Academic journal article American Journal of Health Education

Creating Project Create: Lessons Learned and Best Practices for Developing Web-Based Resources for Public Health Practitioners

Academic journal article American Journal of Health Education

Creating Project Create: Lessons Learned and Best Practices for Developing Web-Based Resources for Public Health Practitioners

Article excerpt

ABSTRACT

Background: This paper discusses the Rural Center for AIDS/STD Prevention's effort to develop a web-based service called Project CREATE that responds to a need for targeted health promotion materials expressed by directors of HIV/ STD prevention services in predominately rural states. Purpose: Project CREATE allows users to select customized photos, taglines and applicable statistics in order to design targeted prevention posters to reach persons at risk for HIV/ STDs in their areas of rural America. Methods: Project CREATE resulted from a bottom-up development process that involved pilot testing the website prototype with members of the target audience (i.e., rural HIV/AIDS health educators, prevention specialists and program coordinators), a model that could be applied to any health promotion effort. Results and Discussion: The assessment data from the pilot test attests to the need for services like Project CREATE that are developed in close coordination with the practitioners who will ultimately use these resources. Translation to Health Education Practice: The paper concludes with recommendations for best practices for public health researchers working with software developers to create web-based tools designed to be used by practitioners.

BACKGROUND

Contrary to popular misconceptions, the effects of the HIV/STD epidemic in the U.S. are not confined to urban settings. By the end of 2007, 56,209 rural people had been diagnosed with AIDS. (1) Although only 5-8% of all AIDS cases occur in rural counties, (2) HW incidence rates in rural America disproportionately affect specific geographic regions, particularly the rural South. For instance, the South accounts for 68% of all rural AIDS cases, and in some areas of the South, HIV/AIDS rates in rural areas almost match rates in urban areas. (3) In 2006, 67% of all new rural AIDS cases were located in the rural South, and more people died from MDS there than anywhere else in the country. (1) Gonorrhea and chlamydia rates in the rural Southeast were some of the highest in the nation in 2008. (4)

The burden of HIV/STD falls especially heavily upon minority populations in rural areas, such as rural African Americans, men who have sex with men (MSM), and injection drug users. Although African Americans comprise only 13% of the U.S. population, they constitute 50% of all rural AIDS cases. (3) More than half of all males diagnosed with AIDS in rural areas are exposed to HIV through male-to-male sexual contact. (1) Additionally, 20% of males diagnosed with AIDS in rural areas are exposed to HIV through injection drug use. (1) These groups might be considered "double minorities," as they both live in rural areas that have been historically underserved in terms of HIV/STD-related services and identify with minority populations whose needs are often marginalized in health policy discourse in rural settings.

Indeed, the Rural HIV/STD Prevention Work Group (5) found evidence for the underservice of rural areas in general and of "double minority" populations in particular in its work to identify factors that contribute to challenges of rural HIV/STD prevention, which include:

* Lack of infrastructure to support MSM.

* Rural to urban travel for sex.

* Denial that HIV exists in rural areas.

* Stigma toward HIV and those at risk.

* Traditional values and heritage of independence/self-sufficiency.

* "Hidden" at-risk populations.

* Social and geographic isolation.

* Lack of community infrastructure.

* Poor access to preventive and medical services.

* Methamphetamine use.

Considering these factors, the socio-cultural and structural issues that typify the U.S. HIV/AIDS epidemic at large may be very different in rural America than in suburban and urban America. Rural residents may not have access to services taken for granted by their metropolitan counterparts, such as high-speed Internet, stores that stock a wide variety of condoms and free or low-cost HIV/STD testing. …

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