between socio-demographic characteristics of the women, MPI, and MPP with maternal health outcomes. Results The mean age of the women was 29.03 years (SD = 5.89). No significant associations were found between MPI and any of the maternal health outcomes contrary to what was hypothesized. Both the bivariate and multivariate analysis indicated a significant association between MPP and higher pregnancy viral load, contrary to the study hypothesis. Insignificant associations were found between MPP and both pregnancy CD4 count and pregnancy blood pressure. The only significant association between maternal health outcomes and socio-demographic characteristics, was between educational attainment and higher pregnancy CD4 count in both the bivariate and multivariate analysis. Conclusion for Practice The study showed no significant support for MPI in improving maternal health outcomes of women in PMTCT in rural South Africa. Future studies should include additional maternal health outcomes for investigation

When the frame fits the social picture:The effects of framed social norm messages on healthy and unhealthy food consumption

We investigated the influence of framed norm messages about food consumption on motivation to consume, and actual consumption of, healthy and unhealthy foods. We proposed that the effects of positive and negative message frames would vary by the type of underlying norms (i.e., injunctive, descriptive). More specifically, based on information processing theories, it was expected that injunctive norms would be more effective when framed negatively compared with positively, while the opposite was expected for descriptive norms. In both experiments, participants were randomly assigned to one of four framed social norm conditions or a no-norm control condition. In experiment 1, motivation to consume healthy and unhealthy foods was assessed by means of both indirect and self-report measures. In experiment 2, actual food consumption was assessed. In both experiments, the predicted interaction was found. Results show that injunctive norms benefit from a negative (vs. Positive) frame, while preliminary evidence suggests the opposite for descriptive norms

Intimate partner violence and its association with self-determination needs and gender-power constructs among rural South African women

This study aimed to identify psychosocial correlates of intimate partner violence (IPV) by using constructs derived from the self-determination theory (SDT) and gender-power scales. Cross-sectional data (N = 238) were collected from women in the Eastern Cape, South Africa, and were used to test a structural equation model (SEM). The majority (87%) of the participants reported having sexual partners in the past 3 months, and in terms of IPV victimization, 36% and 26% of women had ever experienced verbal and physical abuse, respectively. Bivariate correlations showed that autonomy and beliefs about gender equality (BGE) were strongly associated with IPV

Exploring the Perceived Effectiveness of Applied Theater as a Maternal Health Promotion Tool in Rural Zambia

In the current study, we aimed (a) to extend the previous research conducted in Kalomo District on the psychosocial factors that influence women’s intention to utilize maternal health care services (MHS) and (b) to explore community members’ perceptions of the use of a theater-based health promotion program to positively influence these factors among pregnant women. Semistructured, in-depth interviews were conducted with 44 respondents, and confirmed the importance of knowledge, perceived behavioral control, attitudes, social norms, and risk perception as influences on women’s health care utilization. The majority of respondents were positive about the use of theater interventions in improving maternal health care–seeking behavior. The behavior change methods proposed to incorporate in theater plays were seen as appropriate and useful to convey health-related information in theater plays, in particular if the main character was an identifiable role model. Discussion focuses on the unique contributions and possibilities of utilizing theater in (maternal) health promotion

Identifying psychosocial variables that predict safer sex intentions in adolescents and young adults

Young people are especially vulnerable to sexually transmitted infections. The triad of deliberate and effective safer-sex behavior encompasses condom use, combined with additional information about a partner’s sexual health, and the kind of sex acts usually performed. To identify psychosocial predictors of young people’s intentions to have safer sex, as related to this triad we conducted an online study with 211 sexually active participants aged between 18 and 24 years. Predictors (i.e. perceived behavioural control, subjective norms and intention) taken from Fishbein and Ajzen’s Reasoned Action Approach (RAA), were combined with more distal variables (e.g. behavioral inhibition, sensation seeking, parental monitoring, and knowledge about sexually transmitted infections). Beyond the highly predictive power of RAA variables, additional variance was explained by the number of instances of unprotected sexual intercourse during the last twelve months and reasons for using barrier protection during first sexual intercourse. In particular, past condom nonuse behavior moderated perceived behavioral control related to intended condom use. Further, various distal variables showed significant univariate associations with intentions related to the three behaviors of interest. It may, therefore, be helpful to include measures of past behavior as well as certain additional distal variables in future safer-sex programs designed to promote health sustaining sexual behavior

