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Black youth continue to bear an overwhelming proportion of the United States sexually transmitted infection (STI) burden, including HIV. Several studies on web-based and mobile health (mHealth) STI interventions have focused on characterizing strategies to improve HIV-related prevention and treatment interventions, risk communication, and stigma among men who have sex with men (MSM), people who use substances, and adolescent populations. The Electronic Sexual Health Information Notification and Education (eSHINE) Study was an exploratory mixed-methods study among students at a historically black university exploring perceptions on facilitating STI testing conversations with partners using electronic personal health records (PHRs).
The purpose of this paper is to use eSHINE Study results to describe perceived impacts of electronic PHRs on facilitating STI testing discussions between sexual partners.
Semistructured focus groups and individual in-depth interviews were conducted on a heterogeneous sample of students (n=35) between May and July 2014. Qualitative phase findings guided development of an online survey instrument for quantitative phase data collection. Online surveys were conducted using a convenience sample of students (n=354) between January and May 2015. Online survey items collected demographic information, sexual behaviors, beliefs and practices surrounding STI testing communication between partners, and beliefs about the impact of electronic PHR access on facilitating these discussions with partners. Chi-square analysis was performed to assess gender differences across quantitative measures. A Wilcoxon signed rank sum test was used to test the null hypothesis that electronic PHRs are believed to have no effect on the timing of dyadic STI health communication.
Participants described multiple individual and dyadic-level factors that inhibit initiating discussions about STI testing and test results with partners. Electronic PHRs were believed to improve ability to initiate conversations and confidence in STI screening information shared by partners. Among online survey participants, men were more likely to believe electronic PHRs make it easier to facilitate STI talks with potential partners (59.9% vs 51.9%; χ2=3.93,
Findings suggest that electronic PHR access in STI screening settings among similar populations of Black youth may improve both motivation and personal agency for initiating dyadic STI health communication. Results from this study will likely inform novel interventions that use access to electronic PHRs to stimulate important health-related discussions between sexual partners. Moving forward requires studying strategies for implementing interventions that leverage electronic PHRs to create new sexual health communication channels with providers, peers, and family among black youth.
Young black people in the United States (US) are largely overrepresented in cases of sexually transmitted infections (STIs), including HIV. While black people constitute approximately 15.4% of US youth ages 15 to 24 years, they accounted for 29.9% of chlamydia cases, 47.7% of gonorrhea cases, 43.3% of early syphilis, and 54.7% of HIV cases diagnosed in this age group in 2016 [
In young people, conversations on STI testing are more likely to be facilitated by those that routinely screen for STIs [
The US National HIV Strategy calls for federal agencies to encourage the development and implementation of highly accessible digital tools to educate and inform the American people with scientifically accurate information on disease risk, prevention, transmission, and treatment [
The Electronic Sexual Health Information Notification and Education (eSHINE) Study was a mixed-methods study among students 18 to 25 years old attending a historically black university. The project was completed using a dissertation research funding grant from the Agency for Healthcare Research and Quality, and explores perceptions of using electronic PHRs to share electronic STI screening information between sexual partners. The current study is an analysis of eSHINE Study qualitative and quantitative data to explore attitudes and practices surrounding STI testing talks between partners, barriers to talking about STI testing with partners, and perceived impacts of electronic PHRs on risk discussion facilitation. Thus, the purpose of our study is to provide a rich contextual understanding of how diffusing electronic PHR access in our study population may impact health-related communication between sexual partners.
Exploratory mixed methods are a two-phase sequential study design that is particularly useful for exploring new research questions [
Eligible study participants were students, ages 18 to 25 years, enrolled at a southern historically black college and university at the time of study. Qualitative phase participants were recruited between May and July 2014 and quantitative phase participants between January and May 2015. Recruitment flyers were posted on campus along with multiple announcements sent through the university’s student, faculty, and staff email list. Targeted recruitment efforts were conducted in collaboration with University Health Services, the Student Counseling Center, the Office for Residence Life to post study materials and conduct tabling events. Study flyers were posted to a university affiliated Facebook page for lesbian, gay, bisexual, transgendered, and questioning students. Participants were also recruited at student organizational meetings, including theatre, peer educator, and football. Study enrollment included providing eligible students with a detailed description of the project, participation requirements, and terms for receiving incentives. To complete enrollment, prospective participants signed an informed consent form in person or online using Adobe Echosign. Qualitative and quantitative phase research protocols, including focus-group, interview guides and online survey instruments were separately reviewed and approved by the university’s Institutional Review Board.
