---
title: "Adapting LGBTQ-Affirmative CBT into a WeChat Mini-Program for Chinese MSMLWH: User-Centered Design"
id: "pubmed-42735073"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42735073"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42735073/"
doi: "10.2196/98541"
published_at: "2026-09-14T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Adapting LGBTQ-Affirmative CBT into a WeChat Mini-Program for Chinese MSMLWH: User-Centered Design
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42735073
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42735073/)
- **DOI:** [10.2196/98541](https://doi.org/10.2196%2F98541)
- **Published At:** 2026-09-14T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Chinese men who have sex with men living with HIV (MSMLWH) face high psychological distress from **minority stress** and HIV-related challenges, yet culturally tailored digital mental health interventions in China are limited. - The study adapted an evidence-based CBT program (ESTEEM) into a WeChat Mini-Program called **iESTEEM**, using a three-phase, user-centered process guided by the **ADAPT-ITT** framework. - Phase 1: Semistructured qualitative interviews with 20 MSMLWH (mean age 23.25, SD 3.08) identified core distress themes: catastrophic health anxiety, intersectional stigma/internalization, disclosure dilemmas, and intimacy barriers tied to defectiveness and shame schemas; participants preferred anonymity and bite-sized learning. - Phase 2: Systematic adaptation and platform development included theater testing with 5 participants; resulting iESTEEM features counselor assistance, privacy protections, HIV-specific scenarios, multimodal learning modules, and a back-end risk-alert system. - Phase 3: A 2-week pilot with 10 MSMLWH and 5 counselors assessed feasibility, usability, and acceptability via focus groups and platform analytics. Engagement was high: mean 14.1 logins (SD 6.7) and mean 134.3 minutes (SD 103.1) of learning per participant; all accessed module 1 and 90% accessed modules 2–5. - Pilot clinical signals: anxiety scores decreased from mean 8.9 (SD 2.3) to 7.2 (SD 3.0); depression scores were stable. Participants reported willingness to continue and to recommend the program; counselors and users endorsed contextual relevance and privacy features. - The study presents a model for culturally adapting digital mental health interventions for stigmatized groups, combining **LGBTQ-affirmative CBT**, HIV-specific content, and privacy-preserving, counselor-assisted delivery via a widely used platform. - Authors note ongoing randomized controlled trials are planned to evaluate efficacy, implementation outcomes, and mechanisms of action; details of those trials were not reported in this source.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Yale University School of Nursing, Orange, CT, United States. * 2 School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong). * 3 Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan, China, +86 18374961210. * 4 Yale University School of Public Health, New Haven, CT, United States. * 5 Second Xiangya Hospital of Central South University, Changsha, Hunan, China. * 6 Kaifu District Psychiatric Clinic, Changsha, Hunan, China. * 7 Xiangya Hospital Central South University, Changsha, Hunan, China. * PMID: **42735073** * DOI: [ 10.2196/98541 ](https://doi.org/10.2196/98541) Item in Clipboard # Digitally Adapting LGBTQ-Affirmative Cognitive Behavioral Therapy for Chinese Men Who Have Sex With Men Living With HIV: User-Centered Design Approach Weizi Wu et al. J Med Internet Res. 2026. Show details Display options Display options Format Abstract PubMed PMID J Med Internet Res Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Med+Internet+Res%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Med+Internet+Res%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42735073/) . 2026 Sep 14:28:e98541. doi: 10.2196/98541. ### Authors [Weizi Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+W&cauthor_id=42735073)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42735073/#short-view-affiliation-1 "Yale University School of Nursing, Orange, CT, United States.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42735073/#short-view-affiliation-2 "School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China \(Hong Kong\)."), [Xiaohan Song](https://pubmed.ncbi.nlm.nih.gov/?term=Song+X&cauthor_id=42735073)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42735073/#short-view-affiliation-3 "Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan, China, +86 18374961210."), [John Pachankis](https://pubmed.ncbi.nlm.nih.gov/?term=Pachankis+J&cauthor_id=42735073)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42735073/#short-view-affiliation-4 "Yale University School of Public Health, New Haven, CT, United States."), [Mengyao Yi](https://pubmed.ncbi.nlm.nih.gov/?term=Yi+M&cauthor_id=42735073)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42735073/#short-view-affiliation-3 "Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan, China, +86 18374961210."), [Mengshu Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+M&cauthor_id=42735073)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42735073/#short-view-affiliation-3 "Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan, China, +86 18374961210."), [Si