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Reimagining Health Communication

A Noninferiority Randomized Controlled Trial of Crowdsourced Intervention in China

Tang, Weiming*†‡§; Mao, Jessica; Liu, Chuncheng; Mollan, Katie§; Zhang, Ye*†‡; Tang, Songyuan*‡; Hudgens, Michael; Ma, Wei; Kang, Dianmin**; Wei, Chongyi††; Tucker, Joseph D.†‡§ SESH study group

Sexually Transmitted Diseases: March 2019 - Volume 46 - Issue 3 - p 172–178
doi: 10.1097/OLQ.0000000000000930
Original Studies

Background Crowdsourcing, the process of shifting individual tasks to a large group, may be useful for health communication, making it more people-centered. We aimed to evaluate whether a crowdsourced video is noninferior to a social marketing video in promoting condom use.

Methods Men who have sex with men (≥16 years old, had condomless sex within 3 months) were recruited and randomly assigned to watch 1 of the 2 videos in 2015. The crowdsourced video was developed through an open contest, and the social marketing video was designed by using social marketing principles. Participants completed a baseline survey and follow-up surveys at 3 weeks and 3 months postintervention. The outcome was compared with a noninferiority margin of +10%.

Results Among the 1173 participants, 907 (77%) and 791 (67%) completed the 3-week and 3-month follow-ups. At 3 weeks, condomless sex was reported by 146 (33.6%) of 434 participants and 153 (32.3%) 473 participants in the crowdsourced and social marketing arms, respectively. The crowdsourced intervention achieved noninferiority (estimated difference, +1.3%; 95% confidence interval, −4.8% to 7.4%). At 3 months, 196 (52.1%) of 376 individuals and 206 (49.6%) of 415 individuals reported condomless sex in the crowdsourced and social-marketing arms (estimated difference: +2.5%, 95% confidence interval, −4.5 to 9.5%). The 2 arms also had similar human immunodeficiency virus testing rates and other condom-related secondary outcomes.

Conclusions Our study demonstrates that crowdsourced message is noninferior to a social marketing intervention in promoting condom use among Chinese men who have sex with men. Crowdsourcing contests could have a wider reach than other approaches and create more people-centered intervention tools for human immunodeficiency virus control.

The Crowdsourced intervention was noninferior to social marketing intervention in promoting condom use with low cost. The 2 arms also had similar human immunodeficiency virus testing rates and other condom-related secondary outcomes.

From the *Dermatology Hospital, Southern Medical University;

University of North Carolina at Chapel Hill Project-China;

SESH Study Group of University of North Carolina at Chapel Hill, Guangzhou, China;

§School of Medicine;

Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC;

School of Public Health, Shandong University;

**Shandong Provincial Center for Disease Prevention and Control, Jinan, China; and

††Sc Rutgers University, Newark, NJ

SESH study group: Terrence Wong, Haochu Li, Yilu Qin, Bin Yang, Meizhen Liao, Lisa Hightow-Weidman, Barry Bayus, Fern Terris-Prestholt, Ligang Yang, Rosanna Peeling, Kevin Fenton, Shuj, ie Huang, Cheng Wang, Heping Zheng, Peter Vickerman, Kate M Mitchell, Zihuang Cheng, John Best, Thitikarn May Tangthanasup, Larry Han, and Ngai Sze Wong, Lai Sze Tso, Wei Zhang.

Acknowledgments: Thanks to Dr. Joseph Eron and Richard Youngblood for reviewing a prior version of this article. The authors thank all the study participants and staff members at SESH Global, Danlan, and the Guangdong Provincial Center for Skin Diseases and STI Control who contributed. A complete list of acknowledgments is available in the protocol.

Conflicts of Interest: None declared.

Sources of Funding: This study received support from the National Key Research and Development Program of China (2017YFE0103800), the National Institutes of Health (NIAID 1R01AI114310-01), UNC-South China STD Research Training Center (FIC 1D43TW009532-01), UNC Center for AIDS Research (NIAID 5P30AI050410), NIMH (R34MH109359), UJMT Fogarty Fellowship (FIC R25TW0093), the North Carolina Translational & Clinical Sciences Institute (1UL1TR001111), SMU Research Initiation Project (QD2017N030, C1034448), Youth Talent Grant of Guangdong Province (2017WQNCX129), Social Science Young Teacher Supporting Project of Shenzhen University (18QNFC46), and SESH (Social Entrepreneurship to Spur Health) Global.

The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the article.

J.T. and C.W. (Chongyi Wei) conceived the study. J.T., C.W. (Chongyi Wei), W.T., J.M., C.L., and T.W. designed the methods. W.T. did the analyses with the input from K.M. (Katie Mollan), M.H., and L.H., W.T. drafted the article with inputs from J.M., C.L., H.L., Y.Z., M.H., K.M. (Katie Mollan), C.W. (Chongyi Wei), and J.T., T.W., S.T., Y.Q., B.M., M.L., B.Y., W.M., D.K., L.H., B.B., F.T., L.Y., R.P., K.F., S.H., C.W. (Cheng Wang), H.Z., P.V., K.M. (Kate M Mitchell), Z.C., T.T., J.B., and N.W., W.Z., and L.T. also contributed to study design and implementation. All authors critically revised the article.

Correspondence: Weiming Tang, Dermatology Hospital, Southern Medical University; and the University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China. E-mail:

Received for publication May 23, 2018, and accepted October 12, 2018.

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© Copyright 2019 American Sexually Transmitted Diseases Association