Study Protocol for a Peer-led Web-based Intervention to Promote Safe Usage of Dating Applications Amongst Young Adults: A Cluster Randomized Controlled Trial
Phase: NA
Conditions: Sex, Unsafe, Adolescent Behavior, Behavior, Sex
Sponsor: The University of Hong Kong

 
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Evaluation of a peer-led web-based intervention for safe usage of dating 
applications in Hong Kong: a randomized controlled trial  
 
 
 
Study Protocol 
 
 
 
 
 
July 2018  
(Version 5. Dated 16.07.2018) 
 
 
 
 
 
 
 
 
 
 
Principle Investigator: Dr. William Wong 
Address: Department of Family Medicine and Primary Care, 161 Ap Lei Chau Main 
Street, Ap Lei Chau, Hong Kong 
Co-Investigators: Tsz Hei Stephanie Lau, Dr. Julie Chen  
 
 
 

 
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Evaluation of a peer-led web-based intervention for safe usage of dating 
applications in Hong Kong: a randomized controlled trial  
 
Dr. William Wong, The University of Hong Kong  
Miss Tsz Hei Stephanie Lau, The University of Hong Kong 
Dr. Julie Chen, The University of Hong Kong 
 
Background information  
 
With the improvement of mobile technology and reliance on smartphones, the use of 
dating applications has become increasingly prevalent (1). Dating applications users are 
able to access a wide pool of potential partners that are geographically nearby due to the 
GPS usage (2). Users can indicate whether they are interested or not in a potential partner 
and both parties can chat after there is a match in which both parties indicate they are 
interested. As the general public usually has their phone with them at all times, users are 
able to access this vast network of potential partners at any time of the day. Many of the 
applications are free and lack stringent joining criteria, resulting in a diverse range of 
users (2). The increasing usage of dating applications and the factors mentioned above 
indicates that dating application could be a significant risk factor in engaging in risky 
lifestyle behaviors that ultimately have an adverse impact on health. 
 
Previous studies have found that dating application users were significantly more likely 
to have at least one prior diagnosis of sexually transmitted infection as compared to non-
users and also had more sexual partners (3). Homosexual men using dating applications 
were also more likely to have unprotected sexual intercourse (4). A meta-analysis found 
that the odds for seroconcordant and serodiscordant unprotected anal intercourse was 
higher in online initiated encounters as compared to offline initiated encounters among 
men who have sex with men (MSM) (5). In a study regarding HIV risk among MSM in 
East and South-East Asia, findings suggested that online partner finding websites alone 
did not facilitate greater risk taking, but provided more avenues for MSM who engage in 
risky HIV behavior to find more partners (6). In a study conducted in Hong Kong college 
students, dating application usage was significantly associated with unprotected sexual 
intercourse with more lifetime partners, less consistent condom usage, and the likelihood 
of not using a condom in the last sexual encounter (2).  
 
Apart from sexual risk, the usage of dating applications has also been associated with 
recreational drug use in college students (7). Furthermore, dating application users were 
more likely to have experienced sexual abuse in the past year as compared to non-users 
and are also at a higher risk for lifetime sexual abuse (8). The content presented on dating 
application profiles are also a source of concern, particularly for adolescents. A study 
analyzing content on a teen dating site found a variety of risk-related content such as 
sexual content, alcohol use, drug use, and violence (9). Concerns regarding personal 
information and monetary scams are also prevalent. This reveals a strong association 
between using dating applications and detrimental behavior, indicating the need for the 
development of interventions to encourage the safe usage of dating applications.  
 

 
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As adolescents and young adults spend a significant amount of time online, health 
interventions on the Internet represent a promising avenue to reach this population. A 
review of RCTs revealed that interactive computer based interventions were effective 
tools for sexual health learning and had positive effects on self-efficacy, intention, and 
sexual behavior (10). Other advantages of internet based interventions is the level of 
accessibility, confidentially, and availability of tailored messages or content (10). Peer 
led interventions have also been shown to be an appealing approach in health promotion 
for adolescents and young adults, as individuals in this age group tend to seek advice and 
information from their peers instead of from adults or other figures of authority (11). A 
peer led approach in the form of crowdsourcing has been shown to be useful in reaching 
and engaging communities in public health interventions (12). Crowdsourcing is 
conducted by having a large group of people work together to solve a problem (13). 
Ideas, concepts, designs, and other elements are collected from the group and synthesized 
into a final product that is presented to the community. Crowdsourcing may have some 
advantages over traditional methods of public health intervention development. Firstly, 
this is a bottom up approach that will involve community members instead of experts or 
academics. This may result in novel and more relatable ideas for the intervention. 
Secondly, crowdsourcing will also increase community involvement and awareness of a 
specific issue or public health topic (14). A systematic review found that crowdsourcing 
improved the quality, cost, and efficiency of research projects while engaging a large part 
of the public to create innovative material (15). Crowdsourcing has been a popular 
approach in developing HIV interventions and it has been shown to be feasible in 
engaging community members and in gathering culturally and locally relevant material 
(16). Crowdsourcing was also used in the CrowdOutAIDS project launched by UNAIDS 
to gather content incorporating youth perspectives and to increase community 
empowerment and mobilization (17).  
 
