African American Adolescents and Young Adults, New Media, and Sexual Health: Scoping Review

Exploring the Use of Customized Links to Improve Electronic Engagement With Sexual and Reproductive Health Care Among Young African American Male Individuals: Web-Based Survey Study

BACKGROUND

Research has shown that heterosexual African American male individuals aged 18-24 years have a higher prevalence of sexually transmitted infections (STIs) and are more likely to engage in risky sexual behavior. There is a critical need to promote sexual reproductive health (SRH) services among this population, especially in urban settings. Young African American male individuals use social media platforms to access health information, showcasing the potential of social media and web-based links as tools to leverage electronic engagement with this population to promote SRH care.

OBJECTIVE

This study aims to explore electronic engagement with young African American male individuals in discussions about SRH care. This paper focuses on the recruitment and social media marketing methods used to recruit young, heterosexual African American male individuals aged 18-24 years for the Stay Safe Project, a larger study that aims to promote SRH services among this population in Detroit, Michigan. We investigate the use of TinyURL, a URL shortener and customized tool, and culturally informed social media marketing strategies to promote electronic engagement within this population.

METHODS

Participants were recruited between December 2021 and February 2022 through various modes, including email listserves, Mailchimp, the UMHealthResearch website, X (formerly Twitter), Facebook, and Instagram. Images and vector graphics of African American male individuals were used to create social media advertisements that directed participants to click on a TinyURL that led to a recruitment survey for the study.

RESULTS

TinyURL metrics were used to monitor demographic and user data, analyzing the top countries, browsers, operating systems, and devices of individuals who engaged with the customized TinyURL links and the total human and unique clicks from various social media platforms. Mailchimp was the most successful platform for electronic engagement with human and unique clicks on the custom TinyURL link, followed by Instagram and Facebook. In contrast, X, traditional email, and research recruiting websites had the least engagement among our population. Success was determined based on the type of user and follower for each platform, whether gained in the community through sign-ups or promoted at peak user time and embedded and spotlighted on nontraditional media (eg, social media sites, blogs, and podcasts) for the user. Low engagement (eg, traditional email) from the target population, limited visibility, and fewer followers contributed to decreased engagement.

CONCLUSIONS

This study provides insight into leveraging customized, shortened URLs, TinyURL metrics, and social media platforms to improve electronic engagement with young African American male individuals seeking information and resources about SRH care. The results of this study have been used to develop a pilot intervention for this population that will contribute to strategies for encouraging sexual well-being, clinic use, and appropriate linkage to SRH care services among young, heterosexual African American male individuals.

Teaching About Contraception: Adolescent Attitudes Surrounding Sexual Education

Purpose

Adolescent pregnancy remains an important public health issue in the United States as it has profound health consequences for both mother and child. Evidence shows that improved contraception use is a critical factor in decreasing rates of adolescent pregnancy. In order to provide effective and engaging contraception education, it is important to understand adolescents' attitudes, questions, and misconceptions around the topic and its delivery.

Methods

Two searches were conducted using PubMed. Articles were limited to those published in the last 10 years that were written in English. The first search was completed using the search terms "Adolescent attitudes on sex education in the United States", and resulted in 688 articles. The second search was completed using the search terms "Adolescent attitudes on contraception in the United States", and resulted in 840 articles. Articles including contraception but focusing more on HIV, pre-exposure prophylaxis (PrEP), LGBTQ+ health and practices, human papillomavirus (HPV) vaccination, and studies completed in other countries were excluded. Remaining articles were screened by the authors for inclusion, and articles were included if they addressed information on adolescent attitudes on both contraception for pregnancy prevention and sex education, including education by schools, community organizations, the media, peers, parents, and physicians. A total of 56 articles were included in the review.

Results

The overwhelming theme that emerged from the review is that adolescents prefer comprehensive sex education in a safe space that allows for exploration and questioning. Adolescents want to ask their parents questions about sexual health without fear of punishment, and they desire the opportunity to learn from their physicians in a confidential environment.

Conclusion

The foundation of effective sex education is a non-judgmental, confidential, and safe space where adolescents can ask questions. There are multiple resources that adolescents use to gather information and establish their preferences and attitudes.

Applying technology to promote sexual and reproductive health and prevent gender based violence for adolescents in low and middle-income countries: digital health strategies synthesis from an umbrella review

AIM

Adolescents in low-and-middle-income countries (LMICs) are facing numerous developmental, sexual and reproductive health (SRH) challenges including exposure to multidimensional violence. Gender-based violence (GBV) specifically intimate partner violence (IPV) are both highly prevalent in LMICs and are strongly linked with poor SRH outcomes. However, GBV and IPV interventions have not yet been adequately integrated in SRH due to individual, social, cultural, service, and resource barriers. To promote long-term SRH, a more holistic approach that integrates GBV and IPV, and adolescent development needs is imperative. Digital health has the potential to address multiple service setup, provision, and addressing access barriers through designing and providing integrated SRH care. However, there are no guidelines for an integrated digital SRH and development promotion for adolescents in LMICs.

