Crawford Gemma, Maycock Bruce, Tobin Rochelle, Brown Graham, Lobo Roanna
Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, Australia.
Australian Research Centre in Sex Health and Society, La Trobe University, Bundoora, Australia.
J Med Internet Res. 2018 Sep 5;20(9):e10787. doi: 10.2196/10787.
In high-income countries such as Australia, an increasing proportion of HIV cases have been acquired overseas, including among expatriates and travelers. Australia's national strategies have highlighted the need for public health interventions for priority populations. One approach is to expand efforts to places or spaces where expatriate communities reside. Online settings such as forums used by expatriates and travelers have potential for preventing sexually transmissible infections with those hard to reach through more traditional interventions.
Our objectives were to (1) identify and describe domains of social interaction and engagement in 1 online forum used by Australian expatriates and travelers living or working in Thailand; and (2) make recommendations to health-promoting organizations and policy makers regarding the role of these forums in public health interventions with mobile populations who may be at risk of acquiring HIV or other sexually transmissible infections.
We identified forums and users in 2 stages. We identified 13 online forums and analyzed them for inclusion criteria. We searched 1 forum that met the required criteria for users who met inclusion criteria (n=5). Discussion threads, rather than individual posts, were units of analysis. For each user, we collected as transcripts the first 100 posts and 10 most recent posts, including the thread in which they were posted. We analyzed and thematically coded each post (n=550). Transcripts and analyses were reviewed and refined by multiple members of the research team to improve rigor. Themes were not totally emergent but explored against symbolic interactionism concepts of presentation of self, meaning, and socialization.
Key domains were as follows: the forum (characteristics of the space and reasons for use), gaining access (forum hierarchy and rules), identity (presentation of self and role of language), advice, support, and information (sources of information, support provided, influencers, topics of discussion, and receptiveness to advice), and risk (expectations and perceptions). The forum exhibited evidence of unique language, rules and norms, and processes for managing conflict and key influencers. The forum was a substantial source of health information and advice provided to users via confirmation, reassurance, or affirmation of beliefs and experiences. Risk perception and expectations varied. Risk taking, including around sex, appeared to be a key expectation of travel or the experience of being an expatriate or traveler.
Australian expatriate and long-term traveler participation in the online forum formed, influenced, and reinforced knowledge, attitudes, interaction, and identity. Such forums can be used by policy makers and health-promoting organizations to provide supplementary sources of support and information to hard-to-reach mobile populations who may be at risk of acquiring HIV or other sexually transmissible infections. This will complement existing engagement with health professionals and other public health interventions.
在澳大利亚等高收入国家，越来越多的艾滋病毒病例是在海外感染的，包括外派人员和旅行者。澳大利亚的国家战略强调了针对重点人群进行公共卫生干预的必要性。一种方法是将工作扩展到外派人员社区居住的地方或场所。外派人员和旅行者使用的在线论坛等网络环境，有可能预防通过传统干预措施难以触及人群的性传播感染。
我们的目标是：（1）识别并描述在泰国生活或工作的澳大利亚外派人员和旅行者使用的一个在线论坛中的社会互动和参与领域；（2）就这些论坛在对可能感染艾滋病毒或其他性传播感染风险的流动人群进行公共卫生干预中的作用，向健康促进组织和政策制定者提出建议。
我们分两个阶段识别论坛和用户。我们识别了13个在线论坛，并根据纳入标准对其进行分析。我们在1个符合要求标准的论坛中搜索符合纳入标准的用户（n = 5）。分析单位是讨论线程，而非单个帖子。对于每个用户，我们收集了前100个帖子和最近10个帖子作为文字记录，包括帖子所在的线程。我们对每个帖子（n = 550）进行分析并进行主题编码。研究团队的多名成员对文字记录和分析进行了审查和完善，以提高严谨性。主题并非完全自发出现，而是依据自我呈现、意义和社会化的符号互动主义概念进行探索。
关键领域如下：论坛（空间特征和使用原因）、获取途径（论坛层级和规则）、身份（自我呈现和语言的作用）、建议、支持和信息（信息来源、提供的支持、有影响力的人、讨论主题以及对建议的接受度）以及风险（期望和认知）。该论坛展现出独特的语言、规则和规范，以及管理冲突的流程和关键有影响力的人。该论坛是通过确认、安抚或肯定信念和经历向用户提供健康信息和建议的重要来源。风险认知和期望各不相同。冒险行为，包括围绕性方面的冒险，似乎是旅行或作为外派人员或旅行者经历的关键期望。
澳大利亚外派人员和长期旅行者参与在线论坛形成、影响并强化了知识、态度、互动和身份认同。政策制定者和健康促进组织可以利用此类论坛，为可能感染艾滋病毒或其他性传播感染风险的难以触及的流动人群提供补充性的支持和信息来源。这将补充现有的与卫生专业人员的接触和其他公共卫生干预措施。