Qualitative phase participants received US $25 cash for each session (limited to one focus group or one interview per participant). Quantitative phase participants received US $20 cash for completing the online survey; and if eligible, qualitative phase participants could participate in the quantitative phase. Online survey participants were not asked to provide their name or email address on the survey. To receive incentives, participants provided a unique code generated at survey completion. Participants were additionally entered to win prizes in one of three raffle drawings (eg, textbook vouchers, US $25 up to US $100 gift cards, Samsung Galaxy tablets). eSHINE Study data collection and analyses was conducted by KJ as part of his dissertation research, with guidance from project mentors and dissertation committee members. Prior to the study, KJ completed training in qualitative and quantitative research methods, including academic coursework and work as an STD prevention and control program disease intervention specialist.
A total of 35 students participated in the qualitative research phase (19 male; 16 female). Audio-recorded focus group and individual interview sessions were conducted by KJ inside private conference rooms located on the university’s campus. In May 2014, 33 students participated in one of three separate focus group sessions (n=6; n=10; n=17). Semistructured sessions averaging 70 minutes in length were divided into three discussion sections: (1) electronic PHR perceptions, (2) experiences and perceptions related to dyadic STI health communication, and (3) perceptions related to using electronic PHRs in dyadic STI health communication. At the end of each focus group, participants were invited to schedule an in-depth individual interview session. Focus group and interview recordings were played back after sessions by KJ to construct field notes and inform any modifications to main questions in subsequent sessions.
Semistructured interviews were important to explore in depth the statements made by participants during focus groups in a setting isolated from peers. On average, interviews lasted 45 minutes. An oral questionnaire was administered during interviews to collect demographic information, orientation, and sexual risk behavior, such as number of recent sex partners, condom usage, and sex under the influence of alcohol or drugs practices. Considering the sensitivity of sexual topics and to support higher levels of comfort among participants, this information was not collected during focus groups. Sixteen of eighteen individual in-depth interviewees were recruited from a focus group session. Transcripts and field notes were uploaded to ATLAS.ti to facilitate the qualitative analysis [
A Qualtrics online survey was developed during the intermediate survey development phase between July and December 2014 [
To access the online survey, a secured and unique Web-link was sent to the enrolled participant’s student email account using the university’s email database. Between January and May 2015, 1093 participants registered for the online survey and were emailed secured survey links; 501 surveys were started, 380 completed, and 354 completed without missing data.
Survey data were uploaded into STATA 14 for statistical analyses [
Qualitative phase participants were heterogeneous in academic classification, degree major, sexual behaviors, sexual orientation, including for example, student athletes, peer educators, and members of Greek lettered social organizations.
STI testing talks or risk discussion events were described as verbal exchanges between sexual partners regarding STI testing or status. Soliciting information related to STI risk from partners was described as demonstrating personal responsibility and an unalienable right to self-preservation:
You have the right to know.
I feel like if you’re having sex with me you have the right to know my STD history. If I’m having sex with you, I need to know everything too. I owe that to you, you owe that to me.
Conversations vary in both timing and depth. Several multi-level factors, such as self-efficacy, partner-type, and intoxication, can impact when and how discussions occur (
Valuation for risk discussions varied between participants. For most, STI talks are very important to always occur, especially interviewees disclosing a history of STI infection.
It’s very important to have that conversation.
Some participants saw no purpose in talking about STI testing when using condoms. Valuation also varied based on dyadic characteristics such as, partner type.
If I know that I am going to be in something committed then I want to know your history. But if you are just a casual partner then I don’t really care, because I am going to protect myself. I wouldn’t have the conversation with someone I’m just casually having sex with.
