Teaching HIV/STD Prevention to Adolescents/Young Adults though a Mobile App. Kerri Young, RN, BSN Vasanth S. Kainkaryam, MD. Northwestern University

Transcription

1 Running head: MOBILE HIV/STD APP 1 Teaching HIV/STD Prevention to Adolescents/Young Adults though a Mobile App Kerri Young, RN, BSN Vasanth S. Kainkaryam, MD Northwestern University

2 MOBILE HIV/STD APP 2 Teaching HIV/STD Prevention to Adolescents/Young Adults though a Mobile App Scope Statement The Centers for Disease Control and Prevention (CDC) estimates that 20 million new sexually transmitted disease infections occur yearly, including 50,000 new human immunodeficiency virus (HIV) infections (CDC, 2014). Estimates show that nearly 25% of new HIV infections are in adolescents/young adults, with over half of them not aware of the infection and not receiving treatment (CDC, 2012). The authors of this paper have chosen to tackle the challenge Create a mobile application (app) game to teach HIV and STD prevention strategies to teens and young adults. The application designers will be expanding on this challenge and adding several sections to help educate the younger generation about HIV and STDs. In a study done by The Nielson Company in 2013, smartphones were used by 70% of adolescents ages 13-17, and nearly 80% of young adults ages (Kerr, 2013). Providing a fun, educational applications for smart phones will hopefully raise awareness of among these age groups. Studies also show that 74-80% of adults between the ages of also use smart phones. While the target audience is the younger population, the older demographic that utilize this application will have a better understanding and awareness of the prevention strategies and educational information provided within the app. Objectives and Content The challenge is to create a game that can be used by the target demographic audience to increase education and decrease incidents of new HIV and STD cases in the

3 MOBILE HIV/STD APP 3 country. The game must be interesting enough for the audience to want to continue playing and in turn, continue learning. Recent data has shown that second to school, adolescents receive their next significant amount of information on sexual behaviors from media (American College of Pediatricians, 2014). Many game apps today are roleplaying games, such as SIMS. Each person creates an avatar of him/herself and move through the game encountering real life situations. Some studies show that adolescents playing role-playing games can improve problem-solving abilities and also improve school grades (American Psychological Association, 2013). Users of our game/educational app will be able to create their characters, and enter certain social situations where they will have to choose what actions they will take in the scenario. Pop up informational hints will be available to help guide them to the most preventative path to a positive, healthy outcome. Along the way, if they choose an option that may put them at risk, detailed information will be given about the risk they may encounter. They will be rewarded for choosing the correct preventative measures with cash that can be used in the game to buy a variety of items. These items would range from clothing to cars and beyond. For example, consider the following scenario and range of options and rewards that may be available. The player goes on a date with a person that they have previously had sex with in the past, but are not in a committed monogamous relationship with that person. At the end of the night, the player chooses to have sex with this person. If the player decides to have protected sex, he/she will be credited 1,000 dollars to the account. If the player is considering having unprotected sex, a pop-up providing facts on HIV and STD transmission will appear. It will ask if he/she has made a decision regarding the use

4 MOBILE HIV/STD APP 4 of protection in the sexual encounter. If unprotected sex is chosen, no credits will be given, and instead, information regarding testing for HIV and STDs will be presented. The scenario would then continue for the individual who chose to have unprotected sex with giving them symptoms of an STD. The player would be presented with options for STD testing, continuing relationships with other sexual partners. Should high risk decisions be continued, the player will be presented with signs and symptoms of an STD and a diagnosis will be made. This additional aspect to the game provides insight into long-term consequences of actions, as well as awareness of various STDs and their presenting signs/symptoms to promote early evaluation and treatment should these symptoms occur. There will also be optional questionnaires that will present in the game including basic demographic information, answers on evaluation how high the player s anticipated risk of acquiring an STD may be, reasons why they chose to not use protected sex, etc. This data will be anonymously collected and is completely voluntary, and will be used to design modifications to the app to align with the thinking process of the users to further modify the scenarios to increase relevance to daily decisions of the population. In addition to a scenario-based role-playing component, the app will also have suggested recommendations based on customized situations. For example, participants could enter information about themselves, and recommendations would present. For example, if a player entered that she is a female, sexually active, and age 22, it would show up among the recommendations that she should have screening for chlamydia (USPSTF, 2013). In addition to screening testing, it will also have recommendations on vaccinations based on the information that is entered, to encompass

5 MOBILE HIV/STD APP 5 vaccines such as the HPV vaccine and the Hepatitis B vaccine. This will provide a larger scope of information on preventive care in addition to barrier protection, to include biological protection through vaccination for available conditions. In addition to the aforementioned, participants could enter signs and symptoms of an STD, sexual scenarios such as condom breaking, kissing, or same sex partners. One panel in the app will also include information on contraception overall, and which methods provide STD protection and to what degree, and which methods do not. Lastly, there will be a tab which will provide information to seek further care, linking directly to community resources using the GPS location tracker. These resources can include Planned Parenthood among others. It will also link to the CDC resource National HIV and STD Testing Resources and provide location-specific information (CDC, n.d.). It will also link to various hotlines including the National STD Hotline, TEEN Line, National Planned Parenthood Hotline, etc. (Danya International, Inc., 2003). In addition to the role-playing and scenarios entered above, the application could include a type of music trivia game that allows users to compete in song recognition. In order to win the game, the user would have to correctly identify a song and subsequently answer a trivia question related to prevention of STDs. The winner would then be awarded credits toward itunes or Google Play purchases. This can be done via partnership with MTV, through their GYT: Get Yourself Tested campaign (CDCNPIN, n.d.).

