Provision of online HIV-related information to gay, bisexual and other men who have sex with men: a health literacy-informed critical appraisal of Canadian agency websites
Mark Gilbert A B C D L , Warren Michelow D , Joshun Dulai C , Daniel Wexel C , Trevor Hart E , Ingrid Young F G , Susan Martin F , Paul Flowers H , Lorie Donelle I and Olivier Ferlatte C J KA Ontario HIV Treatment Network, 600-1300 Yonge Street, Toronto, Ontario M4T 1X3, Canada.
B Present address: British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada.
C Community-Based Research Centre for Gay Men’s Health, 1007-808 Nelson Street, Vancouver, British Columbia V6Z 2H2, Canada.
D The University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada.
E Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada.
F University of Glasgow, University Avenue, Glasgow G12 8QQ, United Kingdom.
G Present address: University of Edinburgh, Old College, South Bridge, Edinburgh EH8 9YL, United Kingdom.
H Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, United Kingdom.
I Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada.
J Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada.
K Present address: The University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada.
L Corresponding author. Email: mark.gilbert@bccdc.ca
Sexual Health 16(1) 39-46 https://doi.org/10.1071/SH18092
Submitted: 8 December 2017 Accepted: 6 August 2018 Published: 9 January 2019
Abstract
Background: HIV risk and prevention information is increasingly complex and poses challenges for gay, bisexual and other men who have sex with men (GBMSM) seeking to find, understand and apply this information. A directed content analysis of Canadian HIV websites to see what information is provided, how it is presented and experienced by users, was conducted. Methods: Eligible sites provided information relevant for GBMSM on HIV risk or prevention, were from community or government agencies, and were aimed at the public. Sites were found by using a Google search using French and English search terms, from expert suggestions and a review of links. Eligibility and content for review was determined by two reviewers, and coded using a standardised form. Reading grade level and usability scores were assessed through Flesch–Kincaid and LIDA instruments. Results: Of 50 eligible sites, 78% were from community agencies and 26% were focussed on GBMSM. Overall, fewer websites contained information on more recent biomedical advances (e.g. pre-exposure prophylaxis, 10%) or community-based prevention strategies (e.g. seroadaptive positioning, 10%). Many sites had high reading levels, used technical language and relied on text and prose. And 44% of websites had no interactive features and most had poor usability scores for engageability. Conclusions: Overall, less information about emerging topics and a reliance on text with high reading requirements was observed. Our study speaks to potential challenges for agency website operators to maintain information relevant to GBMSM which is up-to-date, understandable for a range of health literacy skills and optimises user experience.
Additional keywords: Canada, HIV infections, homosexuality, male, sexual and gender minorities.
References
[1] Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, Goicochea P, Casapía M, Guanira-Carranza JV, Ramirez-Cardich ME, Montoya-Herrera O, Fernández T, Veloso VG, Buchbinder SP, Chariyalertsak S, Schechter M, Bekker L-G, Mayer KH, Kallás EG, Amico R, et al Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010; 363 2587–99.| Preexposure chemoprophylaxis for HIV prevention in men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 21091279PubMed |
[2] Rodger A. HIV transmission risk through condomless sex if HIV+ partner on suppressive ART: PARTNER Study. Proceedings of the 21st Conference on Retroviruses and Opportunistic Infections; 3–6 March 2014; Boston, USA. San Francisco: CROI Foundation and IAS-USA; 2018. Available online at: http://www.croiconference.org/sessions/hiv-transmission-risk-through-condomless-sex-if-hiv-partner-suppressive-art-partner-study [verified 1 December 2018].
[3] Rönn M, White PJ, Hughes G, Ward H. Developing a conceptual framework of seroadaptive behaviors in HIV-diagnosed men who have sex with men. J Infect Dis 2014; 210 S586–93.
| Developing a conceptual framework of seroadaptive behaviors in HIV-diagnosed men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 25381379PubMed |
[4] Weiss BD. Health literacy and patient safety: help patients understand. Manual for clinicians. Chicago: American Medical Association; 2007.
[5] Rootman I, Ronson B. Literacy and health research in Canada: where have we been and where should we go? Can J Public Health 2005; 96 S62–77.
| 16078556PubMed |
[6] Murray TS, Hagey J, Willms D, Shillington R, Desjardins R. Health literacy in Canada: a healthy understanding. Ottawa, ON: Canadian Council on Learning; 2008.
[7] Mitic W, Rootman I. An inter-sectoral approach for improving health literacy for Canadians. Victoria, BC: Public Health Association of British Columbia; 2012.
[8] Coleman C, Kurtz-Rossi S, McKinney J, Rootman I, Shohet L. The Calgary charter on health literacy: rationale and core principles for the development of health literacy curricula. Montreal, Quebec: The Centre for Literacy; 2011.
[9] Weiss BD. Health literacy: a manual for clinicians. Chicago: American Medical Association; 2003.
[10] Fox S, Duggan M. Health Online 2013. Washington, DC: Pew Research Center’s Internet & American Life Project; 2013. Available online at: http://www.pewinternet.org/2013/01/15/health-online-2013/ [verified 26 November 2018].
[11] Avery E, Lariscy R, Amador E, Ickowitz T, Primm C, Taylor A. Diffusion of social media among public relations practitioners in health departments across various community population sizes. J Public Relat Res 2010; 22 336–58.
| Diffusion of social media among public relations practitioners in health departments across various community population sizes.Crossref | GoogleScholarGoogle Scholar |
[12] Martin S, McDaid L. Sexual health literacy and gay, bisexual and other MSM: a scoping review of the literature. BC Gay Men’s Health Summit; 29–31 October 2014; Vancouver, Canada. Vancouver: Community-Based Research Centre for Gay Men’s Health; 2015.