Participants described sexual partner dynamics ranging from solely pleasure-seeking sex and noncommittal partnerships to socio or emotional interdependent and committed relationships. To simplify and operationalize, partner types were classified as: (1) main partners, defined as partnerships intended to be exclusive relationships; (2) casual partners, defined as recurring partnerships not intended to be exclusive relationships; and (3) hook-up partners, defined as one-time partnerships. Keeping in mind that dyad characteristics vary within partner-type classifications (for example, casual partners may be long-time friends or recent acquaintances, and others).
Finally, valuation appears to also be determined by the extent to which individuals are aware of the importance of discussing STI testing with partners.
I have never discussed STDs with any of my sexual partners. I’m young, so it never really came up. I usually just say, what’s the number of people you have had sex with and if I feel comfortable with the number then, okay.
Self-efficacy contributes to whether STI testing talks are initiated. While some participants described being very comfortable with initiating conversations, many generally describe it as an “[i]t’s an awkward conversation.” The impact of these beliefs as an inhibitor is based on the level of disruption an individual believes the conversation will cause to a potential sexual encounter or relationship. Low self-efficacy to facilitate risk discussions was mostly described in the context of proximal discussions, where consequences of these events may “ruin the mood.” Lack of self-efficacy to initiate STI testing talks without ruining the mood presents as a primary barrier to some.
Focus-group and individual in-depth interview quotations and online survey measures derived from qualitative codes. PHR: personal health record; STI: sexually transmitted infection.
Themes and online survey measure | Quotations | ||
Timing of dyadic STI health communication | |||
Valuation for dyadic STI health communication | |||
Valuation for dyadic STI communication when using condoms; communications barrier: condom use | |||
Self-efficacy to initiate dyadic STI health communication | |||
Communication barrier: precontemplation | |||
Communication barrier: awkward | |||
Communication barrier: people lie | |||
More confidence in STI testing information shared by a partner | |||
Easier for potential partners to talk about STI testing; easier check-in talks with partners on STI testing | |||
Impact on frequency of STI talks; earlier STI talks (proximity to potential encounter) | |||
Intentional beliefs to only use electronic PHRs when distrusting of partners | |||
Soliciting a partner’s electronic record will be awkward | |||
Self-efficacy for sharing a positive STI electronic PHR; preferred method to share STI positive status | |||
Suspicious of partners unwilling to share electronic PHR |
Some participants described talking with partners about STI testing as an exercise in futility because of limitations in the ability to verify shared information.
People lie. One of the big lies is “I’ve been tested” or “I don’t have anything”. Especially when you’re in the moment, it happens all the time.
Allaying a partner’s STI transmission concerns can take precedence over communicating accurate information about STI screening and risk. Several approaches are employed to mitigate risk associated with receiving inaccurate information. For example, some participants reported choosing to avoid risk discussions all together and use condoms. Conversely, some participants said that they engaged in couples testing or require potential partners show verification of STI test results prior to sex.
Any boy I ever ask that question to, I make sure I see papers. Paper says clearly negative or positive.
Though some participants commented that it is unlikely for “papers” to be readily available to validate STI screening information.
Other barriers exist to starting dyadic talks on STI testing. Substance use prior to sex was considered to inhibit ability for facilitating risk discussions with partners.
If someone is drunk, then it’s not going to be discussed.
Self-efficacy to initiate risk discussions may also be diminished when dyads have a previously established intimate relationship or a friendship. Difficulty discussing STI testing “when you have known the person” was described by participants as implying distrust.
Information verification was considered the foremost benefit of incorporating electronic PHRs into risk discussions between sexual partners.
It’s another way of verifying the truth and showing that they did get tested or if we need to get tested— we can go (to a test site) together.
Participants used terms such as, “truth-detector,” “proof,” and “confirmation,” in referring to electronic PHR use with partners. Participants also described limitations of electronic PHRs in determining a potential partner’s real-time infection status.
There is no way to say you are clean today, but you can say you were clean that day.
