Behavioral Aspects of Low-cost Medical Devices to Improve HIV Care

描述(申请人提供)：撒哈拉以南非洲的艾滋病毒相关死亡率仍然居高不下，部分原因是对出现晚期疾病的患者进行监测和干预方面的挑战。移动卫生技术，包括生物传感器和移动电话平台等，在改善对艾滋病毒/艾滋病高危人群的监测、交流和干预目标方面前景广阔。然而，由于对人-技术界面的行为方面的关注不足，这些技术中的大多数都没有实现。总部设在马萨诸塞州总医院的平价医疗技术联盟(CAMTech)正在开发一系列强大的技术，以改善资源有限环境(RLS)的医疗保健。我将通过评估CAMTech产品组合中的一个设备，得出并验证RLS中新的、以患者为中心的技术接受的行为科学框架，CAMTech产品组合是一种用于远程检测异常生命体征的无线生物传感器。我的总体目标是成为低成本医疗技术接受和实施研究的领导者，以改善RLS的医疗保健服务，使用行为理论的基础来评估和解决技术接受的障碍。为了实现独立性，我需要在以下方面进行进一步的培训：1)定性研究方法，以得出以患者为中心的RLS干预的技术接受理论框架；2)行为理论和分析方法，侧重于在RLS中开发和测试技术接受框架；以及3)技术评估方面，包括临床研究方法和设备的技术元素，以评估技术接受并与工程师交流结果。我的指导团队包括大卫·邦斯伯格博士，他是艾滋病毒治疗行为方面的专家，领导CAMTech，以及定性方法(WARE)、行为理论和技术接受(Safren，Venkatesh)、技术设计和实施(Fletcher，Rymen)以及RLS(Lockman，Mulogo，Petersen)临床研究设计和分析方面的专家。在他们的指导下，我将通过以下具体目标检验我的中心假设，即行为理论可以优化RLS中新技术的评估：1)使用定性研究方法在RLS中开发与PLWHA相关的技术接受模型；2)从目标1导出并测试量表以测量紧急模型中的结构；以及3)使用AIMS 1和2中派生的框架，对生物传感器的可接受性和可行性进行初步研究，以识别高危PLWHA中的异常生命体征。该研究计划具有创新性，因为它将衍生和测试适用于多种有前景的低成本技术的框架，以改善RLS的医疗保健服务。此外，它将使我能够申请NIH R01来测试这个设备和其他设备的有效性。我在乌干达成功地进行了研究，在美国和乌干达都有强大的指导团队和机构支持，因此我很有能力实现这些目标。

DESCRIPTION (provided by applicant): HIV-related mortality in sub-Saharan Africa remains high, partly due to challenges with monitoring and intervening on patients presenting with advanced disease. Mobile health technologies, including biosensors and cellular phone platforms, among others, hold great promise to improve monitoring, communication and targeting of interventions to at-risk people living with HIV/AIDS (PLWHA). Yet, the majority of these technologies are not implemented due to inadequate attention to behavioral aspects of the human- technology interface. The Consortium for Affordable Medical Technologies (CAMTech), based at the Massachusetts General Hospital, is developing a robust portfolio of technologies for improving healthcare in resource limited settings (RLS). I will derive and validate a behavioral science framework of technology acceptance for novel, patient-centered technologies in RLS by evaluating 1 device in the CAMTech portfolio, a wireless biosensor for remote detection of abnormal vital signs. My overarching goal is to become a leader in the study of acceptance and implementation of low-cost medical technologies to improve healthcare delivery in RLS, using a foundation in behavioral theory to evaluate and address barriers to technology acceptance. To achieve independence, I require further training in: 1) qualitative research methods to derive a technology acceptance theoretical framework for patient-centered interventions in RLS; 2) behavioral theory and analysis methods focused on developing and testing technology acceptance frameworks in RLS; and 3) aspects of technology evaluation, including clinical research methods and technical elements of devices, to evaluate technology acceptance and communicate results with engineers. My mentoring team includes Dr. David Bangsberg, an expert in behavioral aspects of HIV treatment who leads CAMTech, and experts in qualitative methods (Ware), behavioral theory and technology acceptance (Safren, Venkatesh), technology design and implementation (Fletcher, Remien), and clinical study design and analysis in RLS (Lockman, Mulogo, Petersen). With their guidance, I will test my central hypothesis that behavioral theory can optimize the evaluation of novel technologies in RLS, through the following specific aims: 1) develop a technology acceptance model relevant to PLWHA in RLS using qualitative research methods; 2) derive and test scales to measure constructs in the emergent model from Aim 1; and 3) using the framework derived in Aims 1 and 2, perform a pilot study of acceptability and feasibility of the biosensor to identify abnormal vitl signs in at-risk PLWHA. The research plan is innovative because it will derive and test a framework applicable to the multitude of promising low-cost technologies to improve healthcare delivery in RLS. Further, it will position me to apply for an NIH R01 to test the efficacy of this and other devices. I am well positioned to accomplish these aims based upon my success conducting research in Uganda, strong mentoring team, and institutional support both in the United States and Uganda.