1. Scott Fujino
Chicago Department of Public Health Mobile Application Development for the Reduction
HIV/STI in High Risk Populations: Background Research
Master of Public Health Capstone Project
May 2, 2014
Dr. Edward Mensah
Background: Despite progress in reducing the reported cases of HIV, AIDS and other STIs in
Chicago, the prevalence rates remain significantly higher than the overall national rates. Men
who have sex with Men (MSM), non-Hispanic (NH) Blacks and persons over the age of 30 years
account for most of the prevalent HIV cases and new annual AIDS diagnoses. Primary and
Secondary Syphilis diagnoses and new HIV diagnoses have been most common in NH Black
MSM under the age of 30 years. Chlamydia and gonorrhea are predominately diagnosed in
young people between the ages of 13 and 24 years and NH Blacks. The Chicago Department of
Public Health (CDPH) data suggests that interventions targeted at the improving health among
adolescents, young adults and eliminating the disparities that exist among racial and sexual
minorities is a priority. New studies (Lightfoot, 2012; Guilamo-Ramos, 2014, Hightow-
Weidman, 2011) indicate that smartphone based HIV/STI prevention applications developed to
direct young users to HIV/STI prevention, treatment and education resources demonstrate
promise in reducing the burden of HIV/STI on communities.
Source: Chicago Department ofPublic Health. HIV /STI Surveillance Report,2013.

2. Objective: Design and make available for distribution a free public health smartphone
application (app) that utilizes geographic information system(GIS) capabilities to direct users to
social, educational and health related HIV/STI resources and services within the City of Chicago
and immediate areas in alignment with six broad content areas in alignment with the World
Health Organization’s Global Health Sector Strategy on HIV/AIDS 2011-2015:
 HIV/STI Knowledge and Awareness
 Behavior Change/Risk Reduction/Safer Sex promotion
 Condom Use and Promotion
 HIV/STI testing
 Linkage to resources and care for HIV/STI positive persons
 Tailored content for higher risks populations
Design: Gather geographic reference data, mapping and analyzing social, educational and
health related HIV/STI resources within the City of Chicago and online for use in the mobile app.
Develop a consumer centric social marketing plan incorporating direct consumer participation,
utilizing audience analysis and segmentation to design and implement the HIV/STI intervention
app.
Setting: Chicago, IL
Introduction: HIV and AIDS cases reported in Chicago among males and females, across all
race/ethnic groups, injection drug users and heterosexuals have declined dramatically during
the last 10 years. Despite these observed successes, Chicago continues to have significantly

3. higher rates of reported HIV and other STI cases than the country overall. The HIV infection
prevalence rate for Chicago in 2011 was triple the national rate and new HIV infection and AIDS
diagnosis double the national rate.
The Chicago Public Health Department (CDPH) measures HIV in three categories: prevalent
disease (cumulative new and existing diagnoses), new annual AIDS diagnoses (indicating later
stage disease), and new annual HIV diagnoses. Among prevalent HIV cases and new annual
AIDS diagnoses in Chicago for the year 2011, MSM accounted for 68.9% and 57% of the new
cases respectively. The number of HIV infection diagnoses for those ages between 20 and 24
years of age increased on an average of 5% from 2007 to 2011. Among MSM who were
diagnosed with HIV Infection in 2011, 48% were Black, 20% were White, and 21% were
Hispanic.
Adolescents and young adults comprise the majority of STI diagnoses in Chicago. People 13 to
24 years old made up 67% of gonorrhea cases and 71% of chlamydia cases and 47% of syphilis
cases were among those under age 30. Chlamydia cases have increased 6% annually among 13
to 19 year olds and since 2008 and 51.7% of all Chlamydia cases are found in NH Blacks.
Syphilis infections have increased 19% annually since 2008 for young adults between 20-24
years of age with 49.6% of all syphilis cases found in NH Blacks.
Source: ChicagoDepartment of Public Health. HIV /STI Surveillance Report, 2013.

