Apha 2013 Gonzalez_Public
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Are texting and social networking site's instant messaging appropriate sexual health education tools for urban young women of color? A mixed-methods study Link: https://apha.confex.com/apha/141am/webprogram/Paper287981.html
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Apha 2013 Gonzalez_Public
- 1. Sonia K. González, MPH, Doctoral Student Graduate Center, City University of New York Wednesday, November 6, 2013 APHA, #287981
- 2. Special thanks to the National Institutes of Mental Health for their support. • Research in HIV Intervention: Skills for Underserved Communities and Families (R25 MH083602) • Piloting a Mobile App for HIV Risk Reduction among Young Latinas & Black Females (1F31MH099924-01) 2
- 3. Citation: Hillebrand F, editor. Short Message Service (SMS): The Creation of Personal Global Text Messaging. Chippenham, Wiltshire: Wiley; 2010. Madden M, Lenhart A, Duggan M, Cortesi S, Gasser U. Teens and Technology 2013. Pew Research Center's Internet & American Life Project. 2013; Available at: http://pewinternet.org/Reports/2013/Teens-and-Tech.aspx) 3
- 4. Asking Shared Sexual Reproductive Health (SRH) / HIV Information 4
- 5. 5
- 6. All Young Women Red Hook, Brooklyn connection Mean Age 18 (16-22 year olds) 76% attending school 100% English Speakers 71% were in some sort of romantic relationship 6
- 7. Surveys (n=20) Sources of Information HIV/AIDS Worry Scale HIV/AIDS Knowledge Focus Groups (n=20) Peer Health Educator (PHEs, n=10) Peers Contacted by PHEs (PCs, n=8) Non-PHE/PC Community Member (n=12) 7
- 8. 90% 80% 70% 40% 30% In person Info from personal Info from an Info from media Via electronic authority communication 8
- 9. 92.31% 84.62% 76.92% 69.23% 69.23% 53.85% Friend School classes dult I live with A Doctor, Nurse, Counselor, Teacher Other adults Partner9
- 10. “Because they know that every time they know that we used to do girls group and that we’re peer health educators and stuff, so they ask us for advice instead of going to their mothers….” ~Peer Health Educator “..my doctor gave me a website called ashastd.org or .com, I’m not sure, but most of the time I just Google everything.” ~Peer Contacted by PHE “I go to Google before I even go to a human person. Google is my best friend.” ~Community Member 10
- 11. Frances: That’s why it’s always better to do it in person. If you do it in person you know who you’re around and you’ll know what you’re saying around certain people. Maria: So if it does get out, you know who leaked it. Angie: Like these are the only ones I was talking to so it had to be one of these people going and saying it. But if you’re texting somebody you don’t know who’s on the other side of that phone. August 18,2011 11
- 12. … I had someone I went to high school with and…he was trying to get the word out “everyone get tested” he said, ‘because I actually found out that I was HIV positive’ and I thought that was so big of him. I think it’s [Facebook] still used for good, but it’s the people that abuse it. ~CeCe, December 10, 2011 “Facebook is another world, people be hacking into your stuff and all kinds of crazy things.” ~ Peer Health Educator
- 13. Variance in what was considered a trusted source for SRH Information Acknowledge that trust and privacy are important issues for young people Reminder: HIV & SRH strategies are NOT one-size-fits all; must include target population input early in design 13
- 15. 15
- 16. "I also believe this would be a very useful app…I just have to say you found the real need and I think the app would be really great because young women, especially those of color, they don't have the support services they need, so this is just one thing in the big circle of things that they need, but it 'll be really helpful for them to have - just women on a whole. I like it, and if this is just a pilot, I hope it goes to older women, and younger women, and just goes out there.” ~Paige 16
- 17. It Depends 17
- 18. Vivian Cortés & Liza Fuentes, research collaborators. Drs. Beatrice Krauss, Lynn Roberts, Denis Nash, Christina Zarcadoolas, Jessie Daniels, & Betty Wolder Levin- my mentors who provide on-going guidance. Committee The Red Hook Initiative & broader Red Hook community for supporting formative research. I am in your debt for lessons about the human spirit in the aftermath of Hurricane Sandy. 18
- 19. 19
Hinweis der Redaktion
