Design Considerations for Implementing eHealth Behavioral Interventions for HIV Prevention in Evolving Sociotechnical Landscapes

Dennis H. Li*, C. Hendricks Brown, Carlos Gallo, Ethan Morgan, Patrick S. Sullivan, Sean D. Young, Brian Mustanski

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

28 Scopus citations

Abstract

Purpose of review: Despite tremendous potential for public health impact and continued investments in development and evaluation, it is rare for eHealth behavioral interventions to be implemented broadly in practice. Intervention developers may not be planning for implementation when designing technology-enabled interventions, thus creating greater challenges for real-world deployment following a research trial. To facilitate faster translation to practice, we aimed to provide researchers and developers with an implementation-focused approach and set of design considerations as they develop new eHealth programs. Recent findings: Using the Accelerated Creation-to-Sustainment model as a lens, we examined challenges and successes experienced during the development and evaluation of four diverse eHealth HIV prevention programs for young men who have sex with men: Keep It Up!, Harnessing Online Peer Education, Guy2Guy, and HealthMindr. HIV is useful for studying eHealth implementation because of the substantial proliferation of diverse eHealth interventions with strong evidence of reach and efficacy and the responsiveness to rapid and radical disruptions in the field. Rather than locked-down products to be disseminated, eHealth interventions are complex sociotechnical systems that require continual optimization, vigilance to monitor and troubleshoot technological issues, and decision rules to refresh content and functionality while maintaining fidelity to core intervention principles. Platform choice and sociotechnical relationships (among end users, implementers, and the technology) heavily influence implementation needs and challenges. We present a checklist of critical implementation questions to address during intervention development. Summary: In the absence of a clear path forward for eHealth implementation, deliberate design of an eHealth intervention’s service and technological components in tandem with their implementation plans is critical to mitigating barriers to widespread use. The design considerations presented can be used by developers, evaluators, reviewers, and funders to prioritize the pragmatic scalability of eHealth interventions in research.

Original languageEnglish (US)
Pages (from-to)335-348
Number of pages14
JournalCurrent HIV/AIDS Reports
Volume16
Issue number4
DOIs
StatePublished - Aug 15 2019

Funding

This manuscript was a product of a workgroup on eHealth interventions formed through the Center for Prevention Implementation Methodology for Drug Abuse and HIV (Ce-PIM), which is supported by the National Institute on Drug Abuse (P30DA027828, Brown & Mustanski). This work was also supported by the Keep It Up! 3.0 grant from the National Institute of Mental Health, National Institute on Drug Abuse, Office of Behavioral and Social Sciences Research, and Office of Disease Prevention at the National Institutes of Health (R01MH118213, Mustanski), as well as an individual postdoctoral fellowship grant from the National Institute on Drug Abuse (F32DA046313, Morgan). The sponsors had no involvement in the conduct of the research or the preparation of the manuscript. The content is the sole responsibility of the authors and does not necessarily represent the official views of the funders. This study is funded by the National Institutes of Health and other sponsors. Development, evaluation, and implementation of Keep It Up! was previously sponsored by the National Institute of Mental Health (R34MH079714, Mustanski), National Institute on Drug Abuse (R01DA035145, Mustanski), Chicago Department of Public Health, and ViiV Healthcare. Harnessing Online Peer Education was previously sponsored by the National Institute of Mental Health (K01MH090884, Young) and UCLA Center for AIDS Research (P30AI028697, Zack), with ongoing sponsorship from the former (R01MH106415, Young). Guy2Guy was previously sponsored by the National Institute of Mental Health (R01MH096660, Mustanski & Ybarra), with ongoing work supported by the Third Coast Center for AIDS Research (P30AI117943, D’Aquila) and the American Foundation for Suicide Prevention (SRG-0-110-15, Pisani). HealthMindr was previously sponsored by the MAC AIDS Fund, Emory Center for AIDS Research (P30AI050409, Del Rio), and National Institute on Drug Abuse (R01DA045612, Sullivan).

Keywords

  • HIV
  • Implementation
  • Intervention development
  • Scalability
  • Sustainability
  • Young men who have sex with men
  • eHealth
  • mHealth

ASJC Scopus subject areas

  • Virology
  • Infectious Diseases

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