Systematic review of e-health interventions to address sexual health, substance use and mental health among men who have sex with men: synthesis of process evaluations (Preprint)

BACKGROUND Men who have sex with men (MSM) face disproportionate risks in relation to HIV and other sexually transmitted infections, substance use and common mental illnesses. Interacting to worsen overall health, these outcomes constitute a syndemic among MSM and interventions addressing all three together could have multiplicative effects. E-health interventions offer a means to access prevention privately and evidence suggests these can effectively address these three health outcomes in general populations. It is not clear what factors affect how useable, accessible or acceptable e-health interventions are for MSM and whether these differ across interventions addressing different outcomes; no previous reviews have looked at questions of implementation or synthesised evidence across interventions addressing these different outcomes. OBJECTIVE We undertook a systematic review of e-health interventions addressing sexual risk, substance use and common mental illnesses among MSM and synthesised evidence from process evaluations. METHODS We searched 19 databases, three clinical trials registers, Open Grey and Google. Searches were supplemented by reference-checking and requests from experts. Eligible reports reported on e-health interventions offering ongoing support to MSM and aiming to prevent sexual risk, substance use, and/or anxiety or depression; and assessed how delivery or receipt of these interventions varied with characteristics of interventions, providers, participants and/or setting. Reviewers screened citations on title and abstract then full text. Reviewers assessed study quality and extracted data from eligible reports on intervention and study characteristics and on process evaluation findings. Analysis followed a meta-ethnographic approach and used thematic synthesis methods. RESULTS Twelve reports on ten studies of eight interventions were eligible for the process synthesis. Most addressed sexual risk alone or in combination with other outcomes. Studies were of medium and high reliability but tended to lack depth and breadth. Intervention acceptability was enhanced by: ease of use; privacy protection; use of diverse media; opportunities for self-reflection and to gain knowledge and skills; and content that was clear, interactive, tailored, reflective of MSM’s experiences and affirming of sexual-minority identity. Technical issues and interventions that were too long detracted from acceptability. Some evidence suggested that acceptability varied by race/ethnicity and level of education; findings on variation by socioeconomic status were mixed. No studies explored how intervention delivery or receipt varied by provider characteristics. CONCLUSIONS Findings suggest that e-health interventions targeting sexual risk, substance use and mental health are acceptable for MSM across sociodemographic groups. Our synthesis identified factors shaping MSM’s receipt of such interventions, highlighting the importance of tailored content reflecting MSM’s experiences and of language affirming sexual-minority identities. Findings from this synthesis can inform the development, piloting and process evaluations of integrated e-health interventions to address the syndemic of sexual risk, substance use and mental ill health among MSM. CLINICALTRIAL Protocol registered on PROSPERO in September 2018 (CRD42018110317)