- Good morning. I’m Sonia K. Gonzalez.Thank you for being here. This presentation includes findings from one pilot study conducted in a geographically separated area in Brooklyn, NY and how those findings helped contribute to a current study underway. We’ll have a chance to present some preliminary findings from that study.To give you some context on my approach, I want to share that prior to becoming a researcher, I have about 15 years of HIV prevention community experience5 of which were in NYC with young people of color.----------------------------Are texting and social networking site's instant messaging appropriate sexual health education tools for urban young women of color? A mixed-methods studyLink: https://apha.confex.com/apha/141am/webprogram/Paper287981.html10:30-10:50amBackground: Research shows that youth are tethered to their mobile devices to remain connected to social networks. As such, assumptions are being made by providers and researchers that texting via mobile phones and social networking sites (SNS) are a viable way to reach vulnerable young people of color. This study sought to understand how information about sexual and reproductive health (SRH) is obtained and shared (e.g., texting, SNS, in person) among young women of color who are participants of a peer education program and their networks.Methods: Four focus groups (n=29) were conducted with Black and Latina women (ages 16-22) in Red Hook, Brooklyn and surveys were collected from 22 of the participants. Through an iterative process of reading transcripts and discussing differences thematic domains were developed. Due to a small sample size, quantitative analysis included descriptive statistics and comparison between the peer health educators and others using SAS 9.3.Results: Focus group domains, triangulated with survey findings, explored how young women of color from an isolated neighborhood used texting, internet searches, and SNS instant messaging to seek and share SRH information. Findings from this study suggest that urban young women of color are wary of these modes of communication to obtain and share personal information about SRH.Conclusions: Integrating texting via phones and SNS as a means to disseminate SRH information should be co-designed with communities of interest. This presentation will also discuss how these findings inform the development of future mobile research with young women of color.Learning Areas:Program planningSocial and behavioral sciencesLearning Objectives: Compare the similarities between geographically isolated rural populations and urban populations that are socially isolated. Describe how urban young women of color are wary of using mobile devices and new technology to obtain and share information about sexual health. Discuss how this finding informs future research using a smartphone app that is being designed with young women of color between 18 and 25 years old in an urban area.Keywords: Adolescent Health, Technology
- Special thanks to NIMH for their support of the two studies I’m presenting on today.I have no other relationships to disclose.
- We know that young people are early adopters of new digital technology and that they are connected:Cell phone ownership for young people is nearly ubiquitous with 96% of 18 to 29 year olds owning a mobile phone and nearly 70% of 18 to 24 years olds owning a smart phone._______________________In 2010,96% of 18-29 year olds and 75% of teens owned a mobile phone, by 2013, this rose to nearly 80% (78%).88% of whom text73% of wired American teens use social networking websites (Pew Internet & American Life Project, 2010)(CITE:Hillebrand F, editor. Short Message Service (SMS): The Creation of Personal Global Text Messaging. Chippenham, Wiltshire: Wiley; 2010. Madden M, Lenhart A, Duggan M, Cortesi S, Gasser U. Teens and Technology 2013. Pew Research Center's Internet & American Life Project. 2013; Available at: http://pewinternet.org/Reports/2013/Teens-and-Tech.aspx. Accessed 9/23/2013, 2013.)In, 2012, 67% of 18 to 24 year olds and 71% of 25 to 34 year olds owned a smartphone. 48 (Pew) Both Blacks and English-speaking Latinos are as likely as Whites to own any sort of mobile phone, and are more likely to use their phones for a wider range of activities such as accessing the Internet. 50,51 In addition, those earning less than $30,000 annually increased in smartphone ownership by 12% since 2011; the greatest increase was among 18 to 29 year olds in the same income bracket (58%). 48“Media Multitasking”8-18 year olds spend a total of 10 hours and 45 minutes worth of media content in a typical day (more than 53 hours a week) (Kaiser Family Foundation, 2010 )
- [Animated slide.]The goal of the first pilot study was to better understand how HIV & SRH information [click here] was being shared between and among young people of color in Red Hook, Brooklyn – a geographically isolated area._______________________RQ:What HIV and other SRH information is shared and how is this information being communicated (e.g., texting, social networking sites, chatting, etc.) by young people of color in a geographically defined area?
