University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Rutgers University, New Brunswick, NJ.
Health Educ Behav. 2021 Oct;48(5):604-614. doi: 10.1177/10901981211003859. Epub 2021 Apr 9.
BACKGROUND: Mobile health platforms can facilitate social support and address HIV (human immunodeficiency virus) stigma but pose challenges for intervention design and participant engagement. Giddens's structuration theory, that individuals are shaped by-and shape-their communities through rules and resources that give them power to operate within these environments, provides a useful analytic framework for exploring these dynamic intervention spaces. METHOD: Data were drawn from an online randomized controlled trial intervention (HealthMpowerment) for young Black men who have sex with men to reduce condomless anal intercourse. We applied a conversational analysis informed by structuration theory to 65 user-generated conversations that included stigma content. We aimed to understand how the interdependent relationship between the intervention space and participants' contributions might contribute to behavior change. RESULTS: Thirty five intervention participants contributed to the analyzed conversations. Our analysis identified three types of conversational processes that may underlie behavior change: (1) Through intervention engagement, participants established norms and expectations that shaped their discussions; (2) participants used anecdotes and anonymity to reinforce norms; and (3) intervention staff members sought to improve engagement and build knowledge by initiating discussions and correcting misinformation, thus playing an integral role in the online community. CONCLUSIONS: The lens of structuration theory usefully reveals potential behavior change mechanisms within the social interactions of an online intervention. Future design of these interventions to address HIV stigma should explicitly characterize the context in which individuals (study staff and participants) engage with one another in order to assess whether these processes are associated with improved intervention outcomes.
背景:移动健康平台可以促进社会支持并解决 HIV(人类免疫缺陷病毒)污名问题,但在干预设计和参与者参与方面带来了挑战。吉登斯的结构化理论认为,个人通过规则和资源塑造自己的社区,这些规则和资源赋予他们在这些环境中运作的权力,为探索这些动态干预空间提供了一个有用的分析框架。
方法:数据来自针对与男性发生性关系的年轻黑人男性的在线随机对照试验干预(HealthMpowerment),旨在减少无保护的肛交。我们应用了受结构化理论启发的会话分析,对包括污名内容的 65 个用户生成的对话进行了分析。我们旨在了解干预空间和参与者贡献之间的相互依存关系如何有助于行为改变。
结果:35 名干预参与者为分析对话做出了贡献。我们的分析确定了可能导致行为改变的三种会话过程:(1)通过干预参与,参与者建立了规范和期望,从而塑造了他们的讨论;(2)参与者使用轶事和匿名来强化规范;(3)干预工作人员通过发起讨论和纠正错误信息来寻求提高参与度和建立知识,从而在在线社区中发挥不可或缺的作用。
结论:结构化理论的视角有助于揭示在线干预中社会互动中的潜在行为改变机制。未来针对 HIV 污名设计这些干预措施时,应明确描述个人(研究人员和参与者)相互参与的背景,以评估这些过程是否与改善干预结果相关。
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