Skip to main content

Advertisement

SpringerLink
Log in

Exploring Potential Implementation Barriers and Facilitators of the SMART Program: A Stepped-Care Package of eHealth HIV Prevention Interventions for Adolescent Men Who Have Sex with Men

  • Published:
Sexuality Research and Social Policy Aims and scope Submit manuscript

Abstract

Little is known about how to best implement eHealth HIV interventions for adolescent men who have sex with men (AMSM) in real-world settings. In response, our current study describes formative implementation research with community-based organizations (CBOs) in preparation for future implementation of the SMART Program, a stepped-care package of three interventions adapted for AMSM. In-depth interviews focusing on eHealth implementation were conducted with a convenience sample of 12 stakeholders from nine CBOs that actively implemented sexual minority-focused HIV/AIDS prevention programs. Qualitative analysis was conducted using Dedoose to identify salient themes. Most programs implemented at the CBOs engaged adult MSM for HIV prevention, but CBOs reported less experience with outreach of AMSM for HIV prevention. While comfortable with and skilled at implementing traditional in-person HIV prevention programs, interviewees reported that eHealth programs fell outside of their organizations’ technical capacities. They suggested specific strategies to facilitate successful implementation of SMART and other eHealth programs, including technical-capacity-building at CBOs, better training of staff, and partnering with a national coordinating center that provides support for the technology. Overall, the CBOs reported enthusiasm for the SMART Program and thought it was an efficient way to bridge their current gaps in online programming and lack of AMSM HIV prevention strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Bailey, J., Mann, S., Wayal, S., Hunter, R., Free, C., Abraham, C., & Murray, E. (2015). Sexual health promotion for young people delivered via digital media: A scoping review. Public Health Research, 3(13), 1–120. https://doi.org/10.3310/phr03130.

    Article  Google Scholar 

  • Balaji, A. B., An, Q., Smith, J. C., Newcomb, M. E., Mustanski, B., Prachand, N. G., … National HIV Behavioral Surveillance for Young Men Who Have Sex with Men Study Group. (2018). High human immunodeficiency virus incidence and prevalence and associated factors among adolescent sexual minority males—3 cities, 2015. Clinical Infectious Disease, 66(6), 936–944. doi:https://doi.org/10.1093/cid/cix902.

  • Bennett, G. G., & Glasgow, R. E. (2009). The delivery of public health interventions via the Internet: Actualizing their potential. Annual Review of Public Health, 30, 273–292. https://doi.org/10.1146/annurev.publhealth.031308.100235.

    Article  PubMed  Google Scholar 

  • Brener, N. D., Demissie, Z., McManus, T., Shanklin, S. L., Queen, B., & Kann, L. (2017). School health profiles 2016: Characteristics of health programs among secondary schools. Retrieved from Atlanta, GA: https://www.cdc.gov/healthyyouth/data/profiles/pdf/2016/2016_Profiles_Report.pdf. Accesses 9 May 2019

  • Brown, C. H., Mohr, D. C., Gallo, C. G., Mader, C., Palinkas, L., Wingood, G., et al. (2013). A computational future for preventing HIV in minority communities: How advanced technology can improve implementation of effective programs. Journal of Acquired Immune Deficiency Syndromes, 63(1), S72–S84.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention. (2012). Vital signs: HIV infection, testing, and risk behaviors among youths—United States. Morbidity and Mortality Weekly Report, 61(47), 971–976.

