An mHealth Platform for People With HIV Receiving Care in Washington, District of Columbia: Qualitative Analysis of Stakeholder Feedback.
An mHealth Platform for People With HIV Receiving Care in Washington, District of Columbia: Qualitative Analysis of Stakeholder Feedback.
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DOI：
10.2196/48739
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发表时间：
2023-09-19
影响因子：
2.2
通讯作者：
Ingersoll, Karen
中科院分区：
文献类型：
--
作者：
Caldwell, Sylvia;Flickinger, Tabor;Hodges, Jacqueline;Waldman, Ava Lena D.;Garofalini, Chloe;Cohn, Wendy;Dillingham, Rebecca;Castel, Amanda;Ingersoll, Karen
关键词：
HIV 病毒抑制和保留护理仍然是华盛顿哥伦比亚特区 (DC) 艾滋病毒感染者面临的挑战性目标。 PositiveLinks 移动应用程序与非城市环境中护理保留率的提高和病毒载量抑制相关。该应用程序包括日常用药提醒、情绪和压力检查、用于点对点社交支持的匿名社区委员会、向护理团队发送安全消息以及一般和诊所特定信息的资源等功能。 PositiveLinks 尚未针对这一独特的城市艾滋病毒感染者群体进行定制或测试。这项研究旨在为移动健康应用程序的定制提供信息，以满足华盛顿特区艾滋病毒感染者及其提供者的需求。我们进行了一项由 3 部分组成的形成性研究，以指导为 DC 队列中的患者定制 PositiveLinks，该队列是一个由超过 12,000 名在华盛顿特区接受护理的 HIV 感染者组成的纵向队列。该研究包括对研究诊所的提供者 (n=28) 的深入访谈、哥伦比亚特区队列中登记的艾滋病毒感染者的焦点小组 (n=32) 以及由哥伦比亚特区健康和艾滋病毒区域规划委员会 (COHAH; n=35) 成员组成的焦点小组。定性分析采用不断比较迭代的方法；实现了主题饱和和编码器一致性。对新兴主题进行了识别和分组，以便为患者和提供者量身定制 PositiveLinks 的调整。患者、诊所提供者和 COHAH 提供者的新主题包括人口需求和担忧、参与护理和病毒抑制的促进因素和障碍、技术使用、预期效益、问题和担忧以及建议。 DC Cohort 诊所和 COHAH 提供者访谈产生了另一个主题：诊所流程。对于患者而言，最常讨论的潜在益处包括提高健康知识和素养（n=10 次）、自我监控（n=7 次）以及与同伴的联系（n=6 次）。对于提供者来说，最常见的预期好处是改善与诊所团队的沟通 (n=21)、与同行的联系 (n=14) 以及促进自我监控 (n=11)。数据审查后，网站主要研究人员选择了 PositiveLinks 的核心功能，包括每日用药依从性、情绪和压力检查、资源、常见问题和社区委员会。主要研究人员根据网站需要英语和西班牙语版本。每个诊所站点都选择了两个额外的应用程序功能（消息传递和文档）作为可选功能。总体而言，有 3 项功能未部署，因为并非所有参与诊所都支持它们。 PositiveLinks 的患者和提供者的观点有一些重叠，但有些主题对于每个组来说都是独特的。对定制应用程序进行了 Beta 测试（2022 年 8 月）。这项形成性工作为团队准备了 PositiveLinks 功效的整群随机对照试验。诊所随机分配至 PositiveLinks 或常规护理于 2022 年 8 月进行，随机对照试验于 2022 年 11 月启动。RR2-10.2196/37748
HIV viral suppression and retention in care continue to be challenging goals for people with HIV in Washington, District of Columbia (DC). The PositiveLinks mobile app is associated with increased retention in care and viral load suppression in nonurban settings. The app includes features such as daily medication reminders, mood and stress check-ins, an anonymized community board for peer-to-peer social support, secure messaging to care teams, and resources for general and clinic-specific information, among other features. PositiveLinks has not been tailored or tested for this distinct urban population of people with HIV. This study aimed to inform the tailoring of a mobile health app to the needs of people with HIV and their providers in Washington, DC. We conducted a 3-part formative study to guide the tailoring of PositiveLinks for patients in the DC Cohort, a longitudinal cohort of >12,000 people with HIV receiving care in Washington, DC. The study included in-depth interviews with providers (n=28) at study clinics, focus groups with people with HIV enrolled in the DC Cohort (n=32), and a focus group with members of the DC Regional Planning Commission on Health and HIV (COHAH; n=35). Qualitative analysis used a constant comparison iterative approach; thematic saturation and intercoder agreement were achieved. Emerging themes were identified and grouped to inform an adaptation of PositiveLinks tailored for patients and providers. Emerging themes for patients, clinic providers, and COHAH providers included population needs and concerns, facilitators and barriers to engagement in care and viral suppression, technology use, anticipated benefits, questions and concerns, and suggestions. DC Cohort clinic and COHAH provider interviews generated an additional theme: clinic processes. For patients, the most commonly discussed potential benefits included improved health knowledge and literacy (mentioned n=10 times), self-monitoring (n=7 times), and connection to peers (n=6 times). For providers, the most common anticipated benefits were improved communication with the clinic team (n=21), connection to peers (n=14), and facilitation of self-monitoring (n=11). Following data review, site principal investigators selected core PositiveLinks features, including daily medication adherence, mood and stress check-ins, resources, frequently asked questions, and the community board. Principal investigators wanted English and Spanish versions depending on the site. Two additional app features (messaging and documents) were selected as optional for each clinic site. Overall, 3 features were not deployed as not all participating clinics supported them. Patient and provider perspectives of PositiveLinks had some overlap, but some themes were unique to each group. Beta testing of the tailored app was conducted (August 2022). This formative work prepared the team for a cluster randomized controlled trial of PositiveLinks’ efficacy. Randomization of clinics to PositiveLinks or usual care occurred in August 2022, and the randomized controlled trial launched in November 2022. RR2-10.2196/37748
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