“You Are on the Right Track With the App:” Qualitative Analysis of Mobile Phone Use and User Feedback Regarding Mobile Phone Sexual Risk Assessments for HIV Prevention Research

Abstract

Background: Accurate self-report of sexual behavior assists in identifying potential HIV exposure in HIV prevention trials. Brief mobile phone assessments, completed daily or after sexual activity, can improve the validity and reliability of self-reported sexual behavior and allow for remote survey completion outside of the clinic setting. We conducted a qualitative study to better understand participants mobile phone use and to explore their perspectives on how to improve an existing mobile application-based sexual risk assessment.Methods: Sexually active, HIV seronegative men (n = 14) and women (n = 15) aged 18–39 years were recruited through an HIV counseling and testing clinic and community outreach in Soweto, South Africa. We conducted qualitative research through four age-stratified focus group discussions (FGDs) and analyzed a brief socio-demographics and mobile phone access questionnaire. All participants completed a sexual risk assessment before the FGD. Using a framework analytic approach, data were coded with Nvivo software.Results: All participants had access to mobile phones and internet, and 27 (93.1%) were able to download applications on their personal phones. Participants preferred mobile risk assessments to be offered in a choice of South African languages, using formal language (as opposed to emojis), with straight-forward wording and limited to five to 10 questions. Most participants found it acceptable to complete the assessment once a week, on a weekday, while a few were willing to complete it after each sexual encounter. It was suggested that a message reminder to complete the assessment should be sent at least daily until it is completed. The majority agreed that a password-protected application with a discreet logo was ideal for privacy, ease of use and flexibility for completion in any setting. A concern with this format, however, was the potential data use requirement. Participants expressed privacy concerns with using SMS, WhatsApp and other social media for risk assessments. Most agreed on an airtime incentive between ZAR5-10 (USD 0.29–0.58) per survey. Participants encouraged researchers to provide feedback to them about their sexual risk.Conclusions: Completion of mobile phone sexual risk assessments can be optimized with minimal incentives by ensuring that questionnaires are simple, brief, infrequent and have trusted privacy measures.

Novel Platforms for Biomedical HIV Prevention Delivery to Key Populations — Community Mobile Clinics, Peer-Supported, Pharmacy-Led PrEP Delivery, and the Use of Telemedicine

“…Mobile health technologies for HIV prevention have been used to increase awareness of available sexual health services, ensure privacy and to decrease awkwardness in HIV self-risk assessments with a health provider present [ 57 ]. Some mhealth platforms have applied a PrEP Information-Motivation-Behavior-skills (IBM) model tailored to key populations to promote PrEP adherence or reduction in risk behaviors [ 57 – 59 ].…”

“…Mobile health technologies for HIV prevention have been used to increase awareness of available sexual health services, ensure privacy and to decrease awkwardness in HIV self-risk assessments with a health provider present [ 57 ]. Some mhealth platforms have applied a PrEP Information-Motivation-Behavior-skills (IBM) model tailored to key populations to promote PrEP adherence or reduction in risk behaviors [ 57 – 59 ]. mHealth applications use videos, games, animation, or chatbots to deliver personalized care to users in the form of self-risk evaluation, pill-taking reminders, addressing peer and social norms, considering disclosure, or scheduling follow-up health appointments [ 60 ].…”

Implementing ecological momentary assessments to measure violence and adolescent HIV transmission risk: Lessons from Johannesburg, South Africa

“…Therefore, we planned to provide entry level android smartphones to 20% of participants enrolled in the study. Previous qualitative research on mobile phone-based data collection conducted among youth in Soweto indicated a preference for short surveys that were easy to answer, with mobile phone data provided to participants to access the applications for survey completion, followed by an airtime incentive, a voucher that could be redeemed immediately for mobile phone airtime, after survey submission [13][14][15]. Additionally, reminder messages were recommended for repeated EMA mobile phone based surveys [14].…”

“…In the US, a recent literature review on EMA in HIV research identified EMA methods using smartphone apps for HIV primary prevention, HIV treatment adherence, and substance use among young adults and adult populations [12]. Notably, previous South African research utilising daily mobile phone EMA measures was conducted among young women 18-24 years to assess HIV risk and showed more accurate reporting via the mobile phone when compared to the in-clinic survey measure [13][14][15][16].…”

“Must you make an app?” A qualitative exploration of socio-technical challenges and opportunities for designing digital maternal and child health solutions in Soweto, South Africa

“…This article describes the formative qualitative research phase that was undertaken to contextualise and inform the subsequent co-design process [18] in one of the research sites, the urban township setting of Soweto in Johannesburg Metropolitan Municipality. Previous qualitative research on digital health has been limited in settings like Soweto [19,20]. A better understanding of the socio-technical challenges and opportunities that digital health technologies afford is needed in the context of maternal and child health in Soweto, especially with regards to the COVID-19 pandemic and resulting shifts to digital technologies [9,21].…”