Together, electronic PHRs are believed to be a compatible innovation for adding assurance to STI talks.
I think this will be something good for the gay community. The gay community is big on electronic dating and meeting people online, Grindr and Jack'd and all that. I feel that it would be really good for that.
Gaining electronic PHR access was believed to ease the ability to facilitate conversations on STI testing.
I can just show my partners casually when I got tested and my results. It will ease the tension and make it more comfortable, especially if I am willing to share that information with you.
Another participant explained:
Ultimately the app would make it much easier to have these conversations with someone you are going to have sex with—whether it’s casual or long term.
Participants added that electronic PHRs could make it easier to have “check-in” conversations with partners who have prior established intimate relationships or friendships. Some participants maintained that practices will be determined by partner-type.
If I have a one-night stand, I will use protection. I would not want to ask that question.
However, for most, the idea of an easier STI talk eliminates partner-type related factors as a barrier.
If the app is popular then I’m asking everybody.
Improvements to personal agency was not anticipated across some constraining conditions, such as intoxication or being infected with an STI.
If you’re drunk, I don’t think people would use it, because you really wouldn’t be thinking about that, your mind is somewhere else.
Similarly, it was expressed that individuals with electronic records positive for STI infection may employ strategies to avoid talking with partners about STI screening records.
People who are negative would gladly show their results. People who are positive, it would be harder for them.
Nevertheless, some participants believed that incorporating educational resources within electronic PHR products might prove useful in explaining positive test results and prevention.
While electronic PHRs were compatible with most participants as a potential tool for facilitating STI talks, some participants suggest electronic PHR solicitation as intrusive or implying distrust.
It’s tricky, it’s one thing to ask someone something, but then to tell them to verify it, it messes up the trust. Unless if they are very comfortable.
Additionally, partners unwilling to share electronic screening records are anticipated to raise a “red flag” regarding future sexual decisions and relationship progression. Overall, electronic PHR access was anticipated to have the population-level impact of increasing discussions on STI testing.
If the norm was for people to have the app at hand, then more people would ask to see results. Now, it’s not that realistic, because people can easily say, I don’t have it with me; it’s on paper.
Out of 354 online survey participants, 184 (60.0%) believed that electronic PHR access will lead sexual partners to start conversations on STI testing earlier in the relationship (
Male participants were more likely to believe that electronic PHR access would make it easier for sexual partners to discuss STI testing compared to female participants (59.9% vs. 51.9%; χ2=3.93;
Demographic information and sexual risk behaviors among eSHINE Study online survey participants (n=354). IQR: interquartile range; STI: sexually transmitted infection.
Variables | Total, n (%) | Men, n (%) | Women, n (%) | Chi-square | |||||||
— | — | ||||||||||
Median age (IQR) | 20 (19-22) | 20 (19-22) | 20 (19-22) | ||||||||
23.64 | <.001 | ||||||||||
Freshman | 89 (25.1) | 57 (34.1) | 32 (17.1) | ||||||||
