Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Oct 16, 2020
Date Accepted: Jul 5, 2021
Harnessing narrative persuasion to develop an internet-based behavioral intervention for HIV prevention among Chinese men who have sex with men (HeHe Talks Project): Development study
ABSTRACT
Background:
In the era of potent antiretroviral therapy, the high level of condomless anal intercourse (CAI) continues to drive the increase in HIV incidence in recent years among men who have sex with men (MSM). Narrative persuasion is a novel health communication approach that features the persuasive advantages in overcoming resistance to counter-attitudinal messages. Efficacy of narrative persuasion in promoting health behavior changes has been well documented but critical research gaps exist for its application to HIV prevention.
Objective:
This study aimed to capitalize on narrative persuasion to design an internet-based multi-session intervention for reducing CAI among MSM in Hong Kong (the HeHe Talks Project) following a systematic development process.
Methods:
First, persuasive themes and subtopics related to reduction in CAI were initially proposed based on epidemiological evidence. Second, the biographic narrative interview method was used to elicit firsthand experiential stories from a maximum variation sample of local MSM with diverse backgrounds and experiences related to HIV prevention; different types of role modeling were established accordingly. Third, framework analysis was used to aggregate the original quotes from narrators into collective narratives under six intervention themes. A dedicated website was finally developed for intervention delivery.
Results:
A series of video-based intervention messages in a format of biographic narratives (firsthand experiential stories shared by MSM peers) combined with topic-equivalent argumentation messages were produced, and further programmed into six online intervention sessions. The feasibility and acceptability of the narrative intervention program were well demonstrated in a trial among 174 Hong Kong MSM.
Conclusions:
This study provides the systematic process of translating peer-generated stories into an internet-based HIV prevention intervention. Strategies used to enhance the efficacy of the narrative intervention have been discussed within basic communication components. The study has its practical implications in informing the rigorous development of narrative communication interventions for HIV prevention. Clinical Trial: ISRCTN14109784
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