Developing an HIV prevention text messaging-based intervention for adolescent gay, bisexual, and queer males: Online focus groups to confirm program components

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  • Good afternoon. I’ve very pleased to be here. My name is Tonya Prescott with CiPHR. Today I’m going to be talking about developing…. including recruitment and enrollment strategies
  • Before I begin I want to acknowledge our funding from the NIMH and our partners at Northwestern University, as well as our consultants.
  • Half will be randomized to RCT and half will be randomized to the control group. Topics included: Communication Skills, Healthy Relationships, HIV information, How to Use Condoms Correctly, How to Negotiate Condoms, Motivations to have sex/ not have sex.
  • We utilized a national sampling frame. We also paid special attention to reach a diverse group of participants… Diversity defined as race/ethnicity… but also purposeful for age, region, urban/ rural by sexual experience. We used a purposeful recruitment strategy to reach a diverse sample – though not specific quotas we would monitor enrollment demographics – but we aimed to reach minority rates higher than the national averageWe used a combination of paid/ unpaid adversiting…. We chose Facebook based on a national recruitment effort used in a previous survey in which we were having difficulty reaching younger (12-15) GBQ males – and we found it to be a useful strategy and were able to successful reach them.GoogleAds allows use free ad space because we are a non-profit organization. Partnership with community organizations, we had existing relationship with GLSEN and reached our to TrevorProject because they are a large online community and have a large reach for LGBT adolescents. You want to go where your target population are – but also do so in a financially efficient manner – e.g., partners!
  • Here you can see the number of eligible/ ineligible by recruitment source. 0 enrolled to 12 for FB… improved pictures so more salient, targeting to particular age group, may seem obvious but sometimes forget, target to males… harnessed powers of Facebook advertisement features so you can balance. GoogleAds not effective because too broad… Tailoring greatly increases ad success.Both partners we were able to identify half of participants – did not have to pay – highlights importance of combining strageties. Don’t relay solely on one or the other, but combined stragegy effective to reach audience.
  • As demonstrated from this slide we received a diverse sample in terms of race and urbanicity: 45% were of non-white race (e.g., Asian, Black, Mixed, Native American, or Other)29% were from a rural community
  • 3 main aims of FG: Text buddy (2 participants matched to eachother), SOS Tonight (if going on date able to text program and get messages) , and Message timing (throughout day, particular times, too early/ too late)Guys really excited about Text buddy and being able to connect with other person… multiple suggestions for ways to text…. Code of conduct… block specific words… block picture messaging… Participants suggested introduction text message to facilitate initial conversation (fav color, singer/artist). So, to be more inclusive of adolescent experiences expanding upon SOS Tonight to include more than just dating tips… so sex, relationships, condoms, etc. Participant would text a keyword for tip they are interested in and receive message in returnWeekday – one in morning and then after school hours… weekdays equally spaced.
  • The use of multiple partners – community organizations and paid adversiting – allows you to purposefully target and recruit a diverse sample of a hard to reach population (in this case 14-18 GBQ males).. And do so in a cost-effective manner. FB especially useful in targeting groups we were skewing low on… partners source of half of participants for free. ** particularly text buddy feature that connects GBQ teens with like others


  • 1. 11th International AIDS Impact Conference September 30, 2013, 14:30-16:00pm Session: Information Technologies Developing an HIV prevention text messaging- based intervention for adolescent gay, bisexual, and queer males: Online focus groups to confirm program components Tonya Prescott BA1 Brian Mustanski PhD2 L. Zachary DuBois PhD 2 Michele Ybarra MPH PhD1 1Center for Innovative Public Health Research, San Clemente, California, USA 2 Impact Program, Northwestern University, Chicago, Illinois, USA
  • 2. Acknowledgements The project described is supported by Award Number R01 MH096660 from the National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health. We would like to thank the entire G2G Team from Center for Innovative Public Health Research and Northwestern University. We’d also like to acknowledge the contributions of our consultants, Drs. Sheana Bull and Jeffrey Parsons. Finally, we thank the participants for their time and willingness to participate in this study.
  • 3. Background  HIV among adolescent males who have sex with males (AMSM):  AMSM account for almost 70% of HIV diagnoses among all young people in the US (CDC, 2010)  AMSM are alone in facing increasing incidence of HIV/AIDS (CDC, 2008)  Few HIV prevention programs are targeted specifically towards gay, bisexual, and queer (GBQ) adolescents  Mobile phone use:  78% of US teens report mobile phone ownership (Madden, 2013)  75% of US teens text and 63% exchange text messages daily (Lenhart, 2012)
  • 4. Guy2Guy (G2G): Brief program overview  Text-messaging-based healthy sexuality and HIV-prevention program specifically for GBQ male adolescents  Six-module program based upon the IMB model  Attention-matched control group  Main outcomes: Condom use, abstinence  Content tailored on sexual experience
  • 5. Eligibility criteria  14-18 years of age  Self-identifies as gay, bisexual, or queer  Owns mobile phone  Enrolled in unlimited text messaging plan  Has texted for at least 6 months  Plans to have cell phone number for at least 6 months
  • 6. Online focus groups  Aim: Guide program content and logistic decisions  Four focus groups (n=75)  November 2012 and January 2013  3 consecutive days  Stratified by sexual experience (anal/vaginal sex ever)  Asynchronous, bulletin-board style format  Password-protected website  Participants created anonymous username  Daily moderation and probing
  • 7. Designing and implementing a national recruitment and enrollment strategy  National, online sampling frame  Online strategies to recruit participants:  Facebook  Google Ads  Partnership with community organizations  GLSEN (Gay, Lesbian, Straight Education Network)  TrevorProject
  • 8. Designing and implementing a national recruitment and enrollment strategy Online strategies to recruit participants: Recruitment source Eligible screeners received Ineligible screeners received Total cost Facebook 86 43 $378.35 GoogleAds 0 6 $0 TrevorProject 78 56 $0 GLSEN 59 49 $0 Recruitment source FG #1 (n=37) FG #2 (n=38) Facebook 0 12 GoogleAds Not used 0 TrevorProject 37 3 GLSEN Not used 23 Source for enrolled participants:
  • 9. Participant demographics (n=75) 5% 5% 19% 1% 15% 55% Race Asian Black or African American Mixed racial background Native American or Alaskan native Other White or Caucasian 29% 71% Urbanicity Rural Urban
  • 10. Confirming program components  Text Buddy  Participants liked the idea. Suggested matching on many things: age, sexual orientation, interests, outness, etc.  Some were concerned that it might get ‘creepy’ and encouraged plans to protect against this  SOS Tonight (on-demand dating tips)  The idea was well-received  It has been re-conceptualized as G2Genie (on-demand tips about sex, relationships, condoms, HIV testing)  Message timing  Participants identify their text message time frame  Vary message window during school week vs. weekend
  • 11. Conclusions  Use of multiple recruitment strategies allows you to purposefully target and recruit a diverse national sample in a cost-effective manner  Facebook targeted advertising options allows for further refinement of ad for sub-populations  Community partners allowed us to recruit half of focus group participants at no cost  Proposed G2G program components appear to be acceptable among GBQ youth recruited nationally
  • 12. Thank you! For more information, please contact: Tonya Prescott * Thank you for your interest in this presentation. Please note that analyses included herein are preliminary. More recent, finalized analyses may be available by contacting CiPHR for further information.