Due to the aforementioned reasons, we believe that that a web based peer-led intervention 
to educate the public on dating application risks would be effective and appropriate. In 
this study, we evaluate the effectiveness of a web-based peer-led intervention to promote 
safe usage of dating applications among young adults aged 18-27 in Hong Kong. The 
trial will be conducted in compliance with the protocol, GCP, and the applicable 
regulatory requirements.  
 
Trial Objectives and Purpose  
 
Aim: To promote safe usage of dating applications among young adults in Hong Kong  
 
Objectives 
• 
To evaluate the effectiveness of a web-based, peer-led intervention in: 
• 
Providing appropriate and reliable information about dating applications to 
young adults in Hong Kong 
• 
Increasing the awareness of dating application associated risks and 
benefits among young adults in Hong Kong 
• 
Improving the attitudes towards risk perception and the safe usage of 
dating applications among young adults in Hong Kong 

 
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• 
Promoting behavioral skills related to the safe usage of dating applications 
in young adults in Hong Kong, specifically in preventing and handling 
negative experiences associated with dating applications 
 
 
Trial Design  
 
Study design 
 
The study will use an open-labeled randomized control trial design with one intervention 
arm and one control. The control will have access to an online resource with similar 
interactive elements and time usage on a different topic. Both arms will complete the 
baseline and final questionnaire. There will not be any blinding as it is an open labeled 
study but participants will be randomly assigned to the intervention or control arm with a 
randomization software. Students in the Yijin program may be randomized by clusters to 
minimize the chance of contamination.  
 
Intervention 
 
The intervention is a web-based resource including text content, 4 videos, a scenario 
game and a risk assessment. The program can be accessed on both phones and other 
mobile devices such as smart phones and ipads. The topics of each segment is listed 
below:  
 
Video 1: Introduction of the theme that meeting people on dating apps and meeting 
friends in real life present the same risks. The focus is that users should not have 
assumptions when meeting people in either context. This video also touches upon social 
expectations and pressures to pay for dates, leading to potential risk of falling victim to 
monetary scams.   
Video 2: This video provides a specific example of the discrepancies in behavior in real 
life vs. when using dating apps. The situation is that one may be less alert when speaking 
to a stranger on an application.   
Video 3: This video provides another example of the risks associated with using dating 
applications and how this compares to behavior in real life.  
Video 4: This video is about the legal issues and risk of sexual assault. This video will 
also provide information on the steps to take following a negative experience and the 
available resources.  
 
Scenario game: Participants will make a personalized profile and choose their app at the 
start of the game. They will then start conversation to start the game and go through a 
series of situations where they can pick between 5 choices. With a preset algorithm, the 
choices that the users make will ultimately get them to a certain outcome.  
Topics that are explored in the game include: unsafe sexual behaviors, scams, leakage of 
personal data, intimate photos, and secret photographs.  
 

 
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Risk assessment: A 14-item risk assessment will generate an overall score for 
participants to infer of their level of risk in using dating applications.  
 
Control 
 
The control group will be the “Health Exercise for all” campaign website by the Hong 
Kong Government (18). The website provides information for types of exercises that are 
suitable for all ages and at different settings such as the workplace. The website provides 
informational pamphlets in PDF format, instructional videos on how to carry out different 
exercises, and interactive games (18).   
 
The control website begins with an introduction regarding the background of the 
campaign and it’s aims. Contact information for relevant offices for enquiry are provided. 
The campaign includes nine virtual classes that include 1) Introduction, 2) Points of Note 
and Exercise Guide and a set of videos of the exercise demonstrations. Videos range from 
20 seconds to 10 minutes. Participants in the control group will be sent links to the virtual 
classes with instructions on which time matched video to watch. The website provides 
eight different interactive games such as “Calorie Restaurant”, “Do I have a big tummy”, 
and “I want to be more active”. The “I want to be more active” game is most similar to 
the scenario game developed in the dating application intervention with seven questions 
to determine whether one is suitable to engaging is more active athletic activities.   
 
Delivery of Intervention  
 
There will be two modes of intervention delivery. In the educational settings, a research 
assistant and a member of the investigative team will attend a class session to provide a 
quick introduction to the study and deliver the web-based resource. Participants will be 
asked to bring their computers or phones and will be provided with the link to the 
intervention during a class session. Participants will be told that participation is voluntary 
and that their participation will not have any effect on their grades for the class.  
 
For participants recruited from NGOs, the intervention will be delivered electronically. 
An email containing the same information as presented by the investigative team member 
in the educational settings will be sent to the participants along with the access link to the 
intervention.  
 
Consent for participants in educational settings will be obtained with a written consent 
form. The investigative team will pass out the consent forms to the participants after the 
brief introduction of the study and before the delivery of the intervention content. 
Participants will be given time to read over the information and the signed consent form 
will be collected by the investigative team. There may be a possibility that a few students 
in the Yijin Program are under 18 as the program accepts students who just graduated 
from secondary 6. If this occurs and the student would like to participate, the school will 
provide consent for the student in loco parentis, or in the place of the parent or legal 
guardian.  
  

