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    Feasibility of WeTest-Plus for providing a continuum of HIV services for MSM at risk: Pilot study of a mobile health program in 3 cities in China (Preprint)
    Zhihui ZhuXiaoyan LuPan GaoXiaodong WangXuejiao HuNianhua XieCong LiuYue ZhaoYanqiu ZhaoZhen DaiHongbo ZhangJun WangYehuan SunTao LiuShufang SunPeng YangNickolas ZallerZhihua ZhangDon Operario
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    Abstract:
    BACKGROUND Men who have sex with men (MSM) in China have high risk for HIV infection but evince suboptimal rates of HIV testing and service engagement due to various social and structural barriers. We developed a mobile health (mHealth) intervention entitled “WeTest-Plus” (WeTest+) as a user-centered “one-stop service” approach for delivering access to comprehensive information about HIV risk, HIV self-testing, behavioral and biomedical prevention, confirmatory testing, treatment, and care. OBJECTIVE The goal of the current study was to investigate the feasibility of WeTest+ to provide continuous HIV services to high-risk MSM. METHODS Participants were recruited from 3 large metropolitan cities in China (Chengdu, Suzhou, Wuhan) for a 3-week pilot test of WeTest+ to examine acceptability, feasibility, and recommendations for improvement. Participants completed a structured online questionnaire and qualitative exit interviews facilitated by project staff. “Click-through” rates were assessed to examine engagement with online content. RESULTS Almost all participants (96.4%) remained engaged with the WeTest+ program over a 3-week observational period. The majority (92.9%) self-administered the HIV self-test and submitted their test results through the online platform. Overall click-through rates were high (average 67.9%). Participants provided favorable comments about the quality and relevance of the WeTest+ information content, the engaging style of information presentation, and the user-centered features. CONCLUSIONS This pilot assessment of WeTest+ supports the promise of this program for promoting HIV self-testing and linkage to in-person services. Findings underscore the utility of a user-centered approach to MHealth program design.
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    mHealth
    Preprint
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    Topics:
    HIV/AIDS Research and Interventions
    Adolescent Sexual and Reproductive Health
    Mobile Health and mHealth Applications
    The Influence of Design and Implementation Characteristics on the Use of Maternal Mobile Health Interventions in Kenya: Systematic Literature Review
    JMIR mhealth and uhealth (2021)
    Karen SowonPriscilla MaliwichiWallace Chigona
    Background The growth of mobile technology in developing countries, coupled with pressing maternal health care challenges, has led to a widespread implementation of maternal mobile health (mHealth) innovations. However, reviews generating insights on how the characteristics of the interventions influence use are scarce. Objective This study aims to review maternal mHealth interventions in Kenya to explore the influence of intervention design and implementation characteristics on use by maternal health clients. We also provide a starting inventory for maternal mHealth interventions in the country. Methods Using a systematic approach, we retrieved a total of 1100 citations from both peer-reviewed and gray sources. Articles were screened on the basis of an inclusion and exclusion criterion, and the results synthesized by categorizing and characterizing the interventions presented in the articles. The first phase of the literature search was conducted between January and April 2019, and the second phase was conducted between April and June 2021. Results A total of 16 articles were retrieved, comprising 13 maternal mHealth interventions. The study highlighted various mHealth design and implementation characteristics that may influence the use of these interventions. Conclusions In addition to elaborating on insights that would be useful in the design and implementation of future interventions, this study contributes to a local inventory of maternal mHealth interventions that may be useful to researchers and implementers in mHealth. This study highlights the need for explanatory studies to elucidate maternal mHealth use, while complementing existing evidence on mHealth effectiveness.
    mHealth
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    A systematic review of mHealth interventions for HIV prevention and treatment among gay, bisexual, and other men who have sex with men
    Translational Behavioral Medicine (2020)
    Kimberly M. NelsonNicholas S. PerryKeith J. HorvathLaramie R. Smith
    Abstract The use of mobile health (mHealth) technologies addressing HIV disparities among gay, bisexual, and other men who have sex with men (GBMSM) has increased. A systematic review of mHealth interventions for HIV prevention and treatment among GBMSM was conducted to summarize the current evidence and provide recommendations for future research. PRISMA guidelines were followed (PROSPERO ID: 148452). Studies identified via PubMed, PsychInfo, or Embase were included that (i) were in English, (ii) were published in a peer-reviewed journal prior to July 1, 2019, (iii) presented primary results, (iv) included only GBMSM, and (v) reported the results of an mHealth intervention (e.g., text message, phone/mobile application [app]) to improve HIV prevention or treatment outcomes. Of 1,636 identified abstracts, 16 published studies met inclusion criteria. Eleven studies were conducted in the United States. One study was a fully powered randomized controlled trial (RCT), seven were single-arm pilots with pre–post assessments, four were pilot RCTs, and four tested public health campaigns with post-assessments. Seven developed study-specific apps, five used text messaging, and four used existing social networking apps. Most (81%) targeted prevention outcomes. Nine cited a specific behavioral theory. All studies found that a mHealth approach was feasible and acceptable. All interventions provided evidence of preliminary efficacy or promising trends on primary outcomes. Although mHealth interventions for HIV prevention and treatment appear feasible and acceptable, most published studies are small pilot trials. Additional research assessing the efficacy and mechanisms of mHealth interventions is needed.
