HIV Prevention among Youth Experiencing Homelessness Reaction Paper

REACTION PAPER

Reaction Paper

Part 1

The research article selected for this paper was titled, ‘Acceptability of a Just-in-Time Adaptive Intervention for HIV Prevention among Youth Experiencing Homelessness: A Qualitative Analysis.’ In this particular article, Acorda, Jones, and Maria (2021) seek to assess both the impact and acceptableness of interventions that embrace technology in efforts to attenuate or reduce the risks of contracting HIV among youths experiencing homelessness (YEH). More specifically, the authors seek to evaluate “the acceptability and impacts of an app-based just-in-time adaptive intervention for HIV prevention from the YEH perspective.”

The model used in the development of the intervention was the Information-Motivation-Behavioral Skills (IMB) approach. The model has been used in diverse contexts in efforts to highlight or pinpoint behavioral change determinants. According to the authors of the present study, the model “posits that individuals need relevant health information, motivation, and behavioral skills in order to initiate and maintain health behaviors.” It would be prudent to note that the problem of homelessness happens to be rather significant, with 10% of young adults, as the authors of this article point out, being homeless. Some of the unique challenges experienced by homeless people – specifically homeless youths – relate to lack of access to quality health care, drug and substance abuse, as well as persistent/recurring mental health issues. Homeless persons also experience higher HIV rates. According to the authors, previous studies have indicated that in comparison to their housed counterparts, YEH report higher HIV rates – with some studies reporting a rate as high as 16%. Owing to the aforementioned challenges of being homeless, YEH could be considered a population that is underserved. It therefore follows that there is an urgent need to deploy interventions meant to rein in the high HIV rate among this particular underserved population. To be effective, the intervention deployed ought to take into account the special circumstances of YEH. Some of the factors that could get in the way of the effective deployment of routine interventions, as the authors of the present article indicate, are inclusive of substance and drug abuse issues among YEH as well as their mobility and transience. Thus, these factors ought to be taken into account to ensure successful deployment of the various interventions. It is with this in mind that that the authors make an observation to the effect that “the widespread use of smartphones in this population provides an opportunity to explore mobile HIV prevention strategies serving YEH.”

The population that this particular study focuses on, as has been indicated elsewhere in this write-up, is youth experiencing homelessness (YEH). It should be noted that although no standard age bracket has been universally agreed upon, the United Nations typically considers persons aged between 15 and 24 years as ‘youth.’ Participants in the present study were of ages 18 to 25.

In the present study, a qualitative, descriptive design was used by the authors in their efforts to comprehend YEH perspectives following their encounter with, and utilization of, the app-based intervention. The authors conducted interviews with a total of 16 youths experiencing homelessness. The site of the study was a Southwest city. The authors of the study procured the necessary approvals from the relevant institutions to proceed with the study, which is in itself an indication that they had adhered to the relevant research study ethical standards.

In as far as the results of the study are concerned, it was found that there was a high acceptance of the app among YEH. Most participants indicated that the app could be easily navigated and that the interface made it possible to keep track of the progress the user had made thus far. Indeed, most participants pointed out that they had adapted their behaviors following their enrolment into the study, and subsequent utilization of the app. There were, however, a number of challenges that were indicated, and which should form the basis for recommendations for improvement. The said challenges were inclusive of stolen handsets. Participants also recommended that the app incorporates a mechanism to make it possible for YEH to access real-time support. To rein in redundancy, participants also stressed the need for questions and messages to be customized. In the end, the study made a finding to the effect that YEH embraced the just-in-time adaptive intervention and, thus, the intervention was effective in the prevention of HIV among this population.

One key limitation of the present study happens to be limited sample size. In this case, a total of total of 16 youths experiencing homelessness were interviewed. It is important to note that a small sample size has the potential to render a study meaningless and could have a negative impact on reliability. In the present study, the small sample size could mean that any effects or experiences gleaned might not apply to all youth experiencing homelessness. It therefore follows that to effectively assess what effect the intervention deployed in this case has on HIV risk behavior in the long-term, there may be need to conduct larger studies. Next, it should be noted that the participants in the current research, as the authors indicate, were compensated. The said move to offer multilevel financial compensation to participants could have resulted in undue influence, or greater willingness to participate and elicit desirable responses.

Part 2

As has been indicated elsewhere in this text, the model used in the development of the intervention was the Information-Motivation-Behavioral Skills (IMB) approach. The framework is sound in this case owing to the fact that it has been successfully deployed in various contexts in efforts to define factors that impact or have an influence on healthy behavior. To an even greater extent, the model has also been utilized in research pertaining to HIV prevention. It is for this reason that it was an ideal guiding framework for the formulation of purposed messages on the prevention of HIV that youths experiencing homelessness received via the highlighted intervention. It could, thus, be considered to be of proper efficacy.

The authors, as has been indicated elsewhere in this text, made use of inductive thematic analysis in seeking to look into the encounter and perspectives of youths experiencing homelessness following their interaction with the app-based just-in-time adaptive intervention. This particular approach involves the extraction of meaning, as well as identification of themes from available data – without necessarily beginning with theoretical frameworks or constructs. Thus, the researcher does not in this case have expected outcomes. One key advantage of this approach has got to do with the flexibility it offers researchers. However, it is possible that in utilizing this approach, the authors of the present study could have missed data that happens to be more nuanced. They could also have overlooked outlier topics. This is more so the case given that thematic analysis has the potential to overwhelm a researcher with numerous potential themes. However, in addition to helping the authors assess the experiences of YEH with the app-based intervention, the approach also helped the said authors examine available opportunities improvement. Another method that could have been used in this case is the more specialized interpretative phenomenological analysis. This approach would have enabled the authors of the present study to better comprehend the study participants’ unique perspectives, i.e. via the use of bracketing which helps bar individual assumptions and biases.