[13] Morgan J, Ferlatte O, Salway T, Wilton J, Hull M. Awareness of, interest in, and willingness to pay for HIV pre-exposure prophylaxis among Canadian gay, bisexual, and other men who have sex with men. Can J Public Health 2018; 1–9.
[14] Mitchell KJ, Ybarra ML, Korchmaros JD, Kosciw JG. Accessing sexual health information online: use, motivations and consequences for youth with different sexual orientations. Health Educ Res 2014; 29 147–57.
| Accessing sexual health information online: use, motivations and consequences for youth with different sexual orientations.Crossref | GoogleScholarGoogle Scholar | 23861481PubMed |
[15] Lachowsky N, Brennan D, Georgievski G, Souleymanov R, Malfitano C. What health information are gay men in Ontario searching for online and where are they getting the answers? BC Gay Men’s Health Summit; 29–31 October 2014; Vancouver, Canada. Vancouver: Community-Based Research Centre for Gay Men’s Health; 2015.
[16] Rhodes SD, Hergenrather KC, Duncan J, Vissman AT, Miller C, Wilkin AM, Stowers J, Eng E. A pilot intervention utilizing Internet chat rooms to prevent HIV risk behaviors among men who have sex with men. Public Health Rep 2010; 125 29–37.
| A pilot intervention utilizing Internet chat rooms to prevent HIV risk behaviors among men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 20408385PubMed |
[17] Pedrana A, Hellard M, Gold J, Ata N, Chang S, Howard S, Asselin J, Ilic O, Batrouney C, Stoove M. Queer as F**k: reaching and engaging gay men in sexual health promotion through social networking sites. J Med Internet Res 2013; 15 e25
| Queer as F**k: reaching and engaging gay men in sexual health promotion through social networking sites.Crossref | GoogleScholarGoogle Scholar | 23391459PubMed |
[18] Rosenberger JG, Reece M, Novak DS, Mayer KH. The Internet as a valuable tool for promoting a new framework for sexual health among gay men and other men who have sex with men. AIDS Behav 2011; 15 S88–90.
| The Internet as a valuable tool for promoting a new framework for sexual health among gay men and other men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 21331800PubMed |
[19] Schnall R, Travers J, Rojas M, Carballo-Dieguez A. eHealth interventions for HIV prevention in high-risk men who have sex with men: a systematic review. J Med Internet Res 2014; 16 e134
| eHealth interventions for HIV prevention in high-risk men who have sex with men: a systematic review.Crossref | GoogleScholarGoogle Scholar | 24862459PubMed |
[20] Mustanski B, Ryan DT, Sanchez T, Sineath C, Macapagal K, Sullivan PS. Effects of messaging about multiple biomedical and behavioral HIV prevention methods on intentions to use among US MSM: results of an experimental messaging study. AIDS Behav 2014; 18 1651–60.
| Effects of messaging about multiple biomedical and behavioral HIV prevention methods on intentions to use among US MSM: results of an experimental messaging study.Crossref | GoogleScholarGoogle Scholar | 24907778PubMed |
[21] Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int 2000; 15 259–67.
| Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century.Crossref | GoogleScholarGoogle Scholar |
[22] Patel A, Cobourne MT. The design and content of orthodontic practise websites in the UK is suboptimal and does not correlate with search ranking. Eur J Orthod 2015; 37 447–52.
| The design and content of orthodontic practise websites in the UK is suboptimal and does not correlate with search ranking.Crossref | GoogleScholarGoogle Scholar | 25488944PubMed |
[23] Frost DM, Lehavot K, Meyer IH. Minority stress and physical health among sexual minority individuals. J Behav Med 2015; 38 1–8.
| Minority stress and physical health among sexual minority individuals.Crossref | GoogleScholarGoogle Scholar | 23864353PubMed |
[24] Ferlatte O, Salway T, Trussler T, Oliffe JL, Gilbert M. Combining intersectionality and syndemic theory to advance understandings of health inequities among Canadian gay, bisexual and other men who have sex with men. Critical Public Health 2018; 28 509–21.
| Combining intersectionality and syndemic theory to advance understandings of health inequities among Canadian gay, bisexual and other men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[25] Cyr D. Return visits: a review of how Web site design can engender visitor loyalty. J Inf Technol 2014; 29 1–26.
| Return visits: a review of how Web site design can engender visitor loyalty.Crossref | GoogleScholarGoogle Scholar |
[26] Prestage G, Mao L, Kippax S, Jin F, Hurley M, Grulich A, Imrie J, Kaldor J, Zablotska I. Use of viral load to negotiate condom use among gay men in Sydney, Australia. AIDS Behav 2009; 13 645–51.
| Use of viral load to negotiate condom use among gay men in Sydney, Australia.Crossref | GoogleScholarGoogle Scholar | 19199021PubMed |
[27] Kingdon MJ, Storholm ED, Halkitis PN, Jones DC, Moeller RW, Siconolfi D, Solomon TM. Targeting HIV prevention messaging to a new generation of gay, bisexual, and other young men who have sex with men. J Health Commun 2013; 18 325–42.
| Targeting HIV prevention messaging to a new generation of gay, bisexual, and other young men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 23320963PubMed |
[28] Viswanath K, Kreuter MW. Health disparities, communication inequalities, and eHealth. Am J Prev Med 2007; 32 S131–3.
| Health disparities, communication inequalities, and eHealth.Crossref | GoogleScholarGoogle Scholar | 17466818PubMed |
[29] The Lancet HIV PrEP: why are we waiting? Lancet HIV 2015; 2 e401
| PrEP: why are we waiting?Crossref | GoogleScholarGoogle Scholar | 26614968PubMed |
