Acceptability of a feasibility randomized clinical trial of a microenterprise intervention to reduce sexual risk behaviors and increase employment and HIV preventive practices (EMERGE) in young adults: a mixed methods assessment

• Published in: BMC public health Vol. 20; no. 1; p. 1846
• Main Authors: Jennings Mayo-Wilson, Larissa, Coleman, Jessica, Timbo, Fatmata, Latkin, Carl, Torres Brown, Elizabeth R, Butler, Anthony I, Conserve, Donaldson F, Glass, Nancy E
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 02-12-2020; BioMed Central; BMC
• Subjects: Acceptability; Adolescent; Adult; Adults; African Americans; Baltimore; Cell Phone; Clinical trials; Economic aspects; Economic conditions; Economics; Employment - statistics & numerical data; Empowerment; Feasibility; Feasibility Studies; Female; Health aspects; Health Risk Behaviors; Health risks; HIV; HIV infection; HIV Infections - prevention & control; Human immunodeficiency virus; Humans; Incentives; Male; Messages; Microenterprise; Middle Aged; Mixed methods research; Motivation; Prevention; Racism; Randomization; Risk factors; Risk taking; Sexual Behavior; Sexual Health; Sexual risk behaviors; Sexually transmitted diseases; Short message service; Small Business; STD; Text messages; Text Messaging; Young Adult; Young adults; Baltimore; United States; United States > US; Baltimore Maryland; Baltimore; Economic; Young adults; HIV; African-American; Clinical trial; Microenterprise; Qualitative; Sexual risk behaviors; Text messages; Acceptability
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-020-09904-x

Acceptability is a critical requisite in establishing feasibility when planning a larger effectiveness trial. This study assessed the acceptability of conducting a feasibility randomized clinical trial of a 20-week microenterprise intervention for economically-vulnerable African-American young adults, aged 18 to 24, in Baltimore, Maryland. Engaging MicroenterprisE for Resource Generation and Health Empowerment (EMERGE) aimed to reduce sexual risk behaviors and increase employment and uptake of HIV preventive behaviors.
Thirty-eight participants were randomized to experimental (n = 19) or comparison group (n = 19). The experimental group received text messages on job openings plus educational sessions, mentoring, a start-up grant, and business and HIV prevention text messages. The comparison group received text messages on job openings only. Qualitative and quantitative post-intervention, in-person interviews were used in addition to process documentation of study methods.
Our results found that the study design and interventions showed promise for being acceptable to economically-vulnerable African-American young adults. The largely positive endorsement suggested that factors contributing to acceptability included perceived economic potential, sexual health education, convenience, incentives, and encouraging, personalized feedback to participants. Barriers to acceptability for some participants included low cell phone connectivity, perceived payment delays, small cohort size, and disappointment with one's randomization assignment to comparison group. Use of peer referral, network, or wait-list designs, in addition to online options may enhance acceptability in a future definitive trial. Expanding administrative and mentoring support may improve overall experience.
Microenterprise interventions are acceptable ways of providing young adults with important financial and sexual health content to address HIV risks associated with economic vulnerability.
ClinicalTrials.gov. NCT03766165 . Registered 04 December 2018.