Co-creation and evaluation of people-centered mobile health messages to promote PrEP adherence among GBMSM in China: a feasibility study

Clinical Snapshot

Key Findings

• P Value: Not applicable - feasibility study

• Effect Size: 90.4% of participants found messages helpful

• Primary Outcome: Feasibility of co-creation approach demonstrated with successful development of 25 mHealth messages

• Nnt Or Sensitivity: Mean message quality scores: 8.25 (relevance), 7.86 (appropriateness), 7.25 (elaboration) on 10-point scales

• Confidence Interval: Not reported

Clinical Application

High feasibility demonstrated for co-creation approach in developing culturally appropriate PrEP adherence interventions Relevant for Australian GBMSM PrEP programs, though would require cultural adaptation. Aligns with PBS-subsidised PrEP availability and RACGP guidelines emphasizing patient-centered care GBMSM using or considering PrEP, particularly in culturally diverse settings

Abstract

BACKGROUND: Co-creation has the potential to generate people-centered mobile health (mHealth) interventions to improve PrEP adherence. This study generated people-centered mHealth messages with Chinese gay, bisexual and other men who have sex with men (GBMSM) via a structured co-creation approach, and evaluated the messages quality, and assessed the feasibility of the co-creation approach. METHODS: A three-step co-creation framework was implemented with 19 GBMSM PrEP users and six HIV researchers between 2021 and 2023. Messages were assessed via 10-point scales, and the degree of usefulness by co-creators and 783 participants from a PrEP demonstration trial. Thematic analysis identified PrEP adherence barriers and participants' reflections from meeting notes and materials, with descriptive statistics summarizing evaluation results. RESULTS: Four levels of PrEP adherence barriers were identified (insufficient education, efficacy concerns, inadequate behavioral skills, PrEP stigma). Based on these barriers, 25 mHealth messages (19 posters, three videos, three text messages) were co-created, covering nine themes (e.g. missed dose coping, side-effect management). Seventeen high-quality messages were selected, with mean scores of 8.25 (relevance), 7.86 (appropriateness) and 7.25 (elaboration). Among GBMSM PrEP users who received the messages, 90.4% (708/783) valued the co-created messages as helpful. Reflections from the co-creators highlighted the value of the participatory process, confirming that co-creation effectively engages GBMSM PrEP users. CONCLUSIONS: Co-creation groups are feasible for Chinese GBMSM to identify context-specific PrEP adherence barriers and develop people-centered mHealth messages, supporting the value of co-creation for PrEP adherence intervention development in this population.