6 MOBILE HIV/STD APP 6 Resources The CDC has provided basic prevention guidelines to prevention of STDs. All of the provided strategies will have to be explained further for the young people targeted in this app. For example, one of the strategies they list is vaccination, but they simply put HPV Vaccinations as one of the vaccinations available. Most young people are unaware that the HPV virus is linked with genital warts. Coordination with the CDC to expand upon their ideas to translate the medical terminology into terms our younger generation will understand or perhaps redesigning CDC web pages targeted toward youth and adolescents. A focus group would need to be created, ideally including individuals from the CDC, American Academy of Pediatrics, American Psychological Association, as well as active youth ages to participate in designing this. Youth to participate in this can be recruited through advertising and contests, with prizes. Advertisements can also be made for individuals who have had/have STDs such as HIV to be able to participate in drawing in from their own experiences and choices to share what they have learned. The various state public health departments are also a great source for education and resources regarding the treatment, care and prevention of HIV and STDs. It is estimated that more than 1.1 million individuals are living with HIV/AIDS and that roughly 21% of them do not know their HIV Status (Macrae, 2011). While their focus is more related to HIV/AIDS testing, care and treatment, they provide recommendations for testing and do reference the CDC for prevention guidelines. Support of those with HIV/AIDS is a main concern for the department of Public Health.

7 MOBILE HIV/STD APP 7 Although, not a federal agency, MTV has been working with the CDC, American College Health Association, Kaiser Family Foundation, National Coalition of STD Directors and Planned Parenthood Federation of America (CDCNPIN, n.d.). The campaign, known as GYT: Get Yourself Tested is a campaign that targets our desired audience. Working directly in conjunction with these groups, would help advertise the app. MTV could also help provide the musical categories for the proposed music trivia game. In terms of the programming, there would need to be partnership with an appdesigning company to be able to create and design the app with constant updates released in ios, Android, and Google platforms. The end user of our app will also need a smart phone. Given the national statistics previously quoted, there appears to be increasing access to smartphones, so the reach of a mobile app appears to be quite far. Constraints and Risks Since the app allows an individual to enter personal health information (PHI) such as sexual history, experiences, etc., a major concern is confidentiality of this data as well as storage of this data. If the app is designed such that an individual is able to store a profile of information which allows them to proceed through various scenarios, it will prevent the need to constantly re-enter this data. However, if an individual is allowed to store a profile which contains PHI such as their sexual history, this may be a concern if the individual loses their phone, parents access this information if the phone is shared, or if another friend/individual accesses this. One way to address this issue is by placing an additional passcode restriction on the app the way ADT Pulse, Manilla, and LifeLock

8 MOBILE HIV/STD APP 8 have done. In addition to having the standard password to unlock the phone, the app itself would require an additional level of security with another passcode requirement that would be unique to the user s profile. Each user profile would be linked to a unique passcode. When the apps are toggled as can be done in the ios interface, the user will be prompted to enter a passcode again each time he/she wishes to enter the app after leaving it. This allows for enhanced dual-level security. If an incorrect passcode is entered more than 3 times, the user profile will be deleted. A standard profile deleting time frame can also be built in, such as allowing a profile to be stored no more than 2 weeks to 1 month. The benefit of this is enhanced confidentiality protection, though the drawback would be having to recreate profiles, which may make adolescents less likely to enter accurate information each time. There will definitely be concerns about HIPAA and storage of personal information. A disclaimer will be flashed at the beginning of the app. No identifiable data will be requested in the app no date of birth, no address, or name. Age will be requested either via a single digit or age ranges, in addition to location and the data entered based on the various scenarios by the player. Another constraint is that there may be some restrictions to create accounts to download these apps. For example, itunes may require the teen to discuss with parents intentions/goals of using the smart phone before he/she will be able to create an itunes account to download apps (Heath, 2013). Timetable The data gathering phase of the application could easily take approximately three to five months. During this time, members of the task group as previously noted would

9 MOBILE HIV/STD APP 9 need to review the current data to establish baselines, as well as design scenarios. Scenarios would be derived from polling healthcare professionals to provide feedback on commonly encountered high risk situations their patients face. After the data gathering phase, the design phase would begin, which would include diagramming, programming, and testing the application. There is no clear timeline to predict this, but will likely need to be performed by a team and may take approximately 6 months. Subsequently there would be marketing and launching phases, with partnerships with various national and local organizations to be able to launch this. This may take approximately three to four months. Data gathering would occur after the launch, and would include analyzing trends in use of smartphones, number of unique downloads of the apps, the geography of location of the users, and the incidence of STDs in these geographic locations compared with controls/areas without a significant number of application users but with similar preapp incidence. Though given the continued increase in smartphone use, this data may be somewhat hard to compare to controls. Data could likely be obtained for one to two years after the launch of the app. Users could provide feedback from within the app directly, and the questionnaires would provide further information. Estimated cost of developing this app would be between $20,000 and $30,000 (How Much to Make An App, 2014). These estimated costs include: individual user profiles, logging in through social media (Facebook, Twitter, and Google+), being able to rate certain items, website integration and a custom app icon. There will be some yearly maintenance costs associated with the type of application. For example, Apple charges $99/year for an itunes Connect account. This is how users will be able to download the app onto their smartphone.