Sophomore | 82 (23.1) | 42 (25.1) | 40 (21.4) | ||||||||
Junior | 87 (25.6) | 37 (22.2) | 50 (26.7) | ||||||||
Senior | 88 (24.9) | 31 (18.6) | 57 (30.5) | ||||||||
Graduate student | 8 (2.3) | 0 (0.0) | 8 (4.3) | ||||||||
267.15 | <.001 | ||||||||||
Men only | 172 48.6) | 10 (6.0) | 162 (86.6) | ||||||||
Women only | 156 (44.1) | 149 (89.2) | 7 (3.8) | ||||||||
Men and women | 26 (7.3) | 8 (4.8) | 18 (9.6) | ||||||||
18.88 | <.001 | ||||||||||
No partners in 12 months prior to study or no history of sexual intercourse | 56 (15.8) | 34 (20.4) | 22 (11.8) | ||||||||
1 | 116 (32.8) | 45 (26.9) | 71 (38.0) | ||||||||
2 | 79 (22.3) | 27 (16.2) | 52 (27.8) | ||||||||
3-5 | 78 (22.0) | 47 (28.1) | 31 (16.6) | ||||||||
6+ | 25 (7.1) | 14 (8.4) | 11 (5.9) | ||||||||
— | — | ||||||||||
Main partner(s) | 213 (60.2) | 84 (50.3) | 129 (69.0) | ||||||||
Casual partner(s) | 153 (43.2) | 77 (46.1) | 76 (40.6) | ||||||||
Hook-up partner(s) | 72 (20.3) | 47 (28.1) | 25 (13.4) | ||||||||
21.14 | <.001 | ||||||||||
< 7 months | 153 (43.2) | 53 (31.7) | 100 (53.5) | ||||||||
≥ 7 months | 81 (22.9) | 39 (23.3) | 42 (22.5) | ||||||||
Never tested | 80 (22.6) | 51 (30.5) | 29 (15.5) | ||||||||
No history of sexual intercourse | 40 (11.3) | 24 (14.4) | 16 (8.6) | ||||||||
History of STI diagnosis | 59 (16.7) | 14 (8.4) | 45 (24.1) | 15.62 | <.001 | ||||||
Concurrent sexual partners | 68 (19.2) | 38 (22.8) | 30 (16.0) | 2.56 | .11 | ||||||
Sex under the influence of drugs or alcohol | 172 (48.6) | 65 (38.9) | 107 (57.2) | 11.82 | .001 | ||||||
Condom-less sex with a casual partner | 106 (30.8) | 44 (26.3) | 65 (34.8) | 2.92 | .09 | ||||||
Condom-less sex with a hook-up/one-time partner | 26 (7.3) | 12 (7.2) | 14 (7.5) | 0.01 | .91 | ||||||
Met sex partners using social websites or applications | 56 (15.8) | 39 (23.4) | 17 (9.1) | 13.47 | <.001 | ||||||
Sex without discussing STI testing | 134 (37.8) | 62 (46.3) | 72 (38.5) | 0.07 | .79 |
aPartner type categories reported by participants are not mutually exclusive.
Behavioral attitudes and practices related to dyadic conversations on sexually transmitted infection (STI) testing among eSHINE Study online survey participants, bivariate analyses by gender (n=354).
Variables | Total, n (%) | Men, n (%) | Women, n (%) | Chi-square | ||
3.79 | .05 | |||||
Very important/important | 312 (88.1) | 137 (82.0) | 175 (93.6) | |||
Very unimportant/unimportant | 3 (0.8) | 3 (1.8) | 0 (0.0) | |||
2.29 | .13 | |||||
Very important/important | 254 (71.7) | 105 (62.9) | 149 (79.7) | |||
Very unimportant/unimportant | 9 (2.5) | 6 (3.6) | 3 (1.6) | |||
0.00 | .95 | |||||
Very easy/easy | 169 (47.7) | 76 (45.5) | 93 (49.7) | |||
Very difficult/difficult | 44 (12.4) | 20 (12.0) | 24 (12.8) | |||
1.57 | .21 | |||||
Very likely/likely | 226 (63.8) | 93 (55.7) | 133 (71.1) | |||
Very unlikely/unlikely | 28 (7.9) | 15 (9.0) | 13 (6.9) | |||
2.77 | .43 | |||||
Before sex | 143 (40.4) | 68 (40.7) | 75 (40.1) | |||
Sometimes before sex and sometimes after sex | 145 (41.0) | 64 (38.3) | 81 (43.3) | |||
After sex | 15 (4.2) | 6 (3.6) | 9 (4.8) | |||
Never | 51 (14.4) | 29 (17.4) | 22 (11.8) | |||
Condoms were being used | 158 (44.6) | 86 (51.5) | 72 (38.5) | 0.00 | .97 | |
The topic would make things awkward | 100 (28.2) | 47 (28.1) | 53 (28.3) | 0.14 | .71 | |
People can lie about it regardless | 118 (33.3) | 54 (32.3) | 64 (34.2) | 6.03 | .01 | |
The topic never came to mind | 112 (31.6) | 58 (34.7) | 54 (28.9) | 1.40 | .24 |
Perceptions on incorporating personal health records (PHRs) into risk discussion events among eSHINE Study online survey participants (n=354). STI: sexually transmitted infection.
