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Development and Adolescent Sexual Health

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“Development and Adolescent Sexual Health: The DASH study gets yMSM Online” was presented at Sex::Tech 2011 by Matthew Golden, MD, MPH; Sara Nelson Glick, PhD, MPH and Brittany Walsh, MSW candidate of …

“Development and Adolescent Sexual Health: The DASH study gets yMSM Online” was presented at Sex::Tech 2011 by Matthew Golden, MD, MPH; Sara Nelson Glick, PhD, MPH and Brittany Walsh, MSW candidate of UW Center for AIDS and STD, Public Health of Seattle and King County STD Clinic.

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  • I want to talk about… what is DASHWhat makes it special?What were our methods – recruitment, retention, community partnershipWhat were our challenges and successesWhat did we learn?What were our stats?
  • Purpose of the ResearchEligibility CriteriaStudy Methods – there have been a handful of similar studies but none recruited as broadly and collected the data we needed to look at detailed behavior patterns. We followed 95 yMSM for one year, asking for 3 in person study visits that offered free HIV and STD testing and were accompanied with an online survey. There were two other surveys unaccompanied by visits. And participants were randomized to a diary schedule at baseline and 6 month appointments. Diary schedules ranged from “never, daily, weekly, and every other week”
  • GLBTQ youth service providers and organizations, youth friendly clubs and events, listservs for school groups, school based health clinics, in the bathrooms at the PHSKC STD clinic
  • Is this slide necessary?
  • Insert pie chart with percentages- from Sara:DASH recruitment sites- among those who were eligible (n=103)Thoughts- skip this slide or simply show that facebook brought in 36% of our guys
  • Insert info about race/ethnicity and age.- from Sara:Describe that the racial/ethnic diversity of our sample was quite representative of the seattle MSM population. The trick will be expanding the study to other cities with different demographics from Seattle. Will our recruitment strategies work elsewhere? Its hard to know.
  • Insert info about % of eligible participants who met criteria for sexual inexperience- from SaraIs this slide necessary?
  • Slide info from Sara:Clear improvement in recruitment efforts after expanding eligibility criteria and initiating Facebook adverts.Overall, we were able to recruit a young, diverse cohort of ~100 over an 8-9 month period (which was our goal)
  • Slide info from Sara:It wasn’t that community orgs didn’t maintain the relationship or didn’t continue to help us out, instead it seems like it’s simply easier to reach this population through the internet
  • 6month appt emails were personalized. Sent with 1 months notice and gave dates when I’d follow up with them by… also let them know I might call them if I hadn’t heard from them.Emails were always personalized and tried to check in.Emails sent once a week, phone calls on the other week… for scheduling or outstanding surveysPhone calls and/or emails were sent a week before and sometimes the day before an appointmentOften these young men included personal details in their email about why they were late or what was going on in their life. I tried not to lose sight of that and check in from time to time. Kept a log of my contact with each participant so I’d know how recently we’d been in touch and if it was waiting on me to reach out or if I was waiting to hear from them.Also told them we may reach out to an emergency contact
  • Info from Sara:We hit over 80% retention in every category.
  • Our conclusion is that these diaries were feasible for up to 6 months.
  • A couple of guys dropped out immediately or before their 6 month visit – average loss to follow upOthers moved out of state but continued to do their web-based stuff without the STD testingWith some guys it was harder to engage them without the diary reminders. Every 3 months was too infrequent of communication with this groupWe don’t know for sure that guys internet is changing, but this might have explained some of our participants difficult completed diaries. What if they had been an app instead? And how many guys completed their surveys in the waiting room from their phones?
  • In other words, we reached the goals we set for ourselves and we CAN follow these guys for one year
  • First point- it’s probably a toss up. We want the data from a year’s worth of diaries and the constant contact helps us get it. Sara has looked at this point, and there is some evidence of a difference in behavior over the course of the year between those assigned diaries and those not assigned diaries.Second point- I believe relationship building is part of the process of keeping them engaged. A lot of other details come up in emails that help to connect you to someone’s life. Take note of it. They didn’t have to tell you all of that… they are used to answering to someone. Third point- the challenge will be expanding the study to new cities AND in the context of constantly changing media. What happens Fourth point- Sara and Matt are currently looking at behavior patterns over the year but acknowledge that we probably need more time than that to see any profound changes.