10 MOBILE HIV/STD APP 10 Marketing costs will also have to be taken into account. Stakeholders such as Planned Parenthood and the CDC will usually market education apps such as this free of charge. MTV, a media group, will often charge to advertise on their network. Linking these app advertisements to the GYT campaign, already established, would be one of the best places to include a picture of the app icon. Once users have downloaded the app, they will have the option of setting up an account or continuing as a guest user. They can set up an account using their social media accounts or for those who do not use social media, they will set up an internal account. They will be asked to set up a username and password. For data mining purposes, they will also be asked their age, gender, city and state. In order to gather information from the app for data mining, an additional cost will be added to the overall budget for this project. Data mining capabilities from apps can range from $8,000-$50,000 to develop (Thomas, 2014). Different agencies that receive the data may want different data elements in different formats. Partnering with the local agencies and with links/direct numbers to call the resources noted, calls from various locations could be analyzed to see if there is an increase in access to resources in areas with high download rates of the application. The data would be continually analyzed. Depending on feedback, updates to the application may be launched starting six months after the initial application. Data can be collected for a total of three years after the launch of the application. Stakeholders There will be several sectors of stakeholders: public, private, government. Public stakeholders include the youth in the age group at risk of contracting HIV and STDs.

11 MOBILE HIV/STD APP 11 This population is the target of the greatest benefit of this application, with the benefit of decreasing the incidence of new cases of STDs. However, it may be challenging to evaluate how much of the decrease would be due to this application alone compared to other initiatives and outreach that is occurring. Private stakeholders include Apple (itunes), Google (Google Play/Android). These stakeholders would be impacted by having to launch the product on their platforms, and having to award free credits/music to players based on trivia questions. Although they would be financially impacted, there could be some benefits to them by increasing traffic through their platforms, and possibly tax benefits and write-offs due to providing free services. Moreover, it would increase their label of partnership in reducing STDs. Lastly, the governmental entities that are stakeholders include the Departments of Public Health, and CDC. Potential benefits of the application and results could offset funding costs for other local projects aimed at the same cause. Based on the demographic and survey responses, it could also help collect data for statistical analysis and trends. Some local projects may be impacted negatively should the application be successful and funding be redirected from governmental and not-for-profit agencies to enhance the app. Future benefits for all stakeholders could be creating additional apps with a similar concept focusing on other particular communicable health issues, such as influenza, travel-medicine related illnesses, etc. Prevention of any disease has been proven to lower health care costs across the continuum. In conclusion, making education fun by provider social interaction, games, interesting factoids and easy access to resource information, will help spread awareness about the prevention of HIV and STDs.

12 MOBILE HIV/STD APP 12 References American College of Pediatricians (2014, February). The Media, Children, and Adolescents. Retrieved April 27, 2014, from American Psychological Association (2013, November 25). Video Games Play May Provide Learning, Health, Social Benefits, Review Finds. Retrieved April 27, 2014, from Centers for Disease Control and Prevention National Prevention Information Network (CDCNPIN) (n.d.). GYT: Get Yourself Tested Campaign - STD Awareness Resources. Retrieved April 27, 2014, from Centers for Disease Control and Prevention (CDC) (2012). Vital Signs: HIV Infection, Testing, and Risk Behavior Among Youths - United States. MMWR, 61(47), Centers for Disease Control and Prevention (CDC) (n.d.). National HIV and STD Testing Resources. Retrieved April 27, 2014, from Centers for Disease Control and Prevention (2014, April 8). STD Awareness Month STD Information from CDC. Retrieved April 27, 2014, from Danya International, Inc. (2003). STD Hotlines. Retrieved April 27, 2014, from

13 MOBILE HIV/STD APP 13 Heath, A. (2013, August 22). Apple Allows Educators To Create itunes Accounts For Pre-Teens Ahead Of Back To School Season. Retrieved April 27, 2014, from How Much to Make An App. Retrieved June 1, 2014, from: Kerr, D. (2013, October 29). Smartphones commandeer 70 percent of teen market - CNET. Retrieved April 27, 2014, from Macrae, J. (2011, June 16). HIV/AIDS Care & Treatment in Health Centers. Retrieved April 27, 2014, from U.S. Preventive Services Task Force (USPSTF) (2013, June). Screening for Chlamydial Infection. Retrieved April 27, 2014, from Thomas, C. How much does it cost to develop an app? Retrieved May 25, 2014, from: