Reid Sean C, Wang Vania, Assaf Ryan D, Kaloper Sofia, Murray Alan T, Shoptaw Steven, Gorbach Pamina, Cassels Susan
Department of Geography, University of California, Santa Barbara, Santa Barbara, CA, United States.
Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.
JMIR Form Res. 2023 Jun 22;7:e45188. doi: 10.2196/45188.
The Ending the HIV Epidemic initiative in the United States relies on HIV hotspots to identify where to geographically target new resources, expertise, and technology. However, interventions targeted at places with high HIV transmission and infection risk, not just places with high HIV incidence, may be more effective at reducing HIV incidence and achieving health equity.
We described the implementation and validation of a web-based activity space survey on HIV risk behaviors. The survey was intended to collect geographic information that will be used to map risk behavior hotspots as well as the geography of sexual networks in Los Angeles County.
The survey design team developed a series of geospatial questions that follow a 3-level structure that becomes more geographically precise as participants move through the levels. The survey was validated through 9 cognitive interviews and iteratively updated based on participant feedback until the saturation of topics and technical issues was reached.
In total, 4 themes were identified through the cognitive interviews: functionality of geospatial questions, representation and accessibility, privacy, and length and understanding of the survey. The ease of use for the geospatial questions was critical as many participants were not familiar with mapping software. The inclusion of well-known places, landmarks, and road networks was critical for ease of use. The addition of a Google Maps interface, which was familiar to many participants, aided in collecting accurate and precise location information. The geospatial questions increased the length of the survey and warranted the inclusion of features to simplify it and speed it up. Using nicknames to refer to previously entered geographic locations limited the number of geospatial questions that appeared in the survey and reduced the time taken to complete it. The long-standing relationship between participants and the research team improved comfort to disclose sensitive geographic information related to drug use and sex. Participants in the cognitive interviews highlighted how trust and inclusive and validating language in the survey alleviated concerns related to privacy and representation.
This study provides promising results regarding the feasibility of using a web-based mapping survey to collect sensitive location information relevant to ending the HIV epidemic. Data collection at several geographic levels will allow for insights into spatial recall of behaviors as well as future sensitivity analysis of the spatial scale of hotspots and network characteristics. This design also promotes the privacy and comfort of participants who provide location information for sensitive topics. Key considerations for implementing this type of survey include trust from participants, community partners, or research teams to overcome concerns related to privacy and comfort. The implementation of similar surveys should consider local characteristics and knowledge when crafting the geospatial components.
美国的“终结艾滋病流行”倡议依赖于艾滋病热点地区来确定在哪些地理区域针对性地投入新资源、专业知识和技术。然而，针对艾滋病高传播和感染风险地区（而非仅艾滋病高发病率地区）的干预措施，可能在降低艾滋病发病率和实现健康公平方面更有效。
我们描述了一项基于网络的艾滋病风险行为活动空间调查的实施与验证情况。该调查旨在收集地理信息，用于绘制洛杉矶县的风险行为热点地区以及性网络地理分布。
调查设计团队开发了一系列地理空间问题，这些问题采用三级结构，随着参与者逐步深入各层级，地理定位愈发精确。该调查通过9次认知访谈进行验证，并根据参与者反馈进行迭代更新，直至主题和技术问题达到饱和状态。
通过认知访谈共确定了4个主题：地理空间问题的功能、呈现与可及性、隐私以及调查的长度与理解度。地理空间问题的易用性至关重要，因为许多参与者不熟悉地图软件。纳入知名地点、地标和道路网络对易用性至关重要。添加许多参与者熟悉的谷歌地图界面有助于收集准确精确的位置信息。地理空间问题增加了调查长度，因此有必要加入简化和加快调查的功能。使用昵称指代先前输入的地理位置，限制了调查中出现的地理空间问题数量，减少了完成调查所需时间。参与者与研究团队的长期关系提高了他们披露与吸毒和性行为相关敏感地理信息的舒适度。认知访谈的参与者强调，调查中信任以及包容和认可的语言如何减轻了与隐私和呈现相关的担忧。
本研究为使用基于网络的地图调查收集与终结艾滋病流行相关的敏感位置信息的可行性提供了有前景的结果。在多个地理层面进行数据收集将有助于深入了解行为的空间记忆，以及未来对热点地区空间尺度和网络特征的敏感性分析。这种设计还提升了为敏感主题提供位置信息的参与者的隐私和舒适度。实施此类调查的关键考虑因素包括参与者、社区合作伙伴或研究团队的信任，以克服与隐私和舒适度相关的担忧。在设计地理空间组件时实施类似调查应考虑当地特征和知识。
