Dissertations and Theses

Date of Degree


Document Type


Degree Name

Doctor of Public Health (DPH)


Community Health and Social Sciences


Christian Grov

Committee Members

Denis Nash

Betty Wolder Levin

Jeffrey Birnbaum

Christina Zarcadoolas

Subject Categories

Communication Technology and New Media | Health Communication | Health Psychology | Psychology | Public Health


mHealth; young women of color; sexual and reproductive health; STDs; HIV


Background: Young Black and Latina women suffer from higher sexually transmitted disease (STD) incidences than White women, increasing their susceptibility to contracting human immunodeficiency virus (HIV). The adoption and widespread usage of mobile devices has contributed to the public’s ability to access available information at all hours, including information on sexual and reproductive health (SRH). Despite a growing body of mobile health literature, there is limited understanding of how mobile-based sexual and reproductive health interventions for use by young adult Black and Latina women could improve sexual health knowledge and connection to clinical care.

Methods: This pilot randomized controlled trial evaluated preliminary efficacy of a web-based application (web-app) designed to increase knowledge of HIV and other STDs and to facilitate awareness and use of SRH care via a texting function and a clinic search tool. Participants were assigned randomly to use either the intervention web-app or a standard web-app and were administered knowledge, feasibility, and acceptability assessments at baseline and at follow-up 3 months later. Additional focus groups (n = 4) were conducted after the 3-month follow-up survey was completed and the circumstances around usage (at school, at work, in crisis, for information sharing), attitudes toward the web-app, and barriers to using the app were assessed as were the participants’ perspectives on the apps’ usefulness, trustworthiness, and usability. Inclusion criteria were: self-identified Black or Latina women aged 18 to 25 who owned a smartphone, were living or working in New York City, and reported vaginal or anal intercourse with a male partner in their lifetime. The study compared those who enrolled in the research study to those who were eligible but chose not to enroll on age, race, relationship status, education, individual income, employment status, insurance status, condomless sex acts in their lifetime, number of male sex partners in their lifetime, age of oldest male sex partner, and age of first sexual intercourse. Comparisons were made using t-tests, chi-square, or Fisher’s exact tests as appropriate (Aim 1, n = 156). In addition, drawing from self-report data, the study compared the cost per enrollee by recruitment source. To assess the feasibility and acceptability of the web-app created for this dissertation, focus group results were triangulated with baseline, post-surveys, and analytics results. We compared the treatment arms on demographics, health risk behaviors, understanding of other web-based applications, usability items, and web analytics using t-tests, chi-square, or Fisher’s exact tests, as appropriate. Focus groups were conducted by study arm and findings reported thematically by intervention and control arm (Aim 2, n =105, 4 focus groups). To explore preliminary efficacy, analyses additionally compared self-report access to reproductive health services and SRH knowledge using t-tests, chi-square, or Fisher’s exact tests, as appropriate (Aim 3, n =105). All procedures were reviewed and approved by the City University of New York Institutional Review Board (protocol # 381039).

Results: The Guide to Understanding Reproductive Health for Ladeez (GURHL) Code study found that recruiting via college professors through emails and college LISTSERVs was more effective than recruiting via Facebook banner advertisements. Data on the banner ads and the findings reported by enrollees both revealed that potential enrollees responded more favorably to banner ads that included the study logo and images of women, rather than those displaying the logo alone. Women who enrolled in the GURHL Code study were more likely to report an income below $20,000 and to be working or to be a student than were the women who were eligible but did not enroll. Triangulating focus groups, survey responses, and web analytics results suggest participants were enthusiastic about several aspects of the intervention GURHL Code web-app in comparison to the standard-of-care control web-app. These aspects included the clarity in language, transparency of the developer and designer, access to the Planned Parenthood text function, and Questions, Honest Answers. Participants from both treatment conditions found both web-apps easy to use and well organized, and additionally found the GURHL Code intervention web-app to be trustworthy and useful. We found high retention rates, successful randomization, and non-differential findings on knowledge or connection to care.

Discussion: The study found that GURHL Code, a theory-driven sexual and reproductive health (SRH) mHealth study, was feasible and acceptable among Black and Latina women 18 to 25 years old in New York City and that it merits a larger scale study to explore SRH knowledge and connection to SRH care. Future research might include a suite of web-apps available in the marketplace (e.g., Google Play and Apple’s App Store) tailored for various sub-populations of women. These could include teenaged women and parents or caregivers of young women. Cross-sector collaborations are needed to advance the health-technology field, especially with mobile designers, developers, and e-marketers.


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