    mHealth
    Health psychology
    Citations (42)
    Feasibility of WeTest-Plus for providing a continuum of HIV services for MSM at risk: Pilot study of a mobile health program in 3 cities in China (Preprint)
    Zhihui ZhuXiaoyan LuPan GaoXiaodong WangXuejiao Hu
    BACKGROUND Men who have sex with men (MSM) in China have high risk for HIV infection but evince suboptimal rates of HIV testing and service engagement due to various social and structural barriers. We developed a mobile health (mHealth) intervention entitled “WeTest-Plus” (WeTest+) as a user-centered “one-stop service” approach for delivering access to comprehensive information about HIV risk, HIV self-testing, behavioral and biomedical prevention, confirmatory testing, treatment, and care. OBJECTIVE The goal of the current study was to investigate the feasibility of WeTest+ to provide continuous HIV services to high-risk MSM. METHODS Participants were recruited from 3 large metropolitan cities in China (Chengdu, Suzhou, Wuhan) for a 3-week pilot test of WeTest+ to examine acceptability, feasibility, and recommendations for improvement. Participants completed a structured online questionnaire and qualitative exit interviews facilitated by project staff. “Click-through” rates were assessed to examine engagement with online content. RESULTS Almost all participants (96.4%) remained engaged with the WeTest+ program over a 3-week observational period. The majority (92.9%) self-administered the HIV self-test and submitted their test results through the online platform. Overall click-through rates were high (average 67.9%). Participants provided favorable comments about the quality and relevance of the WeTest+ information content, the engaging style of information presentation, and the user-centered features. CONCLUSIONS This pilot assessment of WeTest+ supports the promise of this program for promoting HIV self-testing and linkage to in-person services. Findings underscore the utility of a user-centered approach to MHealth program design.
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    Recent mobile health interventions to support medication adherence among HIV-positive MSM
    Current Opinion in HIV and AIDS (2017)
    Kathryn E. MuessigSara LeGrandKeith J. HorvathJosé A. BauermeisterLisa Hightow‐Weidman
    We describe recent mobile health (mHealth) interventions supporting antiretroviral therapy (ART) medication adherence among HIV-positive MSM.
    mHealth
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    Five Lessons Learned From Randomized Controlled Trials on Mobile Health Interventions: Consensus Procedure on Practical Recommendations for Sustainable Research (Preprint)
    Daniel PachAlizé A. RoggeJiani WangClaudia M. Witt
    BACKGROUND Clinical research on mobile health (mHealth) interventions is too slow in comparison to the rapid speed of technological advances, thereby impeding sustainable research and evidence-based implementation of mHealth interventions. OBJECTIVE We aimed to establish practical lessons from the experience of our working group, which might accelerate the development of future mHealth interventions and their evaluation by randomized controlled trials (RCTs). METHODS This paper is based on group and expert discussions, and focuses on the researchers’ perspectives after four RCTs on mHealth interventions for chronic pain. RESULTS The following five lessons are presented, which are based on practical application, increase of speed, and sustainability: (1) explore stakeholder opinions, (2) develop the mHealth app and trial simultaneously, (3) minimize complexity, (4) manage necessary resources, and (5) apply behavior change techniques. CONCLUSIONS The five lessons developed may lead toward an agile research environment. Agility might be the key factor in the development and research process of a potentially sustainable and evidence-based mHealth intervention.
