Feasibility of a computer-assisted social network motivational interviewing intervention for substance use and HIV risk behaviors for housing first residents

Abstract

Background: Social networks play positive and negative roles in the lives of homeless people influencing their alcohol and/or other drug (AOD) and HIV risk behaviors.

Methods: We developed a four-session computer-assisted social network motivational interviewing intervention for homeless adults transitioning into housing. We examined the acceptability of the intervention among staff and residents at an organization that provides permanent supportive housing through iterative rounds of beta testing. Staff were 3 men and 3 women who were residential support staff (i.e., case managers and administrators). Residents were 8 men (7 African American, 1 Hispanic) and 3 women (2 African American, 1 Hispanic) who had histories of AOD and HIV risk behaviors. We conducted a focus group with staff who gave input on how to improve the delivery of the intervention to enhance understanding and receptivity among new residents. We conducted semi-structured qualitative interviews and collected self-report satisfaction data from residents.

Results: Three themes emerged over the course of the resident interviews. Residents reported that the intervention was helpful in discussing their social network, that seeing the visualizations was more impactful than just talking about their network, and that the intervention prompted thoughts about changing their AOD use and HIV risk networks.

Conclusions: This study is the first of its kind that has developed, with input from Housing First staff and residents, a motivational interviewing intervention that targets both the structure and composition of one's social network. These results suggest that providing visual network feedback with a guided motivational interviewing discussion is a promising approach to supporting network change. ClinicalTrials.gov Identifier NCT02140359.

Keywords: Alcohol and other drug use; Data visualization; EgoWeb; HIV risk behaviors; Homelessness; Housing First; Motivational interviewing; Social network intervention.

Fig. 1

Example figures from hypothetical MNI session. Network contacts are represented by circles (graph “nodes”) and lines between nodes represent network contacts who interacted with each other in the past 2 weeks. The layout of the nodes, generated with the Fruchterman–Reingold force-directed placement algorithm highlights structural characteristics of the network, such as isolates (completely disconnected nodes) and components (a set of nodes tied together but disconnected from other nodes). The structural layout is consistent across the 4 diagrams. The figure in the upper left (a) uses node color and size, and line thickness to highlight other characteristics of the network structure, including the centrality of network actors (depicted by larger and darker nodes) and stronger relationship ties between actors (highlighted with thicker lines). The other figures use node size and color to highlight network composition. The figure in the upper right (b) highlights the likelihood of AOD use by network members with size (larger = likely, smaller = unlikely) and increased resident use when with network member by color (red drink or use more drugs with, and blue typical use). The figure in the lower left (c) highlights perceived risky sex by network members with node size (larger = likely, smaller = unlikely) and unprotected sex with network members with color (red had unprotected sex with, and blue did not have unprotected sex with). The figure in the lower right hand (d) depicts supportive network members with size and color (large and green supportive, small and blue not supportive)