A Qualitative Exploration of the Meaning and Understanding of Male Partner Involvement in Pregnancy-Related Care Among Men in Rural South Africa

Male partner involvement (MPI) during antenatal care has been promoted as an effective intervention to improve maternal and newborn health outcomes. Although MPI is commonly defined as men attending antenatal clinic visits with their female partner, few men attend antenatal clinic visits in rural communities in the province of Mpumalanga, South Africa. The study aimed to qualitatively explore the meaning and understanding of MPI as perceived by men visiting primary health care clinics in rural communities in Mpumalanga. Six focus groups discussions (n = 53) were conducted, digitally recorded, simultaneously transcribed, and translated verbatim into English. Data were analyzed using thematic content analysis. Perceptions of male roles during and after pregnancy differed among men. Male involvement was understood as giving instrumental support to female partners through financial help, helping out with physical tasks, and providing emotional support. Accompanying female partners to the clinic was also viewed as partner support, including behaviors such as holding a spot for her in the clinic queues. Community attitudes, traditional beliefs, and negative experiences in health facilities were barriers for MPI. This study provides support for concerted efforts to work with both men and women within the cultural context to explore the important roles of all members of the family in working together to provide the best possible health outcomes for mother and infant. In particular, future interventions should focus on making antenatal care services more responsive to male partners, and improving male partner accessibility in health care facilities

Systematically Developing a Web-Based Tailored Intervention Promoting HPV-Vaccination Acceptability Among Mothers of Invited Girls Using Intervention Mapping.

Background: Currently, the eHealth field calls for detailed descriptions of theory-based interventions in order to support improved design of such interventions. This article aims to provide a systematic description of the design rationale behind an interactive web-based tailored intervention promoting HPV-vaccination acceptability. Methods: The 6-step Intervention Mapping (IM) protocol was used to describe the design rationale. After the needs assessment in Step 1, intervention objectives were formulated in Step 2. In Step 3, we translated theoretical methods into practical applications, which were integrated into a coherent intervention in Step 4. In Step 5, we anticipated future implementation and adoption, and finally, an evaluation plan was generated in Step 6. Results: Walking through the various steps of IM resulted in a detailed description of the intervention. The needs assessment indicated HPV-vaccination uptake remaining lower than expected. Mothers play the most important role in decision-making about their daughter's immunization. However, they generally feel ambivalent after they made their decisions, and their decisions are based on rather unstable grounds. Therefore, intervention objectives were to improve HPV-vaccination uptake and informed decision-making, and to decrease decisional conflict among mothers of invited girls. Computer-tailoring was chosen as the main method; virtual assistants were chosen as a practical application to deliver interactive tailored feedback. To maximize compatibility with the needs of the target group, a user-centered design strategy by means of focus groups and online experiments was applied. In these, prototypes were tested and sequentially refined. Finally, efficacy, effectiveness, and acceptability of the intervention were tested in a randomized controlled trial. Results showed a significant positive effect of the intervention on informed decision-making, decisional conflict, and nearly all determinants of HPV-vaccination uptake (P < 0.001). Mothers evaluated the intervention as highly positive. Discussion: Using IM led to an innovative effective intervention for promoting HPV-vaccination acceptability. The intervention maps will aid in interpreting the results of our evaluation studies. Moreover, it will ease the comparison of design rationales across interventions, and may provide leads for the development of other eHealth interventions. This paper adds to the plea for systematic reporting of design rationales constituting the process of developing interventions

The application of intervention mapping in developing STI/HIV health education program for traditionally circumcised men in the Eastern Cape Province of South Africa

This paper describes the application of the IM in the development of an STI/HIV health education program, which can be integrated into the ITMC practices in the Eastern Cape province of South Africa.