Developing a Motion Comic for HIV/STD Prevention for Young People Ages 15-24, Part 2: Evaluation of a Pilot Intervention

A Healthy Liver Will Always Deliver: Impact Study of a Non-Alcoholic Fatty Liver Disease (NAFLD) Awareness Comic

Based on previous work, we developed the comic "A healthy liver will always deliver!" to raise awareness about Non-Alcoholic Fatty Liver Disease (NAFLD) and promote healthy lifestyles. An online pre-post questionnaire design demonstrated an increase in health-threat beliefs regarding NAFLD among the general public, as well as response efficacy and self-efficacy beliefs, normative and control beliefs regarding the maintenance of preventive strategies involving healthy diets and active lifestyles, after interaction with the comic's narrative. This effect was more evident in women. Furthermore, although we could not perform all the ideal controls during the COVID-19 pandemic, and the online strategy attracted mostly university education-level subjects, the comic seemed relatable and engaging. However, more work will have to be performed to ensure its usefulness in terms of acquired knowledge and behavior changes, especially in at-risk segments of the population.

Using Narrative Films to Combat HIV-Related Stigma in Western Kenya: An Exploratory Pilot Study of Adolescents Living With HIV and Their Caregivers

Objective. Interventions that effectively address HIV-related stigma are urgently needed to improve outcomes for adolescents living with HIV (ALHIV). We piloted a series of 4 short narrative films depicting Kenyan ALHIV's lived experiences of stigma and discrimination with 57 ALHIV and 50 adult caregivers of ALHIV in western Kenya. Methods. Participants completed either pre- and post-viewing questionnaires, including an HIV/AIDS-related stigma and discrimination scale, or participated in post-viewing focus group discussions. Three-month follow-up visits were conducted. Results. Caregivers endorsed significantly greater disagreement with stigmatizing statements on the scale at 3-month follow-up, whereas adolescents had no significant differences in scores. Participants reported they believed the films would have a positive impact on their communities and had led to changes in their own attitudes, beliefs and/or behavior. Conclusion. The HIV Stigma Films may show promise as an intervention to reduce stigmatizing attitudes and beliefs about HIV-infection, especially among caregivers of ALHIV.

Development of a Video-Delivered Serial Drama Designed to Reduce Community Homophobia and HIV Stigma, Decrease Sexual Risk Behavior, and Increase HIV Testing Among Black Youth

This article describes the development of a video serial drama intervention that was designed to address factors that influence HIV in the United States among Black youth. These include HIV testing, sexual behaviors not protected by condoms, negative attitudes towards sexual minorities, and HIV stigma. Behavior-change principles (social learning theory and education-entertainment) and input from members of the priority audience formed the basis of this 27-episode (3 minutes each) drama for dissemination on multiple platforms, including in public spaces or privately online. The developmental process, specifically involving members of the population of interest and use of behavioral theory, enriched the narrative elements and likely ensured intervention acceptability, enhancing effectiveness. Public health practitioners and prevention programmers may want to consider using this intervention and/or the narrative communication approach when intervening to change behavior.

A healthy liver will always deliver: development of a NAFLD awareness comic

Comics can be an effective tool to communicate health information and appeal to behavior change. The aim of this project, undertaken by a multidisciplinary team, was to develop a comic to raise awareness about non-alcoholic fatty liver disease (NAFLD) and promote healthy lifestyles regarding dietary practices and regular physical activity patterns. We focused on the ability of comics in portraying abstract concepts to articulate NAFLD biomedical knowledge and use it as an encouragement/empowerment strategy towards disease-related beliefs, attitudes, intentions and behaviors. Formative research by means of a NAFLD awareness study with T2DM patients informed the selection of biomedical content and the design of characters and storylines on which the former was embedded. Mindful of graphic narrative and storytelling as a valuable tool in the domains of health promotion, disease prevention and therapeutic adherence, this work discusses the decisions that were taken for the materialization of the comic ‘A healthy liver will always deliver!’.

Adolescents’ Victim-Blaming Responses to Narratives About Sex Trafficking: Strategies for Curriculum Development

In the United States, sex-trafficking awareness and prevention has increasingly become part of government-mandated health education. This exploratory study surveyed 250 U.S. adolescents to learn more about the use of media narratives in curricula about sex trafficking in light of research findings about victim-blaming responses to survivor narratives, as well as adolescents’ still-developing emotion-regulation skills. Victim blaming is counterproductive to the goals of trafficking awareness and prevention curricula. Participants viewed one of four narrative messages about a sex-trafficking victim/survivor. Over half of participants reported victim-blaming responses after viewing the message. Participants reported low perceived efficacy regarding the ability to recognize the signs of trafficking, and some participants experienced intense fear responses to the messages. Victim blaming was not associated with fear or perceived efficacy, contradicting predictions from the Extended Parallel Process Model. This study concludes with recommendations for educators and others tasked with communicating with adolescents about sex trafficking.

A comic-based body image intervention for adolescents in semi-rural Indian schools: Study protocol for a randomized controlled trial

Adolescents in India experience body dissatisfaction, however, empirically supported interventions are lacking. This paper describes the protocol for the development, acceptability testing, and cluster randomized controlled trial (RCT) of a six-session comic-based intervention, which aims to improve body image and related outcomes among adolescents in semi-rural Indian schools. If found to be acceptable and effective, UNICEF will disseminate the intervention across schools in eight states of India. The acceptability study will be conducted with 24 students in Classes 6-8 (age 11-14) and nine teachers from Hindi-medium government schools using interviews and focus groups. The subsequent RCT will be conducted with 2400 students, with schools randomized to either the comic-based intervention or lessons-as-usual (control) groups. The primary outcome is body esteem, and secondary outcomes are disordered eating, appearance ideal internalization, body-image-related life disengagement, self-esteem, negative affect, and positive affect. Additional exploratory outcome measures are skin colour dissatisfaction, body hair dissatisfaction, appearance-based teasing, and endorsement of traditional gender roles. These outcomes will be examined at three timepoints: baseline (T1), 1 week-post-intervention (T2), and 12-weeks follow-up (T3). Analyses will compare outcomes in the intervention with the control group. This will be the first study to evaluate a body image intervention for adolescents in semi-rural Indian schools.