 
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Participants recruited from NGOs will be sent an electronic consent form. The online 
consent form is made on the program Survey Gizmo and participants can access this form 
either from a share link or through a QR code. Information on the study is provided in the 
online form and participants are prompted to tick the necessary items to indicate their 
understanding and agreement. Participants will then be able to sign the form 
electronically with their computer mouse or touch screen. The age range for recruitment 
for NGOs will be 18-27 therefore there should not be anyone below 18.   
 
The primary endpoint will be 1 month after the delivery of the intervention. Students will 
fill out a baseline questionnaire before the delivery of the intervention and an immediate 
post questionnaire. 1 month later, students will access a follow-up questionnaire via HKU 
Survey Gizmo, a secure survey tool to ensure all data is kept confidential. The details of 
the delivery method of the follow-questionnaire will be discussed with the college’s staff. 
Research staff may attend a special session or class to delivery the follow-up 
questionnaire. Another option is to have teachers deliver the follow up questionnaire. The 
follow-up questionnaire will be online hence participants will be able to access it on their 
computers, phones, or other mobile devices. Participants are estimated to participant in 
the trial for no longer than 4 months. Participants are allowed to withdraw from the study 
at any point in time without any criterion.  
 
Selection and Withdrawal of Subjects  
 
Inclusion criteria 
- 
Aged 17-27 
- 
Able to read and understand Chinese  
- 
Able to provide an active email  
 
Exclusion criteria 
- 
People who have a physical impediment in which they cannot access the material 
in the intervention  
 
Participants are allowed to withdraw from the study at any point in time without any 
criterion. We will utilize the “intention to treat” approach to deal with subjects 
withdrawn.  
 
Treatment of Subjects  
The intervention is a web based intervention and will not involve any medical treatments, 
drugs, or pharmaceuticals. The route of administration is access through any device that 
can access web-based content and the dosage is one visit.  
 
Assessment of Efficacy 
Evaluation will be done with an online survey tool called HKU Survey Gizmo. There will 
be a pre questionnaire containing baseline demographics and other questions concerning 
dating application usage. The participants will be given 30-45 minutes to access the 
program. Following that, the participants will be given a post questionnaire. 1 month 
later, the participants will be asked to fill in a follow up questionnaire.  

 
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Assessment of Safety  
Participants will be given contact information to a dedicated staff if they have any 
questions of concerns regarding the study and their participation in the study. Additional 
psychological risk may occur as the study involves bringing up sensitive topics such as 
risky sexual behavior and personal data, to minimize this risk, participants will be 
ensured that their information is protected with the utmost care and that all their gathered 
information will only be used for researched purposes. Any adverse events will be 
recorded.  
 
Statistics  
 
Sample size calculation  
The sample size was be calculated with the following components:  
•  α (two-tailed) of 0.05 
•  β = 0.8 
• Obtained from a study with a peer-led safe sex online intervention for Hong Kong 
adolescents aged <25 (19) 
o Standard deviation: 0.52 
o Effect size: 0.21  
  
Attrition rate: 15% in online studies (20, 21) 
  
112 people per intervention arm  
 
Data Analysis  
Data will be analyzed using SPSS. Descriptive statistics will be carried out analyze the 
demographics of the target population. Differences in baseline demographic 
characteristics between the intervention and control group will be assessed using chi-
squared tests. 
For outcome evaluation, paired t-tests will be used to examine within group outcome 
changes. For the primary outcome that is a score, linear regression will be used to 
evaluate the difference between the control and intervention group.  
Independent t-tests will be carried out to evaluate the score change within group and also 
between groups. The outcome difference at baseline and at follow-up will also be 
evaluated with linear regression. 
 
Direct Access to Source Data/Documents  
 
The investigator/institution will permit trial-related monitoring, audits, IRB/IEC review, 
regulatory inspections, providing direct access to source data/documents.  
 
Quality Control and Quality Assurance  
 
Ethics  
 

 
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Major ethical issues involve asking about sensitive information regarding risky sex 
behaviors, users' privacy, and legal issues. Participants will be ensured by the project's 
researchers that their information is kept strictly confidential. Researchers will also 
ensure that participants understand the purpose and procedure of every step of the project 
and participants will be provided with a contact for whenever they have any questions or 
concerns. Patients also understand that they are allowed to withdraw at any given point of 
the study. 
 
Data Handling and Record Keeping  
The PI will be responsible for the safekeeping of the personal data during and after the 
study. Members of the investigative team and a research assistant will have access to the 
data. The data will be kept in a password locked computer and will be destroyed after the 
storage period of 7 years.  
Financing and Insurance  
Financing and insurance addressed in the IRB application form.   
Publication Policy  
The results of this study will be used for a PhD thesis and other academic publications 
produced by the investigative team.  
 
 

 
9 
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