METHODS

An umbrella review was conducted to synthesize evidence in three inter-related areas of digital health intervention literature: (i) SRH, (ii) GBV specifically IPV as a subset, and (iii) adolescent development and health promotion. We first synthesize findings for each area of research, then further analyze the implications and opportunities to inform approaches to develop an integrated intervention that can holistically address multiple SRH needs of adolescents in LMICs. Articles published in English, between 2010 and 2020, and from PubMed were included.

RESULTS

Seventeen review articles met our review inclusion criterion. Our primary finding is that application of digital health strategies for adolescent SRH promotion is highly feasible and acceptable. Although effectiveness evidence is insufficient to make strong recommendations for interventions and best practices suggestions, some user-centered design guidelines have been proposed for web-based health information and health application design for adolescent use. Additionally, several digital health strategies have also been identified that can be used to further develop integrated GBV-IPV-SRH-informed services to improve adolescent health outcomes. We generated several recommendations and strategies to guide future digital based SRH promotion research from our review.

CONCLUSIONS

Rigorous research that focuses on intervention effectiveness testing using a combination of digital health strategies and standardized albeit contextualized outcome measures would be important. Methodological improvement such as adoption of longitudinal experimental design will be crucial in generating evidence-based intervention and practice guidelines for adolescents in LMICs.

Educators' Perspectives on Integrating Technology Into Sexual Health Education: Implementation Study

Background

In the last decade, the use of technology-based sexual health education has increased. Multiple studies have shown the feasibility of technology-based interventions, while a subset has also shown efficacy in improving youths’ sexual health outcomes such as increased condom use and knowledge. However, little is known about health educators’ experiences in integrating technology to augment sexual health curricula.

Objective

The purpose of this study was to assess the perceptions and experiences of health educators regarding the incorporation of technology into a sexual health education program designed for underserved youth in Fresno County, California, and to identify facilitators and challenges to incorporating technology into the in-person curriculum.

Methods

This implementation study used data collected as part of a cluster randomized controlled trial to evaluate In the Know (ITK), an in-person sexual health education curriculum that includes technology-based content, such as a resource locator, videos, and games, which can be accessed through a mobile app or website. Data from implementation logs from each cohort (n=51) and annual interviews (n=8) with health educators were analyzed to assess the health educators’ experiences using the technology and adaptations made during the implementation.

Results

The health educators reported that technological issues affected implementation to some degree: 87% of the time in the first year, which decreased to 47% in the third year as health educators’ familiarity with the app increased and functionality improved. Technology issues were also more common in non–school settings. Successes and challenges in 3 domains emerged: managing technology, usability of the ITK app, and youth engagement. The health educators generally had positive comments about the app and youth engagement with the technology-based content and activities; however, they also noted certain barriers to adolescents’ use of the mobile app including limited data storage and battery life on mobile phones.

Conclusions

Health educators require training and support to optimize technology as a resource for engaging with youth and providing sensitive information. Although technology is often presented as a solution to reach underserved populations, educational programs should consider the technological needs and limitations of the participants, educators, and settings.

International Registered Report Identifier (IRRID)

RR2-10.2196/18060

Uptake of and Engagement With an Online Sexual Health Intervention (HOPE eIntervention) Among African American Young Adults: Mixed Methods Study

Background

Regarding health technologies, African American young adults have low rates of uptake, ongoing usage, and engagement, which may widen sexual health inequalities.

Objective

We aimed to examine rates of uptake and ongoing usage, and factors influencing uptake, ongoing usage, and engagement for a consumer health informatics (CHI) intervention for HIV/sexually transmitted infection (STI) prevention among African American young adults, using the diffusion of innovation theory, trust-centered design framework, and O’Brien and Toms’ model of engagement.

Methods

This community-based participatory mixed methods study included surveys at four time points (n=315; 280 African American participants) among young adults aged 18 to 24 years involved in a blended offline/online HIV/STI prevention intervention (HIV Outreach, Prevention, and Education [HOPE] eIntervention), which was described as a “HOPE party.” Qualitative interviews were conducted with a subset of participants (n=19) after initial surveys and website server logs indicated low uptake and ongoing usage. 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

Participants’ initial self-reported eIntervention uptake was low, but increased significantly over time, although uptake never reached expectations. The most frequent activity was visiting the website. Demographic factors and HOPE party social network characteristics were not significantly correlated with uptake, although participant education and party network gender homophily approached significance. According to interviews, one factor driving uptake was the desire to share HIV/STI prevention information with others. Survey and interview results showed that technology access, perceived time, and institutional and technological trust were necessary conditions for uptake. Interviews revealed that factors undermining uptake were insufficient promotion and awareness building, and the platform of the intervention, with social media being less appealing due to previous negative experiences concerning discussion of sexuality on social media. During the interaction with the eIntervention, interview data showed that factors driving initial engagement were audience-targeted website esthetics and appealing visuals. Ongoing usage was impeded by insufficiently frequent updates. Similarly, lack of novelty drove disengagement, although a social media contest for sharing intervention content resulted in some re-engagement.

Conclusions

To encourage uptake, CHI interventions for African American young adults can better leverage users’ desires to share information about HIV/STI prevention with others. Ensuring implementation through trusted organizations is also important, though vigorous promotion is needed. Visual appeal and targeted content foster engagement at first, but ongoing usage may require continual content changes. A thorough analysis of CHI intervention use can inform the development of future interventions 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 our empirical results.