Implementing ecological momentary assessments to measure violence and adolescent HIV transmission risk: Lessons from Johannesburg, South Africa.
Implementing ecological momentary assessments to measure violence and adolescent HIV transmission risk: Lessons from Johannesburg, South Africa.
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DOI：
10.1371/journal.pdig.0000283
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发表时间：
2024-02
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生态瞬时评估（EMA）是了解危险行为的重要方法，并为艾滋病研究带来希望。EMA在撒哈拉以南非洲仍然是一种新的疾病。我们描述的挑战和经验教训的一项新的研究，实施移动的手机EMA与南非的青春期男孩。Tsamaisano研究是一项纵向研究，从2020年到2023年招募15-19岁的青春期男孩;包括那些没有艾滋病毒的人和那些围产期感染和感染艾滋病毒的人。参与者被要求完成52个每周一次的移动的电话调查，内容涉及情绪状态、遭受和实施暴力以及危险性行为。调查是使用随机算法选择日期进行的。我们纳入了评估挑战和优化调查完成的机制：每周与青年代表举行小组会议，并进行实时数据监测。此外，20个频繁与不频繁的调查提交者参加了定性访谈的障碍和建议。实时监测表明，在研究实施的头几个月，调查完成率较低（定义为<50%）。为了确保青少年参与者及其护理人员理解成功EMA所需的承诺，我们在入组访视期间围绕移动的电话访问创建并实施了指导性讨论。我们确定了需要增加和持续的技术支持;通过创建技术指南，在注册后实施标准的两周电话登记，添加自动请求按钮以获得回拨帮助，创建WhatsApp消息流，并联系所有未能提交两次连续调查的参与者。入门级智能手机，包括研究最初分发的智能手机，没有能力进行某些更新，必须更换为更昂贵的型号。参与者在随机分配的调查日中挣扎;通过设置完成日和有针对性的提醒信息，完成情况有所改善。这些措施将调查完成率从2020年12月的40%提高到2022年4月的65%。我们描述了学到的关键经验教训，以告知未来的研究设计与移动的手机EMA，借鉴我们的经验，实施这样的青春期男孩，包括艾滋病毒感染者，在低收入和中等收入的环境。通过Tsamaisano研究获得的关键经验教训对于未来EMA利用移动的电话在中低收入环境中的青春期男孩中收集电子数据的研究设计非常重要。在这项研究中，参与者完成了52个每周一次的移动的电话调查，内容涉及情绪状态、遭受和实施暴力以及性风险行为。虽然我们的数据仅限于青春期男孩，但经验教训可以适用于南非低收入环境中的青年。我们的研究从随机选择的调查提交日开始，然后切换到每周调查日。在整个研究实施过程中，我们通过与PHRU的青少年社区咨询委员会（ACAB）密切合作，纳入了青年参与战略，包括研究运营会议的青年代表。
Ecological Momentary Assessment (EMA) is an important methodology to understand risky behaviour and holds promise for HIV research. EMA is still novel in sub-Saharan Africa. We describe challenges and lessons learned on a novel study implementing mobile phone EMAs with adolescent boys in South Africa. The Tsamaisano study was a longitudinal study from 2020–2023 to recruit adolescent boys aged 15–19 years; including those without HIV and those perinatally infected and living with HIV. Participants were prompted to complete 52 weekly mobile phone survey on emotional state, exposure to and perpetration of violence, and sexual risk behaviour. Surveys were delivered using a random algorithm to choose the day. We incorporated mechanisms to assess challenges and optimize survey completion: weekly team meetings with youth representation and real-time data monitoring. Additionally, 20 frequent vs infrequent survey submitters participated in qualitative interviews about barriers and recommendations. Real-time monitoring indicated low (defined as <50%) survey completion in the first months of study implementation. To ensure that both the adolescent participant and their caregiver understood the commitment required for successful EMA, we created and implemented a guided discussion around mobile phone access during the enrolment visit. We identified a need for increased and ongoing technical support; addressed by creating technical guides, implementing a standard two-week check-in call after enrolment, adding an automated request button for call-back assistance, creating a WhatsApp messaging stream, and reaching out to all participants failing to submit two sequential surveys. Entry-level smartphones, including those initially distributed by the study, did not have capacity for certain updates and had to be replaced with more expensive models. Participants struggled with randomly allocated survey days; completion improved with set completion days and targeted reminder messages. Together, these steps improved survey completion from 40% in December 2020 to 65% in April 2022. We describe key lessons learned to inform future study designs with mobile phone EMAs, drawing on our experience implementing such among adolescent boys, including persons living with HIV, in a low-and-middle income setting. The key lessons learned through the Tsamaisano study are important to inform future study designs with EMA utilizing mobile phone, electronic data collection among adolescent boys in low-and-middle-income settings. In this study, participants completed 52 weekly mobile phone surveys on emotional state, exposure to and perpetration of violence, and sexual risk behaviour. Although our data are restricted to adolescent boys, lessons can be applied to youth in low-income South African settings. Our study started with randomly selected survey submission days and then switched to set weekly survey days. We incorporated youth engagement strategies through working closely with the Adolescent Community Advisory Board (ACAB) of the PHRU throughout the study implementation, including youth representation as of the study operations meetings.