Variables | Total, n (%) | Men, n (%) | Women, n (%) | Chi-square | ||
1.74 | .19 | |||||
Very helpful/helpful | 225 (63.6) | 105 (62.9) | 120 (64.2) | |||
Very harmful/harmful | 2 (0.6) | 0 (0.0) | 2 (1.2) | |||
0.19 | .66 | |||||
Very helpful/helpful | 235 (66.4) | 108 (64.7) | 127 (67.9) | |||
Very harmful/harmful | 3 (0.9) | 1 (0.6) | 2 (1.1) | |||
3.93 | .05 | |||||
Strongly agree/agree | 197 (55 .6) | 100 (59.9) | 97 (51.9) | |||
Strongly disagree/disagree | 16 (4.5) | 4 (2.4) | 12 (6.4) | |||
0.53 | .46 | |||||
Strongly agree/agree | 195 (55.1) | 93 (55.7) | 102 (54.5) | |||
Strongly disagree/disagree | 11 (3.1) | 4 (2.4) | 7 (3.7) | |||
10.85 | .001 | |||||
Strongly agree/agree | 85 (24.0) | 30 (18.0) | 55 (29.4) | |||
Strongly disagree/disagree | 86 (24.3) | 52 (31.1) | 34 (18.2) | |||
6.48 | .01 | |||||
Very easy/easy | 59 (16.7) | 36 (21.6) | 23 (12.3) | |||
Very difficult/difficult | 154 (43.5) | 64 (38.3) | 90 (48.1) | |||
0.70 | .40 | |||||
Strongly agree/agree | 184 (52.0) | 89 (53.3) | 95 (50.8) | |||
Strongly disagree/disagree | 16 (4.5) | 6 (3.6) | 10 (5.3) | |||
24.14 | <.001 | |||||
Strongly agree/agree | 93 (26.3) | 62 (37.1) | 31 (16.6) | |||
Strongly disagree/disagree | 139 (39.3) | 47 (28.1) | 92 (49.2) | |||
1.49 | .22 | |||||
Strongly agree/agree | 268 (75.7) | 117 (68.9) | 153 (81.8) | |||
Strongly disagree/disagree | 2 (0.6) | 0 (0.0) | 2 (1.1) | |||
2.39 | .49 | |||||
Using an electronic PHR | 81 (22.9) | 42 (25.2) | 39 (20.9) | |||
A conversation without electronic PHRs | 158 (44.6) | 68 (40.7) | 90 (48.1) | |||
Avoid sharing infection status | 16 (4.5) | 9 (5.4) | 7 (3.7) | |||
No preference | 99 (28.0) | 48 (28.7) | 51 (27.3) |
aScores between –1 and 1 for belief variables are not reported.
Perceived sexually transmitted infection communication timing with sexual partners with and without electronic personal health record (PHR) access among eSHINE Study online survey participants (n=354). The Wilcoxon signed-rank test indicates significant increases in perceived discussion timing before sex with electronic PHR access (
Together, qualitative and quantitative findings offer several considerations for the potential role of electronic PHRs in facilitating STI health communication between partners. STI health communication is generally an important practice for our study population; however, whether and how discussions occur are functions of multiple individual and dyadic level factors. Inability to validate disclosed STI testing information, low personal agency for initiating discussions, nonawareness of STI testing talks as a health practice, and low discussion valuation related to partner-type or condom use may inhibit STI health communication from occurring. Electronic PHR access for STI screenings pose a viable solution to barriers preventing STI talks. Participants anticipate that access will be accompanied by testing discussions earlier in relationships and more frequently occurring prior to sexual encounters. Electronic PHRs are expected to add novel validation to screening information shared by partners and make it easier to initiate conversations. Male participants were more likely to believe electronic PHRs improve self-efficacy for discussions and in their ability to share positive results. Thus, electronic PHRs additionally offer new avenues for increasing male participation in STI prevention.
