title: A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study.
abstract: BACKGROUND
  Despite ongoing prevention efforts, HIV and other sexually transmitted infections (HIV/STIs) and drug use remain public health concerns. Urban adolescents, many of whom are underserved and racial minorities, are disproportionately affected. Recent changes in policy, including the Affordable Care Act, and advances in technology provide HIV/STI and drug abuse prevention scientists with unique opportunities to deliver mobile health (mHealth) preventive interventions in primary care.
  
  
  OBJECTIVE
  The purpose of this community-engaged study was to develop an mHealth version of the Storytelling for Empowerment preventive intervention for primary care (hereinafter referred to as "S4E").
  
  
  METHODS
  A total of 29 adolescents were recruited from a youth-centered primary care clinic in Southeast, Michigan, to participate in qualitative interviews. Participants were predominantly African American (n=19, 65.5%) and female (n=21, 72.4%) with a mean age of 16.23 (SD 2.09). The principles of community-based participatory research (CBPR), in conjunction with agile software development and the recommended core prevention principles of the National Institute on Drug Abuse (NIDA) were employed during S4E development. CBPR principles are aimed at improving the effectiveness of research by addressing locally relevant health problems, working with community strengths, and translating basic science into applied research. Complementing this approach, the NIDA prevention principles are derived from decades of drug abuse prevention research aimed at increasing the effectiveness and uptake of programs, through the development of culturally specific interventions and ensuring the structure, content, and delivery of the intervention fit the needs of the community. Data were analyzed using thematic analysis.
  
  
  RESULTS
  A total of 5 themes emerged from the data: (1) acceptability of the mHealth app to adolescents in primary care, (2) inclusion of a risk assessment to improve clinician-adolescent HIV/STI and drug use communication, (3) incorporation of culturally specific HIV/STI and drug use content, (4) incorporation of interactive aspects in the app to engage youth, and (5) perspectives on the appearance of the app.
  
  
  CONCLUSIONS
  There is a dearth of mHealth HIV/STI and drug abuse preventive interventions for primary care. Incorporating the principles of CBPR in conjunction with agile software development and NIDA-recommended core prevention principles may be helpful in developing culturally specific mHealth interventions. An important next step in this program of research is to examine the feasibility, acceptability, and efficacy of S4E on adolescent sexual risk and drug use behaviors, and HIV/STI testing. Implications for prevention research and primary care practice are discussed in the context of the Affordable Care Act and technological advances.
authors.affiliation: School of Social Work, University of Michigan, Ann Arbor, MI, United States. cordovad@umich.edu.
authors.forename: David
authors.identifier: http://orcid.org/0000-0001-9998-1934
authors.initials: D
authors.lastname: Cordova
authors.forename: Jose A
authors.identifier: http://orcid.org/0000-0002-9276-2306
authors.initials: JA
authors.lastname: Bauermeister
authors.forename: Kathryn
authors.identifier: http://orcid.org/0000-0001-5408-5220
authors.initials: K
authors.lastname: Fessler
authors.forename: Jorge
authors.identifier: http://orcid.org/0000-0003-0862-8436
authors.initials: J
authors.lastname: Delva
authors.forename: Annabelle
authors.identifier: http://orcid.org/0000-0002-6960-3892
authors.initials: A
authors.lastname: Nelson
authors.forename: Rachel
authors.identifier: http://orcid.org/0000-0003-1979-8537
authors.initials: R
authors.lastname: Nurenberg
authors.forename: Frania
authors.identifier: http://orcid.org/0000-0002-8195-2454
authors.initials: F
authors.lastname: Mendoza Lua
authors.forename: Francheska
authors.identifier: http://orcid.org/0000-0002-6928-6049
authors.initials: F
authors.lastname: Alers-Rojas
authors.forename: Christopher P
authors.identifier: http://orcid.org/0000-0001-7934-8293
authors.initials: CP
authors.lastname: Salas-Wright
keywords: HIV; STI; adolescent; drug users; mHealth; primary health care; primary prevention; sexually transmitted infections; telemedicine