HOPE eIntervention: Uptake and engagement in an online sexual health intervention among African-American young adults (Preprint)

BACKGROUND African American young adults have low rates of uptake and engagement with health technologies, which may further widen sexual health inequalities. OBJECTIVE We examined factors influencing uptake and engagement for a consumer health informatics (CHI) intervention for HIV/STI prevention among African American young adults using the diffusion of innovation theory, the trust-centered design framework and O’Brien and Toms’ model of engagement. METHODS This community-based participatory research, mixed-methods study included surveys at four time points (N=315; 280 African-American) of young adults aged 18 to 24 involved in an HIV/STI prevention intervention described as “parties”. Qualitative interviews were conducted with a subset of participants (N=19) after initial surveys, website server logs, and social media accounts indicated low uptake and engagement. 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 Self-reported eIntervention uptake was low, but increased significantly over time, Demographic factors and HIV/STI-related behaviors were not significantly correlated with uptake. The most frequent activity was visiting the website, followed by visiting the Facebook page. Factors driving uptake were the desire to share HIV/STI prevention information with others, trust in the intervention, and gender homophily. Factors undermining uptake were personal and group distrust online. Factors driving initial engagement were audience-targeted website aesthetics and appealing visuals; long-term engagement was impeded by insufficiently frequent updates. CONCLUSIONS To encourage uptake, CHI interventions for African-American young adults can leverage users’ desire to share information about HIV/STI prevention with others. Ensuring implementation through trusted organizations is also important, though there is a need for vigorous promotion. Visual appeal and targeted content foster engagement at first, but ongoing engagement may require continual content changes. A thorough analysis of CHI intervention use can inform the development of future interventions in order 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 the empirical results presented here.