Self-reported behaviors potentiating STI transmission such as: sex without discussing STI testing, partner concurrency, sex while intoxicated, and condom-less sex practices is evidence of the need to continue targeting young black populations for STI interventions. Our study supports an increasing amount of burgeoning research on the feasibility and acceptability of delivering effective sexual health interventions through web- and mobile-based platforms [
This study has many strengths and limitations. Our findings offer rich data on electronic PHR access beliefs within our sample population in context of when, how, and why STI talks occur. The mixed-methods design allowed us to formatively identify important variables to study quantitatively for a novel practice. Similarly, the context of perceptions emerging from our study is largely in absence of prior participant exposure to electronic PHR access. Resources were not available for research assistants nor secondary coders; thus, qualitative findings lack inter-coder reliability and are therefore subject to researcher biases. Additionally, significant differences were observed in academic classification by gender in our non-random convenience sample of online survey participants.
Although we determined that many participants reported electronic PHR access would lead to earlier dyadic talks on STI prevention, future studies are needed to better understand whether electronic PHR access would truly extend proximity in time between STI talks and sexual encounters. Furthermore, to determine whether an increase in time between the two events minimizes the length of time to next STI screening between dyad members.
Low self-efficacy beliefs for sharing positive electronic results are likely an indicator of stigma associated with being diagnosed with an STI. Given the sample, our study does not provide substantial insight into perceptions about electronic PHR–facilitated STI talks among people with chronic infections like HIV and genital herpes. Nevertheless, reducing stigma and enabling individuals infected with STIs to safely and comfortably disclose infection status to partners remains an important challenge to prevention and care. Reducing stigma associated with discussing infection with partners may reduce behaviors that accompany non-disclosure of diagnosis, such as condom-less sex; in addition to stigma-related impacts on the HIV treatment cascade [
mHealth interventions incorporating electronic PHRs will offer new insight into strengthening infrastructure and the capacity to target disparities in STIs. Findings suggest that access to electronic PHRs for STI screening among subpopulations of black youth may improve both motivation and personal agency for initiating dyadic talks about testing. Results from this study will likely inform novel interventions that use access to electronic PHRs to stimulate important health-related discussions between sexual partners. The preventative capacity of electronic PHRs envisioned by our sample cannot be achieved without policies that support equipping them with patient portal access to STI screening records. Messages presented by healthcare providers on adopting electronic PHR–delivered STI results and electronic PHR–facilitated risk discussions will undoubtedly be key in adoption decisions. Moving forward requires studying strategies for implementing interventions that leverage electronic PHRs to create new sexual health communication channels with providers, peers, and family among black youth. With anticipated proliferation of electronic PHR adoption in generations to come, close attention is needed to ensure that black youth have equitable healthcare access to quality electronic PHR services [
Centers for Disease Control & Prevention
Centers for Medicare & Medicaid Services
Diffusion of Innovation Theory
Electronic Sexual Health Information Notification and Education
Health Information Technology for Economic and Clinical Health Act
herpes simplex virus-2
Integrative Model of Behavioral Prediction
men who have sex with men
personal health record
principal investigator
sexually transmitted infection
The eSHINE Study was supported by a 2014-2016 dissertation research grant (R36HS023057) from the Agency for Healthcare Research and Quality (AHRQ). R36HS023057 Project Mentor, Farin Kamanagar, MD, PhD, MPH (Associate Dean for Research, Morgan State University (MSU), School of Computer, Mathematical and Natural Sciences) and Dissertation Committee Chair, Bazle Mian Hossain PhD, MHS, MS (Professor, MSU, School of Community Health and Policy). Manuscript development was funded by a 2017-2019 T32 NRSA Postdoctoral Training Fellowship in HIV Epidemiology and Prevention Sciences (2T32AI102623-06) within the Johns Hopkins University Center for Public Health and Human Rights. SDB’s effort was funded in part from the Johns Hopkins University Center for AIDS Research, an NIH funded program (P30AI094189), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH nor AHRQ.
None declared.