Transcript

  • 1. Development and Adolescent Sexual Health:the study gets yMSM Online
    Matthew Golden, MD, MPH
    Sara Nelson Glick, PhD, MPH
    Brittany Walsh, MSW candidate
    Matthew Golden, MD, MPH, Sara Nelson Glick, PhD, MPH, Brittany Walsh, MSW candidate
    UW Center for AIDS and STD, Public Health of Seattle and King County STD Clinic
  • 2. Presentation Goals
    • Share successes and challenges of recruitment for the DASH study
    • 3. Share successes and challenges of retention for the DASH study
    • 4. Discuss lessons learned around feasibility of year-long, web-based, follow up and quality of that data over time
    Matthew Golden, MD, MPH, Sara Nelson Glick, PhD, MPH, Brittany Walsh, MSW candidate
    UW Center for AIDS and STD, Public Health of Seattle and King County STD Clinic
  • 5. About
    • Ultimate Goal: Learn about the early sexual experiences and behavior patterns of yMSM
    • 6. Prospective Cohort Study: 95 sexually inexperienced, yMSM
    • 7. Between the ages of 16-30 at enrollment
    • 8. 10 or fewer male lifetime partners OR
    • 9. 5 or fewer years since same-sex sexual debut
    • 10. Feasibility Study: determine if it was possible to recruit and retain a traditionally hard to reach population
    Matthew Golden, MD, MPH, Sara Nelson Glick, PhD, MPH, Brittany Walsh, MSW candidate
    UW Center for AIDS and STD, Public Health of Seattle and King County STD Clinic
  • 11. Recruitment Methods
    • Community Collaboration
    • 12. Listservs and Flyers
    • 13. Facebook
    • 14. Participant Referrals
    • 15. “ If you know someone who might be interested and we enroll them in the study, we’ll compensate you $20 for your referral.”
    Matthew Golden, MD, MPH, Sara Nelson Glick, PhD, MPH, Brittany Walsh, MSW candidate
    UW Center for AIDS and STD, Public Health of Seattle and King County STD Clinic
  • 16. Recruitment Methods
    Matthew Golden, MD, MPH, Sara Nelson Glick, PhD, MPH, Brittany Walsh, MSW candidate
    UW Center for AIDS and STD, Public Health of Seattle and King County STD Clinic
  • 17. Recruitment Success
    SU Triangle
    Club, 1%
    American
    Facebook,
    Friends, 2%
    36%
    Unknown, 3%
    Listserv, 3%
    Other, 5%
    Craigslist, 3%
    Friend, 5%
    Lifelong AIDS
    Alliance, 4%
    STD Clinic,
    Participant,
    10%
    21%
    UW Q Center,
    7%
    Matthew Golden, MD, MPH, Sara Nelson Glick, PhD, MPH, Brittany Walsh, MSW candidate
    UW Center for AIDS and STD, Public Health of Seattle and King County STD Clinic
  • 18. Recruitment Success
    Age
    Mean = 21 years
    35% were 16-19 years old
    Race / Ethnicity
    Matthew Golden, MD, MPH, Sara Nelson Glick, PhD, MPH, Brittany Walsh, MSW candidate
    UW Center for AIDS and STD, Public Health of Seattle and King County STD Clinic
  • 19. Recruitment Success
    Diversity in eligibility criteria
    Matthew Golden, MD, MPH, Sara Nelson Glick, PhD, MPH, Brittany Walsh, MSW candidate
    UW Center for AIDS and STD, Public Health of Seattle and King County STD Clinic
  • 20. Recruitment Success
    Matthew Golden, MD, MPH, Sara Nelson Glick, PhD, MPH, Brittany Walsh, MSW candidate
    UW Center for AIDS and STD, Public Health of Seattle and King County STD Clinic
  • 21. Recruitment Challenges
    • Referrals from community organizations were few
    • 22. Slow-going until we expanded inclusion criteria
    • 23. Cost of Facebook
    Matthew Golden, MD, MPH, Sara Nelson Glick, PhD, MPH, Brittany Walsh, MSW candidate
    UW Center for AIDS and STD, Public Health of Seattle and King County STD Clinic
  • 24. Retention Methods