- This image gives you a sense of what I mean when I say “geographically isolated”.Red Hook is surrounded by water on three sides and separated from Brooklyn by an expressway.There is a concentration of public housing. TheRed Hook Houses are NewYork State’s second largest public housing complex. 75% of RH residents live in public housing. The projected population of the houses is 10,000 people. According to a NYCHA report issued in January 2011 over 50% of residents are living below the poverty level (32% of households make less than $10,000 per year and 60% make less than $20,000 per year). ______________Red Hook, Brooklyn is home to the New York City Housing Authority (NYCHA) Red Hook Houses, NewYork State’s second largest public housing complex. 75% of residents living in NYCHA housing.While official records show over 6,200 residents of the Red Hook Houses, anyone living in the neighborhood knows that the majority of households have one or more people living there who are not listed on the lease. The projected population of the houses is closer to 10,000 – 12,000 people. According to a NYCHA report issued in January 2011 over 50% of residents are living below the poverty level (32% of households make less than $10,000 per year and 60% make less than $20,000 per year).
- Here are some characteristics of the study sample.All participants were young women and self-identified as either Black and/or Latina which was consistent with the make-up of the neighborhood.All lived in Red Hook or had a strong Red Hook connection meaning that they spent all of their weekends in the neighborhood and visited family and friends at least 3 weekends out of a month for the last year.Nearly all were in school.All spoke English.Nearly ¾ of participants were in some sort of romantic relationship in the last year. Interestingly, about 9% self-identified as “dating several people”._______________________ - Dating several people (9%) - Being in a committed relationship (35%) - Dating a single person (27%) - Or not being in a relationship (27%)No women in the pilot had children.
- [click now] This was a mixed methods study. [click now] 3 survey instruments were used.[click now] & focus groups were conducted with 3 groups to assess where and from whom young people were getting sexual health information.A limitation of this study is that it was a convenience sample._____________
- We were surprised by the responses to the Sources of Information Questionnaire (first 3 questions) when we analyzed the data for all participants.Most participants said they got their sexual and reproductive health information in person, and only 30% identified “electronic communication” ________________________These categories are not mutually exclusive. if they checked that they got info from that source it was counted multiple choices were possible. the usefulness rating they gave each was not included in anyway, just of they indicated getting in for from said source
- When we examined who these young women were speaking with to obtain their sexual and reproductive health information, we found that they sought this type of information from a variety of in-person sources. Here you can see, almost all reported friends and school classes. But adults in the home (including care-givers), clinical providers, and other adults were also identified. and partners were least reported, but still over ½ of our sample mentioned them._____________________SIMILAR TO White paper put out by ISIS, Inc. now known as Youth, Tech & Health.People get information about HIV/AIDS from different places. Some of these places are listed below. 1) First, please put a check mark on the line next to the sources where you've gotten HIV/AIDS information. 2) Then, for only the sources you checked, circle how useful you thought the information you got was. Personal Resources________ boyfriend/girlfriend/partner/spouse 1 2 3________ friend(s) 1 2 3 ________ teacher(s) 1 2 3 ________ brother/sister 1 2 3 ________ adult I live with (mother/father/aunt/etc) 1 2 3 ________ other relatives I do not live with (cousins, aunt, uncle, godparents, grandparents) 1 2 3 _______________ (specify)________ other adults I do not live with (boss, friend of the family) 1 2 3 _______________ (specify)________ telephone information hotlines 1 2 3 ________ school classes 1 2 3 ________ school counselors 1 2 3 ________ doctors 1 2 3 ________ nurses 1 2 3 ________ coach 1 2 3
- Qualitative data analysis revealed that seeking sexual health information differed between the community members (CM), the peers educated by PHE PC and the Peer Health Educator groups. Peer Health Educators (PHEs) reported doctors or other medical providers, trusted adults, and organizations such as RHI, PP or the Door as trustworthy places to seek SRH information. In addition, PHEs also discussed how they are sought out by community members as resources and support for SRH information because they are PHEs. [click now]Young People Contacted by PHEs (PCs)reported limited access to or knowledge of the resources that the PHEs described. Google was discussed among this group as filling the need for confidential sexual health information. [click now]The Community Member (CM) focus group differed greatly from the other groups in that they did not describe awareness of knowledgeable individuals or organizations. Some Community Members mentioned that they have one or two friends that they trusted, or havinga close relationship with their mother and felt comfortable asking SRH related questions. Community Member participants discussed searching for information over the Internet as the best way to get accurate information that is also confidential. However, most Community Member participants said that outside of a visit to a healthcare provider, they utilized the Internet as the best way to get accurate information that is also confidential. [click now]
- [animated slide]Trust and worry about personal information becoming a rumor in the neighborhood were re-occurring themes among all 3 groups (PHEs, PCs, and Community Members). As a result, the young women took different approaches to the various technology and in-person forms of communication opportunities available to them. The following quotes highlight this concern. [click now.]
