Mixed - PowerPoint Presentation

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Mixed Method Analyses of the Role of the Internet in Sexual Health Information Seeking Presented at WT Grantmixed methods meeting2011

Brian Mustanski, Ph.D.

George Greene, Ph.D.

Michelle Birkett, Ph.D.Slide2

Talk OverviewResearch on the internet,sexual health, and LGBT youthFormative qualitative researchsee Quantitative researchbased on qualitative findingsIntervention developmentSlide3

Defining sexual health“Sexual health is more than the absence of disease, but instead a state of physical, emotional, mental, and social well-being in relation to sexuality” (WHO, 2004). For Lesbian, Gay, Bisexual, and Transgender (LGBT) youth important dimensions includeKnowing and being empowered to avoid infection with HIV/STIsUnderstanding and feeling acceptance of one’s sexualityHaving a positive approach to sexual/romantic relationships. Mustanski et al. (2011) Arch Sex BehavSlide4

Need for sexual health research on LGBT youthHigh prevalence of HIV among young MSM, transgender women, and sexual risk behaviors among WSWM. Lack of prevention response. Difficult process of achieving sexual self-acceptance and potential for family and peer rejection and internalization. Barriers to developing healthy romantic relationships. Slide5

The role of the Internet as a “risk environment”Slide6

The role of the Internet as a positive environmentA 1998 online study found the majority of LGBT youth were coming out online before doing so offline (!OutProud!, 1998)2 qualitative studies suggests it can be a lifeline for LGBT youth to make friends, find information and support, and form intimate relationships (Hillier & Harrison, 2007; Mustanski et al., 2011)Slide7

But…Little is known about how LGBT youth use the internet to address sexual health, what obstacles may exist, and what is the best way to reach them.No established quantitative measure of needs, usage, and obstacles. Slide8

Qualitative SampleRecruited through flyers, websites, and word of mouth. Targeted sample diverse in terms of sexual and gender identities, age (16-24), and race/ethnicity. Sample size reached when saturation of information occurs (N = 31).

Magee et al., (In Press).

Health Education &

BehavSlide9

SaturationRecruitment of participants continued until the information collected during qualitative interviews was judged to be saturated. Progress towards saturation was assessed by brief notes written by each interviewer to summarize new information that emerged during the interview. Notes were shared with the research team and reviewed against prior notes to determine when interviews were no longer revealing novel information about the topics under study.Slide10

Qualitative Interview60-90 minute semi-structured interview focused on the role of the Internet in the development of sexual health:Identity developmentComing outSexual health knowledgeRomantic relationshipsLikes and dislikes of existing relevant websites and suggestions for our coming siteSemi-structured = set questions and probes, but flexibility to add and refine items over time, ask follow-up questions, and be an “active listener.”4 interviewers conducted interviews after extensive training. All were culturally competent with target population. Before doing interviews each listened to audio of my interviews. I listened to audio of each of their interviews and provided feedback.Magee et al., (In Press). Health Education &

BehavSlide11

Coding methodologyInterviews were transcribed nearly verbatim and then coded in ethnonotes Iterative process of codebook development (i.e. constant comparison Method; Taylor & Bodgan, 1998)Coders independently developed initial set of codes from first 2 transcripts. Codes discussed and refined. Coders attempted to apply refined codes to next 2 interviews.Coders discussed results and made further refinements. Reliability established on next 2 transcripts and again on final 2 transcript. Coders required to achieve at least .7 kappa across codes before doing independent coding (Hruschka et al., 2004)I served as the “master coder”Average kappa was .84

Magee et al., (In Press).

Health Education &

BehavSlide12
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Thematic analysisTopics set based on publication plans. Excerpts relevant to publication were retrieved (e.g. “sexual health information” and “Internet”).Coders first read the same subset of excerpts independently, then discussed the preliminary themes they perceived.Themes generating agreement across coders were retained for analysis of the next subset of excerpts.During the subsequent reading of the next subset of excerpts, coders attended to evidence supporting or contradicting proposed themes, while also noting novel themes (Ryan & Bernard, 2003).To finalize the analysis, coders organized the list into a hierarchy of themes and subthemes and as a group decided

whether

overlapping themes

could be merged

.

Once themes and subthemes were finalized, two coders applied themes to the full set of coded excerpts.

Magee et al., (In Press).

Health Education &

BehavSlide14

ResultsIn thematic analyses, three primary themes emerged from the excerpts coded with “sexual health information “ and “Internet”.Topics of online searchesMotivation for searching onlineReasons for not searching onlineInformation is not relevant (31%)Stigma if caught searching (19%)Mistrust of online information (16%)Magee et al., (In Press). Health Education & BehavSlide15

Group comparisonsFew standards for how to make group comparisons in mixed-methods research. Particular issue in interview that is not 100% structured. We considered gender, race, and age differences to be meaningful to describe if they met 3 criteria:Differences had to be noticed as a themeThemes being compared had to be endorsed by at least 5 participants (> 15% of sample)Code application rates within each group had to differ by at least 20%We emphasize these are exploratory patterns for generating a framework for continuing research rather than a test of group differences. Magee et al., (In Press). Health Education & BehavSlide16

Results: Thematic Analyses: Group Comparisons: RaceMagee et al., (In Press). Health Education & BehavSlide17

Mixed-methodsMixedSlide18

Project Q2: Quantitative componentLongitudinal study of 246 LGBT youth ages 16-20 at baseline. 49% Female, 43% Male; 8% transgender86% Racial/Ethnic minorities

Waves 1- 6 completed (91% retention at 1 year) and

~

80% retention in 5-6

Data presented here is from wave 6 collected using CASI at 30 months from baseline (N = 190).Slide19

Online activities in the last year

%

Social networking

95%

Video site (e.g. Youtube)

91%

Instant Message

85%

LGBT information

76%

Make same-age LGBT friends

65%

Healthy, dieting, fitness info

62%

HIV/AIDS information

59%

Chat room

57%

Meet someone to date

54%

Created a website, podcast, or something else online.

49%

Meet someone to have sex with

33%Slide20

What sort of Information did you search for online?

65 % had made an LGBT Friend Online

% that looked up topic

% that didn’t find

the information they

searched for

AIDS and how it is transmitted

62%

17%

STDs and their transmission

57%

15%

Clinics for HIV or STD Treatment

54%

24%

Condoms or Dental Dams

36%

7%

How to have sex with a same sex person

25%

38%

Dating Advice

25%

50%

How to have a happy relationship

32%

52%

What to do if you feel suicidal

16%

36%Slide21

HIV Information OnlineSlide22

Intervention developmentSlide23

Intervention DevelopmentWatch video here:http://www.impactprogram.org/?page_id=153Slide24

Thank you funders!

Thank you project staff and collaborators!

IMPACT Program Staff

Howard Brown Health Center

Broadway Youth Center

Joshua Magee, Ph.D.

Samantha Dehaan, BA

Robert Garofalo, MD, MPH

Erin Emerson, MA

Michael Newcomb, MA

Amy Johnson, MSW

Peter Freeman, BA

Katherine Samuels, BA

Consultants:

Eli Lieber, PhD

Jeffrey Parsons, Ph.D.

Colleen Monahan, DC, MPH

Ritch Savin-Williams, PhDSlide25

Find out morehttp://www.impactprogram.org/?p=365To download copies of the talk, journal article reporting findings, qualitative interview guide, and qualitative codebook. Password: Mixed