    • DatStat system emailed reminders for diaries and surveys
    • 25. 6 month and 12 month appointments - email from a real person
    • 26. 3 month and 9 month survey - reminders emailed from a real person
    • 27. Phone calls and/or emails as needed
    • 28. $$$
    • 29. Emergency Contact information
    Matthew Golden, MD, MPH, Sara Nelson Glick, PhD, MPH, Brittany Walsh, MSW candidate
    UW Center for AIDS and STD, Public Health of Seattle and King County STD Clinic
  • 30. Retention Success
    Surveys
    Exams
    N = 95
    3mo
    6mo
    BL
    9mo
    12mo
    Matthew Golden, MD, MPH, Sara Nelson Glick, PhD, MPH, Brittany Walsh, MSW candidate
    UW Center for AIDS and STD, Public Health of Seattle and King County STD Clinic
  • 31. Retention Success
    • Web-Based Diaries:
    • 32. 78% of participants completed at least 80% of their diary days during the first 6 months. During the second 6 months, less than 60% completed at least 80% of their diary days
    Matthew Golden, MD, MPH, Sara Nelson Glick, PhD, MPH, Brittany Walsh, MSW candidate
    UW Center for AIDS and STD, Public Health of Seattle and King County STD Clinic
  • 33. Retention Challenges
    • Typical loss to follow up
    • 34. DatStat randomized diary schedules with more “Nevers” in the second half of the study
    • 35. Changing Patterns in Internet Access
    • 36. Probably expanding but moving away from the traditional email + web browser access. Moving toward text messaging+apps+phone web browser access.
    Matthew Golden, MD, MPH, Sara Nelson Glick, PhD, MPH, Brittany Walsh, MSW candidate
    UW Center for AIDS and STD, Public Health of Seattle and King County STD Clinic
  • 37. Is a year Online Feasible?
    • Successful recruitment
    • 38. ~ 100 guys over 8-9 months
    • 39. Successful retention
    • 40. over 80% completion on all surveys and exams
    • 41. Reached the goals we set for ourselves
    • 42. CAN follow these hard to reach guys for 1 year
    Matthew Golden, MD, MPH, Sara Nelson Glick, PhD, MPH, Brittany Walsh, MSW candidate
    UW Center for AIDS and STD, Public Health of Seattle and King County STD Clinic
  • 43. Discussion
    • Diaries and extra contact- an intervention of their own or just added TLC?
    • 44. Relationship building with yMSM participants is key
    • 45. The challenge will be expanding the study to new cities and in the context of constantly changing media
    • 46. Behavior changes differently in everyone and over time. It seems to be worth engaging with yMSM early in their development
    Matthew Golden, MD, MPH, Sara Nelson Glick, PhD, MPH, Brittany Walsh, MSW candidate
    UW Center for AIDS and STD, Public Health of Seattle and King County STD Clinic
  • 47. Where’s
    Now ?
    • It’s submitted! Matt and Sara have several others in the works.
    Questions?
    • Matthew Golden at PHSKC HIV/STD Program
    golden@uw.edu
    (206) 744-6829 , (206) 296-4805
    • Sara Nelson Glick at Center for AIDS and STD
    sjnelson@uw.edu
    (206) 744-8055
    • Brittany Walsh at Center for AIDS and STD
    walshb@uw.edu
    (734) 751-9629
    Matthew Golden, MD, MPH, Sara Nelson Glick, PhD, MPH, Brittany Walsh, MSW candidate
    UW Center for AIDS and STD, Public Health of Seattle and King County STD Clinic
  • 48. (BIG) Thanks!
    Sara Nelson Glick and Matthew Golden
    Tara Hicks and others at the PHSKC STD Clinic
    Our wonderful participants
    Our wonderful community collaborators
    And Sara Nelson Glick, once more.
    Matthew Golden, MD, MPH, Sara Nelson Glick, PhD, MPH, Brittany Walsh, MSW candidate
    UW Center for AIDS and STD, Public Health of Seattle and King County STD Clinic