Enhancing Engagement with Online Health Messaging about Oral and Injectable PrEP Among Young-Adult MSM

Project Summary/Abstract Young-adult men who have sex with men (YMSM)—especially Black, Hispanic, and non-Hispanic White YMSM—are at heightened risk for HIV infection. Pre-exposure prophylaxis (PrEP) is highly effective at reducing HIV risk when taken as directed. Therefore, promoting PrEP—for example, through public health communication messages—represents a key public health strategy toward the long-term objective of reducing the spread of HIV. Despite PrEP's health benefits and despite YMSM's high levels of PrEP awareness, only a fraction of YMSM use PrEP. In December 2021, the US Food and Drug Administration approved long-acting injectable PrEP as a safe, highly effective alternative to oral PrEP. At present, YMSM know little about injectable PrEP but express great interest in it and in seeking more information about it. Exposure to health messaging is a necessary first step for health messages to influence behavior, so as YMSM seek out information about injectable and oral PrEP, it is imperative to understand what kind of health information they seek out about PrEP and what factors underlie those selection preferences. The overarching goal of the proposed studies is to apply health communication theories of information seeking, selective media exposure, and persuasion to examine the various types of health messaging strategies YMSM are most likely to engage with when seeking content about PrEP online (e.g., information about PrEP's effectiveness, an exemplar's testimony). Aim 1 is to determine the messaging strategies that enhance YMSM's engagement with PrEP messages, considering whether these message engagement patterns are moderated by PrEP type (injectable vs. oral). Aim 2 is to test demographic (e.g., race/ethnicity) and psychographic (e.g., perceived stigma) predictors of engagement with these messaging strategies. Aim 3 is to identify how selective engagement with different PrEP messaging strategies predicts intentions to use PrEP. We will accomplish these aims by conducting three studies with PrEP-eligible YMSM (equal portions of Black, Hispanic, and non-Hispanic White), using qualitative and quantitative methods. In Study 1, we will convene focus groups (N = 60) to inductively gather insights about YMSM's preferred (and avoided) messaging strategies. Study 2 (N = 600) and Study 3 (N = 75) will be randomized experiments in which YMSM browse a mock Internet search results page for information about PrEP. To avoid biases associated with self-reported message engagement, Studies 2 and 3 will unobtrusively track browsing behaviors (e.g., clicks). Study 3 will also include the collection of visual behavior data via mobile recruitment methods. Findings will provide actionable guidance for practitioners about the PrEP messages most likely to engage Black, Hispanic, and non-Hispanic White YMSM's attention in service of the ultimate goal of moving them down the HIV care continuum. This R21 will set the stage for an R01 assessing (a) how messaging strategies engage attention when competing with other online content in a social media context and (b) PrEP behavior as an outcome of message engagement over time.