    Google Scholar 

  • Centers for Disease Control and Prevention. (2015a). Results from the school health policies and practices study, 2014. Retrieved from Atlanta, GA: https://www.cdc.gov/healthyyouth/data/shpps/pdf/shpps-508-final_101315.pdf. Accesses 9 May 2019

  • Centers for Disease Control and Prevention. (2015b). Supported activities: Prioritizing high impact HIV prevention. Retrieved from https://www.cdc.gov/hiv/programresources/healthdepartments/supportedactivities.html. Accesses 9 May 2019

  • Centers for Disease Control and Prevention. (2017a). Compendium of evidence-based interventions and best practices for HIV prevention. Retrieved from https://www.cdc.gov/hiv/research/interventionresearch/compendium/index.html. Accesses 9 May 2019

  • Centers for Disease Control and Prevention. (2017b). Diagnoses of HIV infection in the United States and dependent areas, 2016. Retrieved from http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Accesses 9 May 2019

  • Centers for Disease Control and Prevention. (2018). Effective interventions. Retrieved from https://effectiveinterventions.cdc.gov/2018-design/. Accesses 9 May 2019

  • Chillag, K., Bartholow, K., Cordeiro, J., Swanson, S., Patterson, J., Stebbins, S., et al. (2002). Factors affecting the delivery of HIV/AIDS prevention programs by community-based organizations. AIDS Education and Prevention, 14(3 Suppl A), 27–37.

    Article  Google Scholar 

  • Curran, G. M., Bauer, M., Mittman, B., Pyne, J. M., & Stetler, C. (2012). Effectiveness-implementation hybrid designs: Combining elements of clinical effectiveness and implementation research to enhance public health impact. Medical Care, 50(3), 217–226. https://doi.org/10.1097/MLR.0b013e3182408812.

    Article  PubMed  PubMed Central  Google Scholar 

  • Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4, 50. https://doi.org/10.1186/1748-5908-4-50.

    Article  PubMed  Google Scholar 

  • Dedoose. (2015). Web application for managing, analyzing, and presenting qualitative and mixed method data. Los Angeles, CA: SocioCultural Research Consultants, LLC Retrieved from https://www.dedoose.com/. Accesses 9 May 2019

  • Elbert, N. J., van Os-Medendorp, H., van Renselaar, W., Ekeland, A. G., Hakkaart-van Roijen, L., Raat, H., Nijsten, T. E. C., & Pasmans, S. G. (2014). Effectiveness and cost-effectiveness of eHealth interventions in somatic diseases: A systematic review of systematic reviews and meta-analyses. Journal of Medical Internet Research, 16(4), e110. https://doi.org/10.2196/jmir.2790.

    Article  PubMed  PubMed Central  Google Scholar 

  • Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322–1327.

    Article  Google Scholar 

  • Glasgow, R. E., McKay, H. G., Piette, J. D., & Reynolds, K. D. (2001). The RE-AIM framework for evaluating interventions: What can it tell us about approaches to chronic illness management? Patient Education and Counseling, 44(2), 119–127.

    Article  Google Scholar 

  • Glasgow, R. E., Eckstein, E. T., & ElZarrad, M. K. (2013). Implementation science perspectives and opportunities for HIV/AIDS research: Integrating science, practice, and policy. Journal of Acquired Immune Deficiency Syndromes, 63, S26–S31.

    Article  Google Scholar 

  • Glasgow, R. E., Phillips, S. M., & Sanchez, M. A. (2014). Implementation science approaches for integrating eHealth research into practice and policy. International Journal of Medical Informatics, 83(7), e1–e11. https://doi.org/10.1016/j.ijmedinf.2013.07.002.

  • Greenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., Hughes, G., A'Court, C., Hinder, S., Fahy, N., Procter, R., & Shaw, S. (2017). Beyond adoption: A new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. Journal of Medical Internet Research, 19(11), e367. https://doi.org/10.2196/jmir.8775.

    Article  PubMed  PubMed Central  Google Scholar 

  • Guse, K., Levine, D., Martins, S., Lira, A., Gaarde, J., Westmorland, W., & Gilliam, M. (2012). Interventions using new digital media to improve adolescent sexual health: A systematic review. Journal of Adolescent Health, 51(6), 535–543. https://doi.org/10.1016/j.jadohealth.2012.03.014.

    Article  PubMed  Google Scholar 

  • Kegeles, S. M., Hays, R. B., & Coates, T. J. (1996). The Mpowerment Project: A community-level HIV prevention intervention for young gay men. American Journal of Public Health, 86(8), 1129–1136.

