Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Sexual health
Co-creation and evaluation of people-centered mobile health messages to promote PrEP adherence among GBMSM in China: a feasibility study
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.
9 Apr 2026
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Social Media Intervention Based on the Information-Motivation-Behavioral Skills Model Promotes HIV Testing and Reduces High-Risk Behaviors Among Men Who Have Sex With Men in Resource-Limited Settings in China: Randomized Controlled Trial
BACKGROUND: Social media intervention may enhance HIV prevention among men who have sex with men, but the effect of this intervention in resource-limited settings remains unclear. OBJECTIVE: This randomized controlled trial evaluated whether a social media intervention grounded in the information-motivation-behavioral skills (IMB) model could be beneficial for HIV prevention among men who have sex with men in resource-limited settings. METHODS: Participants were recruited in Nanning, China, between April 2023 and April 2024. Eligible participants were randomly assigned to either the social media intervention group or the routine HIV prevention services control group. Participants in the intervention group received a 3-month social media intervention, which included completing video-based tasks. Baseline surveys were conducted, followed by follow-up surveys every 3 months, for a total of 2 follow-ups. Outcomes included HIV testing uptake, high-risk behavior, AIDS-related knowledge, safe sex self-efficacy, and attitude. RESULTS: A total of 180 eligible men who have sex with men were enrolled (90 per group). Follow-up rates were 97.8% (88/90) and 95.5% (86/90) for the intervention and control groups, respectively. At the follow-ups, the intervention group demonstrated significantly higher uptake of HIV testing, a lower proportion of participants reporting high-risk sexual behaviors, and higher condom use self-efficacy compared to the control group (all P<.05). After controlling for sociodemographic variables, generalized estimating equations analysis revealed that the intervention group had significantly higher odds of HIV testing (risk ratio [RR] 1.739, 95% CI 1.110-2.730), HIV self-testing (RR 2.306, 95% CI 1.593-3.340), and consistent condom use (RR 2.457, 95% CI 1.636-3.690) than the control group. Cochran-Armitage trend tests within the intervention group revealed that with increasing intervention duration, both HIV testing and HIV self-testing significantly increased, while high-risk sexual behaviors significantly decreased (all P<.05). CONCLUSIONS: The social media intervention guided by the IMB model demonstrated a positive effect on expanding HIV testing coverage, reducing high-risk behavior, enhancing AIDS-related knowledge, and improving safer sex self-efficacy among men who have sex with men in resource-limited settings. These findings provide valuable guidance for future HIV prevention and control efforts targeting this population.
8 Apr 2026
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