Design Considerations for Implementing eHealth Behavioral Interventions for HIV Prevention in Evolving Sociotechnical Landscapes
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.
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.
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.
KeywordseHealth mHealth Implementation Intervention development Scalability Sustainability HIV Young men who have sex with men
(adolescent/young) men who have sex with men
Accelerated Creation-to-Sustainment (model)
Community Popular Opinion Leader (model)
human immunodeficiency virus
Harnessing Online Peer Education
Information–Motivation–Behavioral Skills (model)
Keep It Up!
randomized controlled trial
sexually transmitted infection
We thank all of our Ce-PIM colleagues and community advisors for their contributions.
Availability of Data and Material
Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.
DL led the analysis and writing of the manuscript. BM, SY, CG, and PS provided details about the four interventions and initial drafts of those sections. CHB provided guidance on implementation science. BM provided guidance on eHealth. EM provided review and feedback. All authors contributed significantly to conceptually framing the manuscript and its conclusions, and all authors read and approved the final manuscript.
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).
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.
Compliance with Ethical Standards
Conflict of Interest
Dr. Sullivan reports grants and personal fees from NIH, grants and personal fees from CDC, grants and personal fees from Gilead Sciences outside the submitted work.
Dr. Li reports grants from National Institutes of Health, during the conduct of the study.
Dr. Brown reports grants from National Institute on Drug Abuse/NIH, during the conduct of the study.
Dr. Mustanski reports grants from National Institutes of Health, during the conduct of the study.
Dr. Morgan reports grants from National Institutes of Health, during the conduct of the study.
Dr. Gallo has nothing to disclose.
Dr. Young has nothing to disclose.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
The authors declare that they have no competing interests.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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