4. Mobile Health Apps in Public Health: New studies (Lightfoot, 2012; Hightow-Weidman, 2011)
indicate that smartphone based HIV/STI and prevention applications developed and tailored to
direct young users to HIV/STI prevention, treatment and education resources demonstrate
promise in reducing the burden of HIV/STI on communities. Holloway et al. (2013) found that
70% of young men who have sex with men (YMSM) expressed interest in using a smartphone
app-based HIV prevention programming and found that their test subjects who sought HIV
testing locations online were more likely to be tested. Guilamo-Ramos (2014) found that
Latino and African American parents and adolescents were motivated to obtain sexual health
information via online and mobile technologies tailored to minority ethnic families due to their
accessibility, widespread use and the ability to deliver large amounts of information quickly.
An analysis of mobile phone applications designed for the prevention and care of HIV/STI found
only 55 unique mobile apps available for either the Android or Apple mobile devices. The
review found that the existing HIV/STI apps were not frequently downloaded and not highly
rated. Of the 55 apps reviewed, only 6 apps covered all four basic areas of prevention
strategies: knowledge raising, risk reduction, condom promotion and testing. Thirteen of the
apps reviewed were geographically focused and only 4 of them were tailored for Black, NH
Black or MSM users, suggesting that most of the available HIV/STI themed apps have not taken
a targeted approach when developing their apps (Muessig et al., 2013). According to Muessig
et al. (2013) MSM felt overwhelmed by the amount of time it took to find usable and easy to
understand HIV/STI prevention and testing information. Subjects expressed an interest in a

5. more robust mobile app that provided prevention and HIV/STI testing information and also
incorporated resources regarding sexual health risk and substance use, information about safer
sex, a forum to discuss sexuality and relationships, resources for gay-friendly service providers,
and connection to support groups.
Targeted technology based interactive HIV/STI prevention interventions have been found to be
effective in changing behaviors (Noar, 2011). Mobile phone apps designed to provide HIV/STI
prevention and care services provide convenience for both the user and the developer because
of they provide a flexible mode to reach large audiences at a reasonable cost. Mobile apps also
allow for individually and interactive HIV/STI prevention interventions that are always available
for users and access to those resources anonymously (Muessig et al., 2013).
Social Marketing Strategy: The use of social marketing in public health continues to gain
traction. Social marketing is generally defined as the planning process that applies commercial
marketing concepts and techniques to promote voluntary behavior change. Marketing’s
conceptual framework includes: exchange theory, audience segmentation, competition, the
“marketing mix”, consumer orientation and continuous monitoring. The concept of exchange
theory states that social marketers must offer something of value to consumers, recognize that
consumers pay some intangible cost in changing behaviors and that everyone involved must
derive some utility from the exchange. Segmentation of consumers in marketing is not based
on typical public health sub-groups such as age or ethnicity, but rather sub-groups broken down
based on shared needs, wants, lifestyles, behavior and values to get them all to respond in the

6. same manner to public health intervention. Competition provides insight into behavioral
options that compete with the intended public health intervention and services. Insight into
the competition can be helpful in determining which specific segments of the population can be
targeted for interventions. Marketing Mix also known as the 4 P’s (product, price, place and
promotion) are central in planning and the implementation of any marketing strategy.
Consumer Orientation involves formulating an understanding of the people whose behavior you
hope to change. Consumer research provides insight to the social and cultural environments
where people act on behavioral decisions and is the backbone of consumer orientation. The
information gathered is used to make decisions on which segments of the population to target,
benefits to offer, price point and promotion strategies. Continuous Monitoring requires the
commitment of substantial resources during the initial planning process to continuously
evaluate and monitor the social marketing intervention throughout the interventions lifecycle.
The social marketing process is a constantly evolving method that can be broken down into six
major tasks:
 Initial Planning: Gather relevant information to identify behavioral objectives, determine
target markets and recognize potential determinants and strategies.
 Formative Research: investigate factors identified during the initial planning phase to
segment audiences and determine those factors that must be addressed to bring about
behavior change.
 Strategy Development: Strategy development involves the preparation of a realistic
marketing plan based on the 4 P’s (product, price, place and promotion) and comprised
of specific, measurable objectives and a step-by-step work plan that will guide the
development, implementation, and tracking of the project.
 Program Development and pretesting of material and non-material interventions:
Campaign materials are developed, pretested, piloted and revised prior to app
implementation.

7.  Implementation: App is available for download on selected mobile device platform.
 Monitoring and evaluation: Conducted throughout the implementation process to
identify opportunities for revision and evaluate effectiveness of the app to proactively
make updates and corrections as needed.
Source: Grier, S, Bryant, C. Socialmarketing inPublic Pealth.AnnualReview Public Health,2005
Smart Phone Usage: Recent data from the Pew Research Center (2014) indicates the following:
 58 % of all Americans own a smartphone.
 52% of smartphone owners access health or medical information using their phone.
 19% of smartphone owners have at least one health app on their phone.
 53% of Whites, 59% of African Americans and 61% of Hispanic adults own a smart
phone.
 77% of those 18-29 years of age with a household income of less than $30,000 own a
smartphone.
 83% of those between the ages 18-29 who have a cell phone own a smartphone.
 85% of those between the ages of 18-29 use the Internet, email or access the Internet
via a mobile device.
 74% of African Americans and 68% of Hispanic cell phone owners access the Internet via
their mobile device.
 66% of urban dwellers access the Internet via their mobile device.
Source: Pew Research Center’s Internet& American Life Project,April17-May 19, 2013 Tracking Survey.
Smartphone Ownership:
 31% of men own an Android smartphone
 43% of those 18-24 own an Android smartphone versus 31% who own an iPhone.
 40% of those 25-34 own and Android smartphone versus 40% who own an iPhone
 42% of NH Black people own an Android smartphone versus 16% who own an iPhone

