“To reach the new generation… TikTok:” Applying behavioral economics to adolescent and young adult HIV pre-exposure prophylaxis education

Abstract

Objectives: To investigate how adolescents and young adults (AYA) would respond to the framing of health messages for HIV pre-exposure prophylaxis (PrEP) using principles of psychology and economics (behavioral economics). Our hypothesis was that gain-frame messaging (focused on benefits) would be better received than loss-frame messaging (focused on risks). Methods: Focus groups were held to determine AYA preferences for messaging around PrEP to design a social media video. Two videos were developed using either gain-frame (emphasized positive effects of PrEP) or loss-frame messaging (emphasized negative consequences of non-use). Thirty AYA were shown the videos and interviewed about their impressions, message framing preferences, and impact. Results: Interviews were held May – October 2023. Participants ranged in age from 15 to 25 years (mean 21.5 years) and the majority identified as White (70.0 %). Most (80.0 %) identified as cisgender. A third (33.3 %) had ever tested for HIV, none had an HIV diagnosis, and 36.7 % did not feel that PrEP applied to them personally. Thematic findings included: generally positive views of PrEP, AYA would like to see the video in a doctor's office as this would make it more trustworthy (20 %), and the video would lead them to do additional research. Gain-framed messaging was preferred over the loss-framed video messaging (53.3 %). PrEP efficacy was the most important medical fact presented. AYA disliked advertisement-like or “staged” video elements and favored genuineness and relatability. Conclusion: AYA preferred gain-framed over loss-frame PrEP messaging, and information on PrEP efficacy delivered by authentic messengers is likely to resonate. Our study generalizability may be limited due to a primarily cisgender and White sample. These findings offer novel insights into AYA perspectives around PrEP messaging for brief videos that could be disseminated through social media for PrEP education. Practice implications: Health care professionals should consider using social media and gain-framed messages for health education.