Developing a Consensus for Adolescent and Young Adult mHealth HIV Prevention Interventions in the United States: A Delphi Method Study
Authors: Knowles Kayla , Dowshen Nadia , Lee Susan , Tanner Amanda 
Published: June 2022

Background
Engaging adolescents and young adults (AYAs) who are at elevated risk for HIV acquisition or who are living with HIV in health care has posed a major challenge in HIV prevention and care efforts. Mobile health (mHealth) interventions are a popular and accessible strategy to support AYA engagement despite barriers to care present along the HIV care continuum. Even with progress in the field of mHealth research, expert recommendations for the process of designing, evaluating, and implementing HIV-related mHealth interventions are underdeveloped.

Objective
The aim of this study was to compile expert recommendations on the development, evaluation, and implementation of AYA-focused HIV prevention and care mHealth interventions.

Methods
Experts from adolescent mHealth HIV research networks and investigators of recently funded HIV mHealth projects and programs were identified and invited to complete a series of electronic surveys related to the design, implementation, and evaluation of HIV-related mHealth interventions. A modified Delphi method was used to ask experts to score 35 survey items on a 4-point Likert scale from not important to very important and encouraged experts to leave additional comments in textboxes. Responses were reviewed by the researchers, a team of 4 HIV mHealth intervention experts. The average importance ratings from survey responses were calculated and then categorized as retained (high importance), flagged (mid-level importance), or dropped (no/low importance). Additionally, thematic analysis of expert comments helped modify survey items for the next survey round. An evaluation of the level of agreement among experts on the most important items followed each round until consensus was reached.

Results
Of the 35 invited experts, 23 completed the first survey representing a variety of roles within a research team. Following two rounds of Delphi surveys, experts scored 24 of the 28 (86%) survey items included in round two as important to very important. The final consensus items included 24 recommendations related to the mHealth intervention design process (n=15), evaluation (n=2), and implementation (n=7). The 3 survey items with the highest average scores focused on the design process, specifically, (1) the creation of a diverse team including researchers, app software developers, and youth representation; (2) the importance of AYA-focused content; and (3) the value of an iterative process. Additionally, experts highlighted the importance of establishing the best ways to collect data and the types of data for collection during the evaluation process as well as constructing a plan for participant technology disruption when implementing an mHealth intervention.

Conclusions
The modified Delphi method was a useful tool to convene experts to determine recommendations for AYA-focused HIV prevention and care mHealth interventions. These recommendations can inform future mHealth interventions. To ensure the acceptability, feasibility, and efficacy of these AYA HIV prevention interventions, the focus must be on the specific needs of AYAs by including representation of AYAs in the process, including consistent and relevant content, ensuring appropriate data is collected, and considering technology and health accessibility barriers.