Background: Men who have sex with men (MSM) face disproportionate risks concerning HIV and other sexually transmitted infections, substance use, and mental health. These outcomes constitute an interacting syndemic among MSM; interventions addressing all 3 together could have multiplicative effects. eHealth interventions can be accessed privately, and evidence from general populations suggests these can effectively address all 3 health outcomes. However, it is unclear how useable, accessible, or acceptable eHealth interventions are for MSM and what factors affect this. Objective: We undertook a systematic review of eHealth interventions addressing sexual risk, substance use, and common mental illnesses among MSM and synthesized evidence from process evaluations. Methods: We searched 19 databases, 3 trials registers, OpenGrey, and Google, and supplemented this by reference checks and requests to experts. Eligible reports were those that discussed eHealth interventions offering ongoing support to MSM aiming to prevent sexual risk, substance use, anxiety or depression; and assessed how intervention delivery or receipt varied with characteristics of interventions, providers, participants, or context. Reviewers screened citations on titles, abstracts, and then full text. Reviewers assessed quality of eligible studies, and extracted data on intervention, study characteristics, and process evaluation findings. The analysis used thematic synthesis. Results: A total of 12 reports, addressing 10 studies of 8 interventions, were eligible for process synthesis. Most addressed sexual risk alone or with other outcomes. Studies were assessed as medium and high reliability (reflecting the trustworthiness of overall findings) but tended to lack depth and breadth in terms of the process issues explored. Intervention acceptability was enhanced by ease of use; privacy protection; use of diverse media; opportunities for self-reflection and to gain knowledge and skills; and content that was clear, interactive, tailored, reflective of MSM’s experiences, and affirming of sexual-minority identity. Technical issues and interventions that were too long detracted from acceptability. Some evidence suggested that acceptability varied by race or ethnicity and educational level; findings on variation by socioeconomic status were mixed. No studies explored how intervention delivery or receipt varied by provider characteristics. Conclusions: Findings suggest that eHealth interventions targeting sexual risk, substance use, and mental health are acceptable for MSM across sociodemographic groups. We identified the factors shaping MSM’s receipt of such interventions, highlighting the importance of tailored content reflecting MSM’s experiences and of language affirming sexual-minority identities. Intervention developers can draw on these findings to increase the usability and acceptability of integrated eHealth interventions to address the syndemic of sexual risk, substance use, and mental ill health among MSM. Evaluators of these interventions can draw on our findings to plan evaluations that explore the factors shaping usability and acceptability.

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中文翻译：

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解决男男性行为者的性健康、物质使用和心理健康问题的电子健康干预措施：过程评估的系统审查和综合

背景：男男性行为者 (MSM) 在 HIV 和其他性传播感染、药物滥用和心理健康方面面临着不成比例的风险。这些结果构成了 MSM 之间的相互作用；将这三者结合起来进行干预可能会产生倍增效应。电子医疗干预可以私下访问，来自普通人群的证据表明，这些干预可以有效解决所有 3 种健康结果。然而，目前尚不清楚电子健康干预对 MSM 的可用性、可访问性或可接受性以及影响这一点的因素。目标：我们对解决 MSM 中性风险、物质使用和常见精神疾病的电子健康干预措施进行了系统审查，并从过程评估中综合了证据。方法：我们检索了 19 个数据库、3 个试验注册库、OpenGrey 和 Google，并通过参考检查和对专家的要求对此进行了补充。符合条件的报告是那些讨论电子健康干预措施的报告，这些干预措施为 MSM 提供持续支持，旨在预防性风险、药物滥用、焦虑或抑郁；并评估干预措施的实施或接收如何随干预措施、提供者、参与者或背景的特征而变化。审稿人先筛选标题、摘要和全文的引文。评审员评估合格研究的质量，并提取有关干预、研究特征和过程评估结果的数据。分析使用了主题综合。结果：共有 12 份报告，涉及 8 项干预措施的 10 项研究，符合工艺综合条件。大多数单独或与其他结果一起解决性风险。研究被评估为中等和高可靠性（反映整体调查结果的可信度），但在探索的过程问题方面往往缺乏深度和广度。易于使用提高了干预的可接受性；隐私保护; 使用多种媒体；自我反省和获得知识和技能的机会；清晰、互动、量身定制、反映 MSM 经历并肯定性少数群体身份的内容。技术问题和干预措施太久影响了可接受性。一些证据表明，可接受性因种族或民族和教育水平而异；关于社会经济地位差异的调查结果喜忧参半。没有研究探讨干预提供或接收如何因提供者特征而异。结论：调查结果表明，针对性风险、物质使用和心理健康的电子健康干预措施对于社会人口群体的 MSM 来说是可以接受的。我们确定了影响 MSM 接受此类干预的因素，强调了反映 MSM 经历的定制内容和肯定性少数群体身份的语言的重要性。干预开发人员可以利用这些发现来提高综合电子卫生保健干预措施的可用性和可接受性，以解决 MSM 中性风险、药物滥用和精神疾病的综合问题。这些干预措施的评估者可以利用我们的发现来规划评估，探索影响可用性和可接受性的因素。我们确定了影响 MSM 接受此类干预的因素，强调了反映 MSM 经历的定制内容和肯定性少数群体身份的语言的重要性。干预开发人员可以利用这些发现来提高综合电子健康干预的可用性和可接受性，以解决 MSM 中性风险、药物滥用和精神疾病的综合问题。这些干预措施的评估者可以利用我们的发现来规划评估，探索影响可用性和可接受性的因素。我们确定了影响 MSM 接受此类干预的因素，强调了反映 MSM 经历的定制内容和肯定性少数群体身份的语言的重要性。干预开发人员可以利用这些发现来提高综合电子卫生保健干预措施的可用性和可接受性，以解决 MSM 中性风险、药物滥用和精神疾病的综合问题。这些干预措施的评估者可以利用我们的发现来规划评估，探索影响可用性和可接受性的因素。干预开发人员可以利用这些发现来提高综合电子卫生保健干预措施的可用性和可接受性，以解决 MSM 中性风险、药物滥用和精神疾病的综合问题。这些干预措施的评估者可以利用我们的发现来规划评估，探索影响可用性和可接受性的因素。干预开发人员可以利用这些发现来提高综合电子卫生保健干预措施的可用性和可接受性，以解决 MSM 中性风险、药物滥用和精神疾病的综合问题。这些干预措施的评估者可以利用我们的发现来规划评估，探索影响可用性和可接受性的因素。

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