Background: Regarding health technologies, African American young adults have low rates of uptake, ongoing usage, and engagement, which may widen sexual health inequalities. Objective: We aimed to examine rates of uptake and ongoing usage, and factors influencing uptake, ongoing usage, and engagement for a consumer health informatics (CHI) intervention for HIV/sexually transmitted infection (STI) prevention among African American young adults, using the diffusion of innovation theory, trust-centered design framework, and O’Brien and Toms’ model of engagement. Methods: This community-based participatory mixed methods study included surveys at four time points (n=315; 280 African American participants) among young adults aged 18 to 24 years involved in a blended offline/online HIV/STI prevention intervention (HIV Outreach, Prevention, and Education [HOPE] eIntervention), which was described as a “HOPE party.” Qualitative interviews were conducted with a subset of participants (n=19) after initial surveys and website server logs indicated low uptake and ongoing usage. A generalized linear mixed-effects model identified predictors of eIntervention uptake, server logs were summarized to describe use over time, and interview transcripts were coded and thematically analyzed to identify factors affecting uptake and engagement. Results: Participants’ initial self-reported eIntervention uptake was low, but increased significantly over time, although uptake never reached expectations. The most frequent activity was visiting the website. Demographic factors and HOPE party social network characteristics were not significantly correlated with uptake, although participant education and party network gender homophily approached significance. According to interviews, one factor driving uptake was the desire to share HIV/STI prevention information with others. Survey and interview results showed that technology access, perceived time, and institutional and technological trust were necessary conditions for uptake. Interviews revealed that factors undermining uptake were insufficient promotion and awareness building, and the platform of the intervention, with social media being less appealing due to previous negative experiences concerning discussion of sexuality on social media. During the interaction with the eIntervention, interview data showed that factors driving initial engagement were audience-targeted website esthetics and appealing visuals. Ongoing usage was impeded by insufficiently frequent updates. Similarly, lack of novelty drove disengagement, although a social media contest for sharing intervention content resulted in some re-engagement. Conclusions: To encourage uptake, CHI interventions for African American young adults can better leverage users’ desires to share information about HIV/STI prevention with others. Ensuring implementation through trusted organizations is also important, though vigorous promotion is needed. Visual appeal and targeted content foster engagement at first, but ongoing usage may require continual content changes. A thorough analysis of CHI intervention use can inform the development of future interventions to promote uptake and engagement. To guide future analyses, we present an expanded uptake and engagement model for CHI interventions targeting African American young adults based on our empirical results.

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中文翻译：

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非裔美国年轻人对在线性健康干预 (HOPE eIntervention) 的接受和参与：混合方法研究

背景：关于健康技术，非裔美国年轻人的使用率、持续使用率和参与率较低，这可能会扩大性健康不平等。目标：我们旨在检查非裔美国年轻人中预防 HIV/性传播感染 (STI) 的消费者健康信息学 (CHI) 干预的吸收率和持续使用率，以及影响吸收率、持续使用率和参与度的因素，使用创新理论的传播、以信任为中心的设计框架以及 O'Brien 和 Toms 的参与模型。方法：这项基于社区的参与式混合方法研究包括在四个时间点（n=315；280 名非裔美国人参与者）对参与混合离线/在线 HIV/STI 预防干预（HIV Outreach，预防，和教育 [HOPE] 电子干预），被描述为“希望派对”。在初步调查和网站服务器日志表明低使用率和持续使用后，对一部分参与者 (n=19) 进行了定性访谈。广义线性混合效应模型确定了 eIntervention 采纳的预测因素，汇总了服务器日志以描述随时间推移的使用情况，并对访谈记录进行编码和专题分析，以确定影响采纳和参与的因素。结果：参与者最初自我报告的电子干预吸收率很低，但随着时间的推移显着增加，尽管吸收率从未达到预期。最频繁的活动是访问网站。人口统计学因素和 HOPE 党社交网络特征与吸收没有显着相关，尽管参与教育和党内网络性别同质性接近意义。根据采访，推动采用的一个因素是希望与他人分享 HIV/STI 预防信息。调查和访谈结果表明，技术获取、感知时间以及制度和技术信任是采用的必要条件。采访显示，影响采用的因素是宣传和意识建设不足，以及干预平台，由于之前在社交媒体上讨论性行为的负面经历，社交媒体的吸引力较低。在与 eIntervention 的互动过程中，访谈数据显示，推动初始参与的因素是针对受众的网站美学和吸引人的视觉效果。持续使用受到更新不够频繁的阻碍。同样，缺乏新鲜感导致了脱离，尽管分享干预内容的社交媒体竞赛导致了一些重新参与。结论：为了鼓励采用，针对非洲裔美国年轻人的 CHI 干预措施可以更好地利用用户与他人分享有关 HIV/STI 预防信息的愿望。确保通过受信任的组织实施也很重要，尽管需要大力推广。视觉吸引力和有针对性的内容起初会促进参与，但持续使用可能需要不断更改内容。对 CHI 干预使用的彻底分析可以为未来干预的发展提供信息，以促进吸收和参与。为了指导未来的分析，

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