Chat Room Interventions: Protecting and Respecting Participants - Scott D. Rhodes

Chat Room Interventions:
   Protecting and Respecting
          Participants

              Scott D. Rhodes
Department of Social Sciences and Health Policy
      Division of Public Health Sciences
  Wake Forest University School of Medicine

The Internet

An important tool for social networking
 and support, meeting friends and
 sexual partners, and building
 community

The Internet
and risk for HIV & STD infection
More likely to report:
• Sex with men and women
• Unprotected anal sex
• More partners, and
• STD infection history

CyBER/M4M
 Chat room-Based Education and Referral/ Men for Men

                                 Chat room HIV prevention
                                    intervention designed
                                    using CBPR
                                 Interventionists trained to
                                    serve as health
                                    advisors, opinion
                                    leaders, community
                                    advocates
                                 Quantitative and
                                    qualitative data
                                    collected
Rhodes SD, et al. A pilot intervention utilizing Internet chat rooms to
   prevent HIV risk behaviors among men who have sex with men.
                               Public Health Reports 2010;S1:29-37.

HIV testing
Preliminary data suggests disproportionately
 low rates
37% of CyBER/M4M participants ages 18-62
  years old reported testing in past 12
  months
  – 32% of those 25-44 years old

    Rhodes SD, et al. Comparing MSM in the southeastern US who
       participated in an HIV prevention chat room-based outreach
          intervention and those who did not: how different are the
                                         baseline HIV-risk profiles?
                                 Health Educ Res 2007;23:180-90.

CyBER/testing
                R21MH082689

CBPR proof-of-concept study
Builds on CyBER/M4M
Based in natural helping, social cognitive
 theory, and empowerment education
Designed to increase HIV testing through
 chat room promotion

Implementation
CyBER/testing interventionist
 Insider’s knowledge of MSM communities
Housed at community partner agency

Every 30 minutes posts standardized
 theory-based triggers about HIV testing
 and his availability to provide information
 and answer questions about testing
 within the public chat room

Evaluation
Brief online behavioral assessment
  – At pretest and 6-months after initiation of
    implementation

Extant data abstracted from profiles at 3
  months
• To compare those who participated in
  the assessment and those that did not

Preliminary findings
                  Pretest      At 6 mons     OR (95% CI)       p
                  (n=346)       (n=315)
Mean age         37.2 (11.3)   36.9 (11.8)                     .7
Sex w both       74 (21.4%)    60 (19.0%)                      .5
Tested for HIV
during past 12
months           154 (44.5%)   187 (59.4%)   1.8 (1.4, 2.5)

Respecting chat room MSM
• Is this intervention even appropriate given
  the purpose of the online space for MSM?
  – Reviewed published community norms and
    standards
  – Careful training of all staff to adhere to these
    guidelines
    • Safe space and nonintrusive
  – Part of the key is use of public room
    • Although this makes other types of online sites
      difficult (or impossible) to intervene within using
      this approach: BGClive; Manhunt; Dudesnude;
      Squirt; Craigslist; SilverDaddies…

Respecting chat room MSM
• Low intensity approach
• Engagement of interventionist as
  participant in the chat room
     • Building trust; being defended for “right” to be
       in the room by others
• Ongoing steering committee review,
  guidance
– Approach, types of triggers and messages,
  profile representation

What about assessment data?
• Recruitment in the public chat room
  – Not targeting individuals
• Low intensity approach
• Security of the data

What about those
             < 18 years old?
• Reducing risk of those under 18 years old:
  – Before providing URL or password through
    private chat, recruiter asks, "By the way, how
    old are you?"
  – If ≥ 18 years old, provides password and URL
    using private instant messaging
  – No indication that participants must be ≥18
    years old. If the participant is

Consent?
Must be brief because of competing priorities of
  being in the chat room
Introductory paragraph on the URL that explains
  that we are asking the potential participant to
  participate in a research study that is designed
  to explore HIV testing rates among men online,
  participation is voluntary, and all information
  is anonymous.
– Includes Dr Rhodes’ telephone number and e-
  mail address for questions or concerns, and
  the IRB Director’s telephone number.
– Recruiter’s profile provides further detail
   • Committed to transparency

Collecting extant profile data
Online responses to closed-ended
 standardized items that are accessible
 to all within the chat room
Considered to be public if anyone can go
 into the room and read
  – Eavesdropping or ethnography

                Moreno MA, Fost NC, Christakis DA.
                Research ethics in the MySpace era.
                    Pediatrics 2008;121(1):157-61.

Aliases and e-mail addresses
Risks associated with abstracting chat
 room aliases may be minimal given that
 aliases tend to be unrecognizable (e.g.,
 “Top4U,” “BadBoyNC,” “Almoststr8”)
  – For some chatters, point is to maintain
    anonymity
We have never seen a chat room alias
  such as “Scott_Rhodes”
E-mail addresses may be different.
• For PayPal compensation, etc.

Key to success
Community member involvement: what is
 realistic, what will work
Maintain relationships and open communication
 with IRB and NIH personnel
  – Understandings and interpretations vary,
    priorities vary
     • Participants < 18 years old became
       problematic for some
     • NIH Code 44
     • Certificate of Confidentiality
  – Summoned to IRB to show them how the
    rooms function, ease of entering a chat
    room, what aliases look like

Chat room interventions

The Internet has emerged as an important
 tool for the delivery of health promotion
 and disease prevention interventions

Multiple questions remain in terms of
 harnessing the rapidly evolving
 environment while exhibiting high levels
 of respect and ensuring the protection of
 online communities