A Realistic Talking Human Embodied Agent Mobile Phone Intervention to Promote HIV Medication Adherence and Retention in Care in Young HIV-Positive African American Men Who Have Sex With Men: Qualitative Study

Dworkin, Mark S.; Chakraborty, Apurba; Lee, Sang Yoon; Monahan, Colleen; Hightow-Weidman, Lisa; Garofalo, Robert; Qato, Dima M.; Jimenez, Antonio D.

doi:10.2196/10211

Cited by 38 publications

(53 citation statements)

References 22 publications

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“…Overall, across risk groups in higher-income countries, there seemed to be a theme of advanced mHealth interventions (using apps, social media, and game-like interventions) . Examples in our review included EPIC Allies, the talking avatar, and the weCare interventions that contrasted mainly to call and text-related interventions in lower-income countries [ 72 - 74 , 90 ]. This could potentially be explained by the availability of smartphones and internet connectivity in higher-income countries [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

mHealth Interventions to Promote Anti-Retroviral Adherence in HIV: Narrative Review

Lee¹,

Valerius²

2020

JMIR Mhealth Uhealth

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Background Antiretrovirals (ARVs) are key in the management of HIV. Although no cure exists, ARVs help patients live healthy lives and prevent transmission to others. Adherence to complex regimens is paramount to outcomes and in avoiding the emergence of drug-resistant viruses. The goal of therapy is to reach an undetectable viral load. However, adherence is a common problem, stemming from issues such as mental health, chaotic home situations, and busy work schedules. Mobile health (mHealth) represents a new approach in improving medication adherence, and multiple studies have been performed in this area. Objective This study aims to review the current implementation of mHealth in the management of HIV among different groups of patients. Methods We used PubMed, Academic Search Elite, and 1 journal database with various search terms to review the current implementation of mHealth in HIV care. Results Titles and abstracts were screened, and 61 papers were identified and fully reviewed. The literature was divided into lower- and higher-income nations, as defined by the United Nations. A total of 20 studies with quantitative results were identified, with 10 being text- and SMS-based interventions (the majority of these being in lower-income countries) and 8 being smartphone-based apps (primarily in higher-income countries). The majority of these studies determined whether there was an effect on adherence or biochemical parameters (viral load and CD4 count). Various qualitative studies have also been conducted, and many have focused on determining the specific design of interventions that were successful (frequency of messaging, types of messages, etc) as well as priorities for patients with regard to mHealth interventions. Conclusions There seems to be a role of mHealth in the management of HIV in lower-income nations; however, the optimal design of an intervention needs to be delineated. In higher-income countries, where the 2 significant risk factors were injection drugs and men who have sex with men, the benefit was less clear, and more research is needed.

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Section: Discussionmentioning

confidence: 99%

mHealth Interventions to Promote Anti-Retroviral Adherence in HIV: Narrative Review

Lee¹,

Valerius²

2020

JMIR Mhealth Uhealth

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“…Current apps targeting African American men have mainly been utilized in prostate cancer awareness and screening (26,27) or HIV testing and prevention (28)(29)(30)(31). To our knowledge, no apps exist that target PA or related chronic diseases.…”

Section: Introductionmentioning

confidence: 99%

Development of a mobile phone app to maintain physical activity in African American men: MobileMen

Wyatt¹,

Patton²,

McClellan³

et al. 2019

mHealth

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Background: African American men experience health disparities across a number of chronic diseases. mHealth technology is widely utilized to address lifestyle factors that contribute to these conditions. Participation of African American men in qualitative and quantitative studies of mHealth is low. Therefore, little is known regarding the acceptability of mHealth interventions and few interventions have been specifically developed for this population. The purpose of the current study is to describe the development of a smartphone application, MobileMen, to promote the maintenance of physical activity (PA) in African American men and to report on app feasibility when applied to the target population. Methods: We used a mixed methods study design including formative research, user-centered design, and a feasibility study. Focus groups (n=26) were conducted to inform the acceptability of the app and desired features. Lab usability (n=19) was used to develop the app through an iterative process. A feasibility study was conducted to assess utilization of the app over a 1-month timeframe. Measures of usability and userfriendliness were collected during lab usability sessions. Satisfaction and app usage were collected following the feasibility study. Results: The focus groups revealed that African American men use smartphone apps and that they are willing to utilize an app to maintain PA habits. The MobileMen app was subsequently developed and contained a dashboard, rewards, a learning component, a prompting system, and activity tracking. Scores increased between the first and last lab sessions for usability [5.0 (0.0) vs. 4.3 (1.0)] and user-friendliness [74.2 (17.0) vs. 70.6 (12.4)]. Participants reported acceptable satisfaction (mean values >3.5 on a 1-5 Likert scale) with most app components. Conclusions: African American men are willing to utilize mHealth to improve their health behavior, including PA. An initial version of the MobileMen app has been developed that is acceptable and user-friendly. However, there are several components requested by African American men could not be included in the current app but warrant future app development.

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“…For instance, across both groups, participants suggested having choice in the degree to which text-messages discussed the presence of HIV or a health condition, as they noted varying comfort levels with potential disclosure of health information. Such privacy concerns echo those previously reported in qualitative work among African American PLWH during the development of technology-based interventions for promoting retention in care [39,40]. Specifically, African American PLWH have stressed the importance of protecting sensitive personal information, such as sexuality and HIV serostatus, and allowing for anonymous participation to mitigate risks of inadvertent disclosure [39,40].…”

Section: Discussionmentioning

confidence: 65%

Tailoring a mobile health text-messaging intervention to promote antiretroviral therapy adherence among African Americans: A qualitative study

et al. 2020

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African Americans are disproportionately affected by HIV and socio-structural barriers that impact antiretroviral (ART) adherence. Two-way text-messaging interventions have shown promise in supporting adherence in US studies of mostly White people living with HIV (PLWH). However, culturally-appropriate tailoring is necessary to maximize intervention effectiveness among other racial/ethnic groups. Thus, to refine an existing text-messaging intervention, we examined barriers and facilitators to ART adherence among African Americans and perspectives on features to integrate into the extant intervention. Three focus groups, two with African American PLWH (n = 5 and n = 7) and one with providers of care (n = 11) were conducted; transcripts of audio-recordings were thematically analyzed. Adherence supports operated at individual, interpersonal, and structural/environmental levels (e.g., using reminders and pill organizers, wanting to protect partners from HIV, and positive interactions with providers). Adherence barriers also operated at multiple ecological levels (e.g., poor mental health, fear of disclosure of HIV status, and unstable housing). Participant-suggested features for refinement included: i) matching content to participants' comfort with receiving messages referencing HIV or medication-taking, ii) culturally-tailoring content for African Americans, iii) tracking adherence, and iv) encouraging adherence interactions between patients and providers. Feedback from both patients and providers is foundational to designing effective ART interventions among African American PLWH.

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A Realistic Talking Human Embodied Agent Mobile Phone Intervention to Promote HIV Medication Adherence and Retention in Care in Young HIV-Positive African American Men Who Have Sex With Men: Qualitative Study

Cited by 38 publications

References 22 publications

mHealth Interventions to Promote Anti-Retroviral Adherence in HIV: Narrative Review

mHealth Interventions to Promote Anti-Retroviral Adherence in HIV: Narrative Review

Development of a mobile phone app to maintain physical activity in African American men: MobileMen

Tailoring a mobile health text-messaging intervention to promote antiretroviral therapy adherence among African Americans: A qualitative study

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