8.  27% of Hispanic people own an Android smartphone versus 26% who own an iPhone.
Source: Pew Research Center’s Internet& American Life Project,April17-May 19, 2013 Tracking Survey.
Discussion: Targeted technology based interactive HIV/STI prevention interventions have been
found to be effective in changing behaviors (Noar, 2011). Furthermore, mobile phone apps
designed to provide access to HIV/STI prevention and care services provide convenience for
both the user and the developer and provide a flexible mode to reach large audiences at a
reasonable cost. Mobile apps also allow for individual and interactive HIV/STI prevention
interventions that are always available for users and facilitate access to those resources
anonymously (Muessig et al., 2013). Well thought out apps allow users to self-tailor and
personalize the user-experience by allowing them to choose which app features and
notifications they use. Research shows retention rates of apps by smartphone owners in the
US is only 12%, indicating that any app must be sufficiently useful and entertaining at time of
deployment. Health related apps that feature interactive components such as games, quizzes
and other enjoyable activities have been shown to improve and sustain healthy behaviors
(Barankowski et el., 2003). Leveraging smartphones geo-location capabilities in conjunction
with implementation of the core elements of social marketing provide public health
practitioners an opportunity to deploy a targeted HIV/STI smartphone app based intervention
for Chicago’s high risk adolescent, young adult, SMS and NH Black populations. A smartphone
based app intervention has the potential to increase access to HIV/STI prevention; treatment
and education resources to underserved populations located in the city and have the potential
to reduce the prevalence and burden of HIV/STI in Chicago.

9. Mobile App Development Phases:
DesignProcess
A. Requirements:
1. Identifythe targetusersandthe core functionalities.
B. Design:
1. Define the apprequirementsandproduct roadmap.
2. Determine whetherready-madeorcustomapplication.
3. Decide whethertomake orbuy.
4. Identifytargetmobileplatforms.
C. Development:
1. Identifytargetdevelopmentenvironment.
2. Developanditerate app.
3. Integrate andsynchronize withbackenddata,testandqualitycontrol(repeat)
D. Testing:
1. Secure andauthenticate users,appsanddata; access,storage and intransmission
E. Implementation:
1. Selectchannelsof distribution;provision,fulfill andtrack
F. Manage:
1. Control software versioning(blacklist,white list) establishandenforce policycompliance;
monitor,analyze reportappusage

10. Rollout Overview
Phase Features
I – Android
Version
 Available forAndroiddevices
 To be able tosign-upformobile application
 Profile Management
 To access Cityof Chicagowebsite
 To access “311” resources
 Able toviewhealthbenefits
 Able tosearch andview mappeddistributionsites
 Able toreceive SMS/promptsforrelatedhealthandsocial services.
 NotificationsandAlerts
 AbilitytoaccessCDPH viaTwitterand Facebook
II - iOSVersion  Addon to Base version
 Available foriPhonesi.e.iOS devices
 Betterprofile management
 More updatesrelatedtohealthandsocial services
III– Nice to have  Add-ontoPhase 2
 Available forWindowsdevices(on requestandusage based)
App Details
Requirement# Description Comments
1.1 ApplicationSetup –Landing
page
Thisis the firstscreenafterapp
installation,whichwill display
the followingandaskfor basic
demographicinformationsuch
as Name,Gender,Age (inrange
format?)
 Welcome message with
username
 Clickable buttonfor
callingHIV information

11. line
 Take the userto
“Settings”
1.2 User Interaction
1.2.1 Home Page and Navigationbar
User will be shownthe Home
page everytime applicationand
iscomprise of icon suchas:
- My Profile
- Searchfor locations
- HealthServices
- Social Services
- Social Media(Twitter,
Facebook,Instagram
- Chat (HIV chat line?)
- HealthUpdates
- “311” Access
- CDPH STI/HIV Access
1.2.2 Settings
1.2.2.1 My Profile
The user will be able toregister
and provide aprofile forhim.
Thisincludesdetailsabouthim
such as:
Needtospecifywhichuser
informationshouldbe captured
by the system, fore.g.,First
Name,Last Name,Date of Birth,
Age,Gender,SSN,etc. (HIPPA
considerationsmustbe
accountedfor)
-How oftendoyou use condoms
duringsex?