Pan](https://pubmed.ncbi.nlm.nih.gov/?term=Pan+S&cauthor_id=42735073)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42735073/#short-view-affiliation-5 "Second Xiangya Hospital of Central South University, Changsha, Hunan, China."), [Ying He](https://pubmed.ncbi.nlm.nih.gov/?term=He+Y&cauthor_id=42735073)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42735073/#short-view-affiliation-5 "Second Xiangya Hospital of Central South University, Changsha, Hunan, China."), [Fei Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+F&cauthor_id=42735073)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42735073/#short-view-affiliation-6 "Kaifu District Psychiatric Clinic, Changsha, Hunan, China."), [Yang Xiong](https://pubmed.ncbi.nlm.nih.gov/?term=Xiong+Y&cauthor_id=42735073)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42735073/#short-view-affiliation-7 "Xiangya Hospital Central South University, Changsha, Hunan, China."), [Xianhong Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+X&cauthor_id=42735073)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42735073/#short-view-affiliation-3 "Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan, China, +86 18374961210.") ### Affiliations * 1 Yale University School of Nursing, Orange, CT, United States. * 2 School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong). * 3 Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan, China, +86 18374961210. * 4 Yale University School of Public Health, New Haven, CT, United States. * 5 Second Xiangya Hospital of Central South University, Changsha, Hunan, China. * 6 Kaifu District Psychiatric Clinic, Changsha, Hunan, China. * 7 Xiangya Hospital Central South University, Changsha, Hunan, China. * PMID: **42735073** * DOI: [ 10.2196/98541 ](https://doi.org/10.2196/98541) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Chinese men who have sex with men living with HIV (MSMLWH) experience substantial psychological distress driven by minority stress and HIV-related challenges. However, culturally tailored digital mental health interventions that address HIV-specific maladaptive cognitive schemas and culturally specific psychosocial stressors remain scarce in China. **Objective:** This study aimed to systematically adapt an evidence-based cognitive behavioral therapy (CBT) intervention Effective Skills to Empower Effective Men (ESTEEM) into a WeChat (Tencent) Mini-Program-based intervention (iESTEEM) specifically for Chinese MSMLWH and to evaluate its preliminary feasibility and usability. **Methods:** We used a three-phase user-centered design approach guided by the Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, and Testing (ADAPT-ITT) framework. The study proceeded in three phases: (1) a qualitative needs assessment using semistructured interviews with 20 MSMLWH (mean age 23.25, SD 3.08 years); (2) systematic intervention adaptation and platform development, including theater testing (n=5); and (3) a 2-week pilot study involving 10 MSMLWH and five counselors to evaluate feasibility, usability, and acceptability through focus groups and objective platform analytics. **Results:** Phase 1 identified 3 major themes of psychological distress: persistent health anxiety fueled by catastrophizing, intersectional stigma internalization, the disclosure dilemma, and intimacy barriers rooted in defectiveness and shame schemas. Participants also prioritized anonymity and bite-sized learning. Guided by these findings, iESTEEM was developed as a counselor-assisted, privacy-preserving WeChat Mini-Program incorporating HIV-specific scenarios, multimodal learning modules, and a back-end risk-alert system. During the 2-week pilot, participants logged into the platform 14.1 (SD 6.7) times per person and completed 134.3 (SD 103.1) minutes of learning activities; all participants accessed module 1, and 90% (9/10) accessed modules 2-5. Anxiety scores decreased from 8.9 (SD 2.3) to 7.2 (SD 3.0), whereas depression scores remained stable. All participants expressed a willingness to continue using the program and to recommend it to peers. Participants and counselors endorsed its contextual relevance, privacy protections, and clinical utility. **Conclusions:** This study provides a theory- and evidence-informed model for culturally adapting digital mental health interventions for highly stigmatized populations. By integrating lesbian, gay, bisexual, transgender, and queer (LGBTQ)-affirmative CBT principles, HIV-specific adaptations, and a privacy-preserving, counselor-assisted WeChat Mini-Program, iESTEEM demonstrated promising preliminary feasibility, acceptability, and engagement among Chinese MSMLWH. These findings support the potential of culturally tailored digital interventions to expand access to psychological support for this stigmatized population in resource-constrained settings. Ongoing randomized controlled trials will further evaluate its efficacy, implementation outcomes, and mechanism of action. **Keywords:** HIV; cognitive behavioral therapy; digital health; men who have sex with men; mental health; minority stress. © Weizi Wu, Xiaohan Song, John Pachankis, Mengyao Yi, Mengshu Li, Si Pan, Ying He, Fei Li, Yang Xiong, Xianhong Li. Originally published in the Journal of Medical Internet Research (https://www.jmir.org). 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