Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Prev Sci. 2020 Oct;21(7):885-897. doi: 10.1007/s11121-020-01148-w.
Adolescent men who have sex with men (AMSM) experience a dramatic health disparity in HIV, accounting for over 80% of new diagnoses among youth. Current evidence-based HIV prevention programs, however, focus primarily on adults and heterosexual youth, thereby missing the unique experiences and socio-environmental contexts of AMSM aged 13-18. To address these gaps, we used the Intervention Mapping (IM) protocol to developmentally adapt an existing evidence-based online HIV risk reduction program (i.e., Keep it Up!/KIU!), originally designed for young adult MSM aged 18-29, into a new intervention called SMART Squad. Using a hybrid of IM creation and adaptation tasks, we specified three behavioral outcomes and identified corresponding performance objectives for SMART Squad based on the original goals of KIU!. We constructed matrices of change objectives using determinants from the Information-Motivation-Behavioral Skills model, modifying them for the younger population with additional theoretical and empirical evidence and expert review. SMART Squad activities were operationalized from theory-based behavior change methods matched to the change objectives and guided by program themes, components, and scope imported from KIU!. The final SMART Squad intervention comprises 6 episodes/modules delivered in 2 sessions plus 2 booster episodes occurring 1 and 3 months after the main program. It is currently being evaluated nationally as part of a stepped-care package of 3 programs, in which the receipt and sequencing of interventions is tailored to individual AMSM development and needs. Despite substantial changes to KIU!, IM was a useful method for retaining the hypothesized essential elements of the eHealth HIV risk reduction program. Challenges and recommendations for future researchers and practitioners are discussed.
与男性发生性关系的青少年男性（AMSM）在 HIV 方面经历了巨大的健康差距，占青年人群中新增诊断的 80%以上。然而，目前基于证据的 HIV 预防方案主要侧重于成年人和异性恋青年，从而忽略了 13-18 岁 AMSM 的独特经历和社会环境背景。为了解决这些差距，我们使用干预映射（IM）协议，将一个现有的基于证据的在线 HIV 风险降低计划（即 Keep it Up!/KIU！），最初是为 18-29 岁的年轻男男性行为者设计的，发展成为一个新的干预措施，称为 SMART Squad。我们使用 IM 创建和适应任务的混合方法，根据 KIU！的原始目标，为 SMART Squad 指定了三个行为结果，并确定了相应的绩效目标。我们使用信息-动机-行为技能模型中的决定因素构建了变化目标矩阵，并对年轻人进行了修改，增加了额外的理论和经验证据以及专家审查。SMART Squad 活动是根据与变化目标相匹配的基于理论的行为改变方法实施的，并以从 KIU！导入的项目主题、组成部分和范围为指导。最终的 SMART Squad 干预措施包括 6 个情节/模块，分 2 次进行，加上主要方案后 1 个月和 3 个月进行 2 次强化情节。它目前正在全国范围内作为 3 个方案的阶梯式护理包的一部分进行评估，根据个别 AMSM 的发展和需求，对干预措施的接收和排序进行了调整。尽管对 KIU！进行了大量更改，但 IM 是保留电子健康 HIV 风险降低计划的假设基本要素的有用方法。讨论了对未来研究人员和从业者的挑战和建议。
