JMIR Publications

ABSTRACT

Background:

Black adolescents and young adults (AYA) in Alabama are disproportionately impacted by HIV because of multifaceted levels of stigma, limited access to sexual health education and services, and lack of adequate support from trusted adults and peers. Although HIV pre-exposure prophylaxis (PrEP) coupled with accurate sexual health information has the potential to reduce new HIV diagnoses, PrEP uptake and adherence are low. Mobile health (mHealth) applications have been identified as a strategy able to improve sexual health behaviors and HIV prevention among AYA.

Objective:

This study explores Alabama Black AYA mHealth preferences for an app focused on improving sexual health and HIV prevention.

Methods:

This qualitative study is grounded in Social Cognitive Theory (SCT) and the Integrated Behavioral Model, with in-depth interviews (IDIs) focused on identifying a support person, communication via an app, and sociodemographic and geographical data. AYA aged 14 to 21 years old were recruited in-person and remotely from schools, clinics, and community organizations throughout Alabama. IDIs were analyzed using rapid qualitative analysis with Excel spreadsheets with deductive coding.

Results:

Twenty-six participants recruited between October 2022 through June 2023 completed IDIs. Mean age was 18 years (range 14-21 years), with 65% identifying as a woman, 23% resided in rural communities, and 38% identified as LGBTQ+. Themes mapped back to SCT included: 1) mHealth as a Mechanism for Trusted, Bidirectional Communication (behavioral factors), 2) Youth-Driven Preferences for Health Information Packaging (cognitive factors), and 3) Privacy, Security, and Confidentiality are Important in Youth mHealth Use (behavioral factors).

Conclusions:

Alabama Black AYA prefer mHealth apps focused on holistic health behaviors that are also interactive, connect AYA to multifaceted health information and are safe. Development and implementation of apps with these types of features may be needed in communities with less access to unbiased sexual health information and health services.