    Article  Google Scholar 

  • Kegeles, S. M., Hays, R. B., Pollack, L. M., & Coates, T. J. (1999). Mobilizing young gay and bisexual men for HIV prevention: A two-community study. Aids, 13(13), 1753–1762.

    Article  Google Scholar 

  • Kelly, J. A., Heckman, T. G., Stevenson, L. Y., Williams, P. N., Ertl, T., Hays, R. B., … Neumann, M. S. (2000). Transfer of research-based HIV prevention interventions to community service providers: Fidelity and adaptation. AIDS Education and Prevention, 12(5 Suppl), 87–98.

  • Lelutiu-Weinberger, C., Pachankis, J. E., Gamarel, K. E., Surace, A., Golub, S. A., & Parsons, J. T. (2015). Feasibility, acceptability, and preliminary efficacy of a live-chat social media intervention to reduce HIV risk among young men who have sex with men. AIDS and Behavior, 19(7), 1214–1227. https://doi.org/10.1007/s10461-014-0911-z.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lenhart, A. (2015). Teen, social media and technology overview 2015. Retrieved from http://www.pewinternet.org/files/2015/04/PI_TeensandTech_Update2015_0409151.pdf. Accesses 9 May 2019

  • McKleroy, V. S., Galbraith, J. S., Cummings, B., Jones, P., Harshbarger, C., Collins, C., … Team, A. (2006). Adapting evidence-based behavioral interventions for new settings and target populations. AIDS Education and Prevention, 18(4 Suppl A), 59-73.

  • Muessig, K. E., Nekkanti, M., Bauermeister, J., Bull, S., & Hightow-Weidman, L. B. (2015). A systematic review of recent smartphone, Internet and Web 2.0 interventions to address the HIV continuum of care. Current HIV/AIDS Reports, 12(1), 173–190. https://doi.org/10.1007/s11904-014-0239-3.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mustanski, B., Greene, G. J., Ryan, D., & Whitton, S. W. (2015). Feasibility, acceptability, and initial efficacy of an online sexual health promotion program for LGBT youth: The Queer Sex Ed intervention. Journal of Sex Research, 52(2), 220–230. https://doi.org/10.1080/00224499.2013.867924.

    Article  PubMed  Google Scholar 

  • Mustanski, B., Parsons, J. T., Sullivan, P. S., Madkins, K., Rosenberg, E., & Swann, G. (2018). Biomedical and behavioral outcomes of Keep It Up!: An eHealth HIV prevention program RCT. American Journal of Preventive Medicine, 55(2), 151–158. https://doi.org/10.1016/j.amepre.2018.04.026.

    Article  PubMed  PubMed Central  Google Scholar 

  • Noar, S. M. (2011). Computer technology-based interventions in HIV prevention: State of the evidence and future directions for research. AIDS Care, 23(5), 525–533. https://doi.org/10.1080/09540121.2010.516349.

    Article  PubMed  PubMed Central  Google Scholar 

  • Noar, S. M., & Willoughby, J. F. (2012). eHealth interventions for HIV prevention. AIDS Care, 24(8), 945–952. https://doi.org/10.1080/09540121.2012.668167.

    Article  PubMed  PubMed Central  Google Scholar 

  • Parsons, J. T., Lelutiu-Weinberger, C., Botsko, M., & Golub, S. A. (2014). A randomized controlled trial utilizing motivational interviewing to reduce HIV risk and drug use in young gay and bisexual men. Journal of Consulting and Clinical Psychology, 82(1), 9–18. https://doi.org/10.1037/a0035311.

    Article  PubMed  Google Scholar 

  • Rebchook, G. M., Kegeles, S. M., Huebner, D., & Team, T. R. (2006). Translating research into practice: The dissemination and initial implementation of an evidence-based HIV prevention program. AIDS Education and Prevention, 18(4 Suppl A), 119–136. https://doi.org/10.1521/aeap.2006.18.supp.119.