12. -Engage insex acts how many
timesperweek?
-Medical condition(HIV/STI)
positive?
-Have youeverbeendiagnosed
as havingan STI?
-Preferredcondomtype/brand?
1.2.3 DailyFunctionality
User will be shownthe Home
Page each time the application
iconis clicked,whichwillbring
the userto the appdashboard
that will consistof iconsthat
bringup respective pages
1.2.3.1 Searchfor locations
User will be able touse current
locationor manuallyenter
searchparametersforHIV/STI
relatedservices.
1.2.3.2 HIV/STIHealthServices
User will have searchable access
to HIV/STIhealthservicesin
area.
1.2.3.3 HIV/STISocial Services
User will have searchable access
to HIV/STIsocial servicesin
area.
1.2.3.4 HIV/STIrelatedSocial Media
streams.
User will have accesstoTwitter
and FacebookHIV/STIandTeen
PregnancyPreventionrelated

13. CDPH content.
1.2.3.5 HIV/STI, TeenPregnancyChat
User will have accesstochat
room functionalitytoexchange
informationwithotherapp
users.
1.2.3.6 HIV/STIHealthUpdates
User will have accesstonews
and educational HIV/STIrelated
content.
1.2.4 Help
1.2.4.1 HIV/STI 311 Access
User will have accessto311
ServicesforSTI/HIV/AIDS
evaluationresources.
User will have access to311
HIV/AIDSonline courses.
1.2.4.1.2 HIV/STIPublicHealthSTI/HIV
Online Access.
User will have accesstoCDPH
STI/HIV webpage.
References
 Chicago Department of Public Health. HIV /STI Surveillance Report, 2013. Chicago, IL:
City of Chicago; December 2013. Retrieved from:
http://www.cityofchicago.org/content/dam/city/depts/cdph/infectious_disease/STI_HI
V_AIDS/HIV_STISurveillanceReport2013.pdf

14.  Pew Research Center (2013) Smartphone Ownership – 2013 Update. Retrieved from:
http://pewinternet.org/Reports/2013/Smartphone-Ownership-2013.aspx
 Fox, S., Duggan, M. (2012) Mobile Health 2012. Pew Research Internet Project.
Retrieved from: http://www.pewinternet.org/2012/11/08/mobile-health-2012/
 Hightow-Weidman LB, Fowler B, Kibe J, et al. HealthMpowerment.org: development of a
theory-based HIV/STI website for young black MSM. AIDS Educ Prev. 2011; 23(1):1–12.
doi:10.1521/aeap.2011.23.1.1
 Health Organization’s Global Health Sector Strategy on HIV/AIDS 2011-2015: Retrieved
from: http://www.who.int/hiv/pub/hiv_strategy/en/
 Guilamo-Ramos, V., Lee, J. J., Kantor, L. M., (2014) Potential for Using Online and Mobile
Education with Parents and Adolescents to Impact Sexual and Reproductive Health.
Prevention Science, DOI 10.1007/s11121-014-0469-z. Retrieved from;
http://link.springer.com.proxy.cc.uic.edu/article/10.1007%2Fs11121-014-0469-z#
 Holloway, I., Rice, E., et al. (2013) Acceptability of Smartphone Application-Based HIV
Prevention Among Young Men Who Have Sex With Men. AIDS Behav (2014) 18:285–
296, DOI 10.1007/s10461-013-0671-1
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Med Internet Res 2013;15(1):e1, URL: http://www.jmir.org/2013/1/e1/,doi:
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 Muessig KE, Pike EC, Fowler B, et al. Putting prevention in their pockets: developing
mobile phone-based HIV interventions for black men who have sex with men. AIDS
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15.  Hightow-Weidman LB, Fowler B, Kibe J, et al. HealthMpowerment.org: development of a
theory-based HIV/STI website for young black MSM. AIDS Educ Prev. 2011; 23(1):1–12.
doi:10.1521/aeap.2011.23.1.1
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Prevention Science, DOI 10.1007/s11121-014-0469-z. Retrieved from;
http://link.springer.com.proxy.cc.uic.edu/article/10.1007%2Fs11121-014-0469-z#
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