Johnson Amy K, Haider Sadia, Nikolajuk Katie, Kuhns Lisa M, Ott Emily, Motley Darnell, Hill Brandon, Hirschhorn Lisa
Division of Adolescent and Young Adult Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States.
Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
JMIR Form Res. 2022 Jul 28;6(7):e37738. doi: 10.2196/37738.
Young Black women between the ages of 18 and 24 years are disproportionately impacted by HIV, yet they have a low self-perception of HIV risk and limited exposure to prevention strategies. Pre-exposure prophylaxis (PrEP) is a safe and effective biomedical HIV prevention strategy for those at risk for HIV infection, but uptake has been slow among cisgender women. Family planning clinics are a primary source of health care access for young women, providing an ideal opportunity to integrate PrEP information and care into existing clinic practices.
The aim of this study was to use a multistage, community-engaged process to develop a mobile health app and to evaluate the feasibility and acceptability of the app.
Using user-centered design, the In the Loop app was developed in collaboration with a community advisory board of young Black women. This study employed a multistage design, which included community-engaged app development, user testing, and evaluation of the app's feasibility and acceptability. A pre- and postdesign was used to assess the impact of the app on PrEP knowledge immediately after app use. Descriptive statistics (eg, mean, SD, and percentage values) were used to describe the sample, and Wilcoxon matched-pairs signed-ranks test was used to detect changes in PrEP knowledge before and immediately after using the app.
A total of 50 sexually active, young Black women, aged 18-24 (mean 21, SD 1.9) years, were enrolled in this study. Analysis comparing scores before and immediately after use of the app revealed a significant increase in PrEP content knowledge scores on a 7-item true or false scale (z=-6.04, P<.001). Overall, participants considered the In the Loop app feasible and acceptable to use while waiting for a family planning visit. The majority of participants (n=46, 92%) agreed that they would recommend In the Loop to friends to learn more about PrEP. Participants rated the overall quality of the app 4.3 on a 1-5 scale (1=very poor and 5=very good). Of 50 participants, 40 (80%) agreed that the app was easy to use, and 48 (96%) agreed that they found the information in the app easy to understand. Finally, 40 (80%) agreed that they had enjoyed using the app while waiting for their family planning visit.
Our findings suggest that young Black women waiting for family planning visits found the In the Loop app to be feasible and acceptable. This study demonstrates the value of engaging young Black women in the app design process. As family planning clinics are a primary source of health care access for young women, they provide an ideal setting to integrate PrEP information and care into existing clinic practices. Next steps in the development of the In the Loop app include implementing user-suggested improvements and conducting efficacy testing in a randomized controlled trial to determine the app's impact on PrEP uptake.
18至24岁的年轻黑人女性受艾滋病毒影响的比例过高，但她们对艾滋病毒风险的自我认知较低，接触预防策略的机会有限。暴露前预防（PrEP）是一种针对有感染艾滋病毒风险人群的安全有效的生物医学艾滋病毒预防策略，但在顺性别女性中的采用率一直很低。计划生育诊所是年轻女性获得医疗保健的主要来源，为将PrEP信息和护理纳入现有诊所实践提供了理想机会。
本研究的目的是通过多阶段、社区参与的过程开发一款移动健康应用程序，并评估该应用程序的可行性和可接受性。
采用以用户为中心的设计，与一个由年轻黑人女性组成的社区咨询委员会合作开发了“In the Loop”应用程序。本研究采用多阶段设计，包括社区参与的应用程序开发、用户测试以及对应用程序的可行性和可接受性进行评估。使用前后设计来评估应用程序使用后立即对PrEP知识的影响。描述性统计（如均值、标准差和百分比值）用于描述样本，Wilcoxon配对符号秩检验用于检测使用应用程序前后PrEP知识的变化。
本研究共纳入了50名性活跃的18至24岁年轻黑人女性（平均年龄21岁，标准差1.9岁）。对应用程序使用前后的得分进行分析比较，发现在一个7项对错量表上，PrEP内容知识得分有显著提高（z=-6.04，P<.001）。总体而言，参与者认为“In the Loop”应用程序在等待计划生育就诊时使用是可行且可接受的。大多数参与者（n=46，92%）同意他们会向朋友推荐“In the Loop”以了解更多关于PrEP的信息。参与者在1至5分的量表上对应用程序的整体质量评分为4.3分（1=非常差；5=非常好）。在50名参与者中，40名（80%）同意该应用程序易于使用，48名（96%）同意他们觉得应用程序中的信息易于理解。最后，40名（80%）同意他们在等待计划生育就诊时喜欢使用该应用程序。
我们的研究结果表明，等待计划生育就诊的年轻黑人女性认为“In the Loop”应用程序是可行且可接受的。本研究证明了让年轻黑人女性参与应用程序设计过程的价值。由于计划生育诊所是年轻女性获得医疗保健的主要来源，它们为将PrEP信息和护理纳入现有诊所实践提供了理想环境。“In the Loop”应用程序开发的下一步包括实施用户建议的改进措施，并在随机对照试验中进行疗效测试，以确定该应用程序对PrEP采用率的影响。