    Article  PubMed  Google Scholar 

  • Robert, G., Greenhalgh, T., MacFarlane, F., & Peacock, R. (2010). Adopting and assimilating new non-pharmaceutical technologies into health care: A systematic review. Journal of Health Services Research & Policy, 15(4), 243–250. https://doi.org/10.1258/jhsrp.2010.009137.

    Article  Google Scholar 

  • Shelley, G., Williams, W., Uhl, G., Hoyte, T., Eke, A., Wright, C., Rebchook, G., Pollack, L., Bell, K., Wang, Y., Cheng, Q., & Kegeles, S. M. (2017). An evaluation of Mpowerment on individual-level HIV risk behavior, testing, and psychosocial factors among young MSM of color: The Monitoring and Evaluation of MP (MEM) Project. AIDS Education and Prevention, 29(1), 24–37. https://doi.org/10.1521/aeap.2017.29.1.24.

    Article  PubMed  Google Scholar 

  • Slater, H., Briggs, A., Stinson, J., & Campbell, J. M. (2017). End user and implementer experiences of mHealth technologies for noncommunicable chronic disease management in young adults: A qualitative systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, 15(8), 2047–2054. https://doi.org/10.11124/JBISRIR-2016-003299.

    Article  PubMed  Google Scholar 

  • Strecher, V. (2007). Internet methods for delivering behavioral and health-related interventions (eHealth). Annual Review of Clinical Psychology, 3, 53–76. https://doi.org/10.1146/annurev.clinpsy.3.022806.091428.

    Article  PubMed  Google Scholar 

  • Valdiserri, R. O., West, G. R., Moore, M., Darrow, W. W., & Hinman, A. R. (1992). Structuring HIV prevention service delivery systems on the basis of social science theory. Journal of Community Health, 17(5), 259–269.

    Article  Google Scholar 

  • White House Office of National AIDS Policy. (2015). National HIV/AIDS strategy for the United States: Updated to 2020. Retrieved from https://aids.gov/federal-resources/national-hiv-aids-strategy/nhas-update.pdf. Accesses 9 May 2019

Download references

Funding

This research was supported by a grant from the National Institute on Minority Health and Health Disparities (U01MD011281; PI: B. Mustanski). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Minority Health and Health Disparities. Finally, we would like to thank the CBO staff and community partners that participated in this study for their time.

Author information

Authors and Affiliations

  1. Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Ana Ventuneac

  2. Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, 60611, Illinois, United States

    Dennis H. Li, Melissa C. Mongrella, David A. Moskowitz & Brian Mustanski

  3. Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA

    Dennis H. Li, Melissa C. Mongrella, David A. Moskowitz & Brian Mustanski

  4. Pear Therapeutics, San Francisco, CA, USA

    Kenneth R. Weingardt

  5. Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    C. Hendricks Brown

  6. Center for Prevention Implementation Methodology for Drug Abuse and HIV, Northwestern University, Chicago, IL, USA

    C. Hendricks Brown & Brian Mustanski

  7. Department of Psychology, Hunter College and the Graduate Center of the City University of New York (CUNY), New York, NY, USA

    Jeffrey T. Parsons

Authors
  1. Ana Ventuneac
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dennis H. Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Melissa C. Mongrella
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David A. Moskowitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kenneth R. Weingardt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Hendricks Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jeffrey T. Parsons
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Brian Mustanski
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brian Mustanski.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

This study was granted a waiver of parental consent and waiver of written consent by the institutional review board at Northwestern University. CCB members were given a copy of the CCB consent form and verbally consented to the interview.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ventuneac, A., Li, D.H., Mongrella, M.C. et al. Exploring Potential Implementation Barriers and Facilitators of the SMART Program: A Stepped-Care Package of eHealth HIV Prevention Interventions for Adolescent Men Who Have Sex with Men. Sex Res Soc Policy 17, 378–388 (2020). https://doi.org/10.1007/s13178-019-00402-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13178-019-00402-3

Keywords

Search

Navigation