Limitations
sexual behaviors
SECONDARY, RECRUITMENT
There are several limitations and implications for further studies. First, social media, such as Instagram, was used to recruit participants. An online screening survey and electronic consent forms were also used in this study. Participants who were not technology-savvy may thus have been excluded in the recruitment phase. Therefore, the study findings may not be applicable to those who are not technology-savvy and those with low eHealth literacy. Second, study participants were not blinded to group allocation. The study might be subject to performance bias, as participant knowledge of group allocation may have affected their behaviors. Third, we only evaluated participants’ intention to have chemsex in the last 3 months. Further studies should assess their intention to have chemsex in the future such as in the next 3 months. Fourth, the study outcomes were measured 3 months after the baseline, so the long-term sustainability of the intervention remains unknown. Trials with a longer follow-up period are needed to evaluate the sustained effect of eHealth interventions in enhancing the self-efficacy of MSM in refusing risky sexual behaviors and chemsex. Also, an analysis of the cost-effectiveness of eHealth interventions for chemsex should be considered. Fifth, we did not record information about the study participants’ engagement, such as the duration or frequency of their visits. These parameters should be recorded in the future to further investigate how study engagement impacts the effectiveness of interventions. Sixth, during the follow-up interviews, the number of people who had engaged in chemsex in the last 3 months was small (n=31), which might have affected the statistical power and precision of some of the secondary outcomes. Seventh, qualitative interviews should be conducted to obtain qualitative feedback from study participants in the future. Finally, similar trials should be developed and tested in other geographic areas to provide more empirical evidence to support the effectiveness of such interventions in enhancing the self-efficacy of MSM in refusing risky sexual behaviors and chemsex.