- [Animated slide]CeCe’s quote highlights how FB as being viewed to have positive impact under a specific circumstances.However, this is primarily for a community-wide health promotion effort, rather than at the individual-level. [click now & read quote.] Participants from all 3 groups discussed rumors about conspiratorial security concerns over Facebook, as well. [click now & read quote.]______________________________________________ Entire Quote:I personally feel that Facebook is still used for some good. .. I had someone I went to high school with and…he was trying to get the word out “everyone get tested” he said, ‘Because I actually found out that I was HIV positive’ and I thought that was so big of him. Someone that I knew in high school to come out and kind of spread the word to encourage other people because someone you know is affected by it. I think it’s still used for good, but it’s the people that abuse it. ~CeCe December 10, 2011“Facebook is another world, people be hacking into your stuff and all kinds of crazy things.” – participant in PHE focus group.“I’m not having an HIV conversation on Facebook.” – participant in PHE focus group
- What did we learn from conducting this pilot study in Red Hook, Brooklyn?It is critical to acknowledge that trust and privacy are issues of paramount importance for young people. The themes about worrying about who was on the receiving end of text messages, were an important reminder of ethical considerations researchers should be making when considering new digital technologies as platforms for interventions. We learned that digital technology for SRH should be tailored to the specific population that we are targeting and assumptions shouldn’t be made simply because young people are known to widely use mobile devices and new digital technology. We found some differences between peer educators, those educated by peer educators, and the broader community.And this reminded us of the importance of developing new digital technology and intervention approaches in conjunction with the communities we’re serving.
- We took these lessons from the RH pilot project to develop a 2-phase study currently under-way. In this study, I will be developing a sexual health education tool on a mobile platform that will also allow for connection to services by drawing from the geolocation function on smartphones specifically for young women of color in NYC between 18 and 25 years old.The first phase draws from formative research to inform a health education tool that will be available on smartphones.The second phase of the project will be a randomized trial to evaluate the sexual health education mobile tool.To respond to communities’ needs and ensure that this tech tool is being developed with and for young women of color, we have:Formed a community advisory committee & Conducted 4 focus groups with a total of 17 young women, 1 more FG is scheduled.App development: we have employed rapid prototyping protocol, which aims to get early and frequent feedback on an early beta version of the app. If there is a specific question about this, I can say more about this process.
- The CommunityAdvisory Committee is made up of 4 adult providers who have served the target population for at least 5 years and6 youngwomen who self-identify as Black (n=4) and/or Latina (n=2) and are between the ages of 18 and 25 years old. The adult providers have a total of 49 years experience working with youth between 13 and 25 years old, and …Combined,community advisory members have 54 years experience working in thesexual and reproductive health field.This group ensures on-goingcommunity input during all phases of research, and has already proven invaluable to assist with focus group recruitment & providinginput for the Randomized Trial phase of research.
- Early findings from the formative focus groups shows a need and interest in providing sexual health information through an app platform on a smartphone. [Click now]
- [animated slide]The title of this presentation posed this question. [click now]We believe that there is the potential for the use of a variety of new digital technology to address negative sexual health outcomes for young people in urban settings. But it is essential to meaningfully engage young people throughout the early developmental stages of product or tool development to appropriately match the technology abilities and interest of the population of interest.
- Finally, I want to thank the many people who have informed the development of these research projects.