Identifying management practices for promoting infection prevention: Perspectives on strategic communication

BACKGROUND

Engaging leaders to share information about infections and infection prevention across their organizations is known to be important in initiatives designed to reduce healthcare-associated infections (HAIs). Yet the topics and communication strategies used by leaders that focus on HAI prevention are not well understood. This study aimed to identify and describe practices around information sharing used to support HAI prevention.

METHODS

We visited 18 U.S. hospitals between 2017 and 2019 and interviewed 188 administrative and clinical leaders to ask about management practices they used to facilitate HAI prevention. Interview transcripts were analyzed to characterize practices involving strategic communications.

RESULTS

Sharing information to support infection prevention involved strategic communications around two main topics: (1) facilitators of success and best practices, and (2) barriers to success and lessons learned. In addition, the practice of storytelling reportedly allowed leaders to highlight impact and elicit emotion, provide education, and acknowledge success in infection prevention by providing examples of real events.

CONCLUSIONS

Our findings provide insight about how strategic communication of information around HAIs and HAI prevention can be used to support improvement. Organizations and leaders should consider the different opportunities to incorporate the practice of strategic communication, including using storytelling, to advance their infection prevention efforts.

The use of comics to promote health awareness: A template using nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) constitutes a major threat to public health systems worldwide on account of its widespread prevalence and increasing incidence. More effective tools to raise awareness and increase health communication are therefore needed. Comics may constitute an effective language for this purpose, given the permanence, adaptability and ability of this form of communication to convey complex information, using both visual components and the creation of narrative involvement, thus promoting both awareness and health-conscious behaviours. Importantly, this process requires careful preparation in terms of selecting both the key biomedical concepts to be conveyed, as well as a graphical style and appropriate characters and a narrative arc with which a target audience can identify with. Here we provide a brief introduction to the use of comics in health communication and propose a possible roadmap for the development of comic-based tools for diverse conditions, using the context of NAFLD.

mHealth to reduce HIV-related stigma among youth in the United States: a scoping review

Multiple intersecting stigmas and discrimination related to sex, gender, HIV, and race/ethnicity may challenge HIV prevention and treatment service utilization, particularly among youth. This scoping review describes recent and ongoing innovative mobile health (mHealth) interventions among youth in the United States that aim to reduce stigma as an outcome or as part of the intervention model. To identify examples of stigma-mitigation via mHealth, we searched peer-reviewed published literature using keyword strategies related to mHealth, HIV, stigma, and youth (ages 10 to 29). We identified eleven articles that met our inclusion criteria, including three describing data from two randomized controlled trials (RCTs), five describing pilot studies, one describing the process evaluation of an ongoing intervention, one describing formative work for intervention development, and one published study protocol for an ongoing intervention. We review these articles, grouped by HIV prevention and care continuum stages, and describe the mHealth approach used, including telehealth, simulation video games, motion comics, smartphone applications (apps), social media forums, online video campaigns, video vignettes, and a computerized behavioral learning module. Four studies focused on preventing primary acquisition through individual-level behavior change (e.g., reducing condomless anal intercourse), three focused on increasing HIV testing, three focused on linking to prevention services [e.g., pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP)] and one focused on promoting adherence to antiretroviral therapy (ART). Our review did not identify any published studies using mHealth with a primary aim to reduce stigma as a way to improve care engagement and increase viral suppression among youth in the United States. Additional RCTs and implementation studies examining the effectiveness of mHealth stigma-reduction interventions on HIV-related outcomes are needed to end the HIV epidemic among youth. mHealth offers unique advantages to address the complex intersecting stigma barriers along the HIV continuum to improve HIV-related outcomes for youth.

Developing a Motion Comic for HIV/STD Prevention for Young People Ages 15-24, Part 2: Evaluation of a Pilot Intervention

In the United States, young people (ages 15-24 years) are disproportionately affected by human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs), due at least in part to inadequate or incorrect HIV/STD-related knowledge, attitudes, beliefs, and behavioral intentions (KABI). Comic book narratives are a proven method of HIV/STD prevention communication to strengthen KABI for HIV/STD prevention. Motion comics, a new type of comic media, are an engaging and low-cost means of narrative storytelling. The objective of this study was to quantitatively evaluate the effectiveness of a pilot six-episode HIV/STD-focused motion comic series to improve HIV/STD-related KABI among young people. We assessed change in HIV/STD knowledge, HIV stigma, condom attitudes, HIV/STD testing attitudes, and behavioral intentions among 138 participants in 15 focus groups immediately before and after viewing the motion comic series. We used paired t-tests and indicators of overall improvement to assess differences between surveys. We found a significant decrease in HIV stigma (p < .001) and increases in both HIV knowledge (p = .002) and behavioral intentions to engage in safe sex (p < .001). In summary, this motion comic intervention improved HIV/STD-related KABI of young adult viewers by reducing HIV stigma and increasing behavioral intentions to engage in safer sex. Our results demonstrate the promise of this novel intervention and support its use to deliver health messages to young people.