title: Get+Connected: Development and Pilot Testing of an Intervention to Improve Computer and Internet Attitudes and Internet Use Among Women Living With HIV.
abstract: BACKGROUND
  For persons living with chronic medical conditions, the Internet can be a powerful tool for health promotion, and allow for immediate access to medical information and social support. However, women living with human immunodeficiency virus (HIV) in the United States face numerous barriers to computer and Internet use. Health behavior change models suggest that the first step towards adopting a new health behavior is to improve attitudes towards that behavior.
  
  
  OBJECTIVE
  To develop and pilot test Get+Connected, an intervention to improve computer and Internet attitudes and Internet use among women living with HIV.
  
  
  METHODS
  To develop Get+Connected, we reviewed the extant literature, adapted an existing curriculum, and conducted a focus group with HIV-positive women (n=20) at a community-based organization in the Bronx, New York. Get+Connected was comprised of five weekly sessions covering the following topics: basic computer knowledge and skills, identifying reliable health-related websites, setting up and using email and Facebook accounts, and a final review session. We recruited 12 women to participate in pilot testing. At baseline, we collected data about participants' sociodemographic information, clinical characteristics, and technology device ownership and use. At baseline, intervention completion, and three months postintervention, we collected data regarding attitudes towards computers and the Internet (Attitudes Towards Computers and the Internet Questionnaire [ATCIQ]; possible scores range from 5-50) as well as frequency of Internet use (composite measure). To examine changes in ATCIQ scores and Internet use over time, we used generalized estimating equations. We also collected qualitative data during intervention delivery.
  
  
  RESULTS
  Among women in our sample, the median age was 56 years (interquartile range=52-63). All participants were black/African American and/or Latina. Seven participants (7/12, 58%) had a high school diploma (or equivalent) or higher degree. Ten participants (10/12, 83%) reported owning a mobile phone, while only one (1/12, 8%) reported owning a computer or tablet. Only one participant (1/12, 8%) reported having ever used the Internet or email. Internet nonusers cited lack of computer/Internet knowledge (6/11, 54%) and lack of access to a computer or similar device (4/11, 36%) as the main barriers to use. Over time, we observed an improvement in attitudes towards computers and the Internet (ATCIQ scores: 33.5 at baseline, 35 at intervention completion, and 36 at three months postintervention; P=.008). No significant increase in Internet use was observed (P=.61). Qualitative findings indicated excitement and enthusiasm for the intervention.
  
  
  CONCLUSIONS
  In our sample of urban, technology-inexperienced HIV-positive women, participation in Get+Connected was associated with an improvement in attitudes towards computers and the Internet, but not Internet use. Changing attitudes is the first step in many health behavior change models, indicating that with improved access to computer and Internet resources, frequency of Internet use may also have increased. Future studies should consider addressing issues of access to technology in conjunction with Get+Connected.
authors.affiliation: Mailman School of Public Health, Columbia University, New York, NY, United States.
authors.forename: Gabriela
authors.identifier: http://orcid.org/0000-0001-8697-142X
authors.initials: G
authors.lastname: Seplovich
authors.affiliation: Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, United States.
authors.forename: Keith J
authors.identifier: http://orcid.org/0000-0003-1372-7244
authors.initials: KJ
authors.lastname: Horvath
authors.affiliation: Montefiore Medical Center/Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, NY, United States.
authors.forename: Lorlette J
authors.identifier: http://orcid.org/0000-0001-5933-5276
authors.initials: LJ
authors.lastname: Haughton
authors.affiliation: Montefiore Medical Center/Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, NY, United States.
authors.forename: Oni J
authors.identifier: http://orcid.org/0000-0002-2787-1661
authors.initials: OJ
authors.lastname: Blackstock
keywords: Internet literacy; access to health information; digital divide; information seeking behavior; technology intervention; women and HIV