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    Incorporating Health Behavior Theory into mHealth (Preprint)
    Jessica Keefe Salwen-DeremerAlyssa KhanSeth S. MartinBreanna HollowayJanelle W. Coughlin
    UNSTRUCTURED Health behavior interventions are effective for many modifiable lifestyle behaviors. In some cases, remotely-delivered behavioral interventions, particularly those that include some form of contact with a provider and strong behavioral strategies, have been shown to be as effective as traditional in-person interventions; they are also more flexible, disseminable, and cost-effective. With ubiquitous increases in mobile phone use, opportunities for remote delivery of health interventions (mHealth) have grown exponentially, particularly in the use of behavioral smartphone applications. Despite research suggesting that mHealth interventions can be effective at initiating and maintaining behavior changes, many mHealth interventions are not theoretically-based, and evidence-based behavioral strategies are not often adapted into the mobile format. Thus, there is a need for clear summaries of behavioral change theories and examples of theoretically driven behavioral strategies to unify and improve the field of mHealth. Herein, we briefly summarize both traditional and contemporary theories of behavior change, evidence-based behavioral strategies, and the methods for evaluating the degree to which they are included in existing mHealth behavioral interventions. We also discuss future research design and mobile technology development considerations.
    mHealth
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    Behavior change methods
    Mobile phone
    Behavioural sciences
    Health behavior
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    Ecological Momentary Assessment and mHealth Interventions Among Men Who Have Sex With Men: Scoping Review (Preprint)
    Viktor ClarkSunny Jung Kim
    BACKGROUND Ecological momentary assessment (EMA) is a research design that allows for the measurement of nearly instantaneous experiences within the participant’s natural environment. Using EMA can help improve recall bias, ecological validity, and patient engagement while enhancing personalization and the ubiquity of interventions. People that can benefit from the use of EMA are men who have sex with men (MSM). Previous EMA studies have been successful in capturing patterns of depression, anxiety, substance use, and risky sexual behavior. These findings are directly relevant to MSM, who have high rates of each of these psychological and behavioral outcomes. Although there is a driving force behind the growing literature surrounding EMAs among MSM, no synthesizing reviews yet exist. OBJECTIVE The aims of this study were to (1) synthesize the literature across fields on how EMA methods have been used among MSM, (2) better understand the feasibility and acceptability of EMA interventions among MSM, and (3) inform designs for future research studies on best evidence-based practices for EMA interventions. METHODS Based on 4 library databases, we conducted a scoping review of EMAs used within interventions among MSM. The eligibility criteria included peer-reviewed studies conducted in the United States and the use of EMA methodology in an intervention for MSM. Modeling after the Centers for Disease Control and Prevention’s Compendium of Evidence-Based Interventions as the framework, we applied a typology that used 8 distinct review criteria, for example, sample size, design of the intervention, random assignment, design of the follow-up investigation, rate of retention, and rate of engagement. RESULTS Our results (k=15, N=952) indicated a range of sample sizes; the smallest sample size was 12, while the largest sample size was 120. Of the 15 studies, 7 (47%) focused on outcomes related to substance use or outcomes related to psychological experiences. Of the 15 studies, 5 (33%) implemented an EMA intervention across 30 days. Of the 15 studies, 2 studies (13%) used random assignment, and 2 studies (13%) had quasi-experimental designs. Of the 15 studies, 10 studies (67%) reported acceptable retention rates greater than 70%. The outcomes that had event-contingent prompts (ie, prompts after engaging in substance use) were not as effective in engaging participants, with overall engagement rates as low as 37%. CONCLUSIONS Our systematic scoping review indicates strong evidence that the EMA methodology is both feasible and acceptable at high rates among MSM, especially, when examining psychological and behavioral outcomes such as negative or positive affect, risky sexual behavior, or substance use. Further research on optimal designs of EMA interventions for MSM is warranted.
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    Design, validation and testing of short text messages for an HIV mobile-health intervention to improve antiretroviral treatment adherence in Mexico
    AIDS Care (2018)
    Ivonne Nalliely Pérez-SánchezMaría Candela IglesiasEvelyn Rodríguez EstradaGustavo Reyes‐TeránNancy Patricia Caballero-Suárez
    Mobile Health (mHealth) interventions have become effective strategies to increase adherence to antiretroviral treatment (ART) in people living with HIV (PLWH). mHealth interventions use phone calls, e-mails, smartphone apps or short text messages (SMS) as reminders of medical appointments or ART adherence. SMS are a highly accepted mHealth strategy. Systematized processes to validate SMS tailored to end-user preferences are required to increase the effectiveness of mHealth interventions. We describe a structured approach to develop a set of SMS tailored to Mexican HIV+ individuals, focused on improving ART adherence and healthcare appointments. The process included three sequential phases: SMS design by HIV-healthcare professionals, validation by expert referees, and testing by PLWH. A set of 108 SMS in four categories (motivational self-healthcare messages, ART-collection, medical and laboratory-appointment reminders) was designed. Expert referees assessed 94.5% of messages as adequate, 65.7% as useful. Seventy-one SMS were further tested by PLWH, who considered 100% of SMS to be understandable and 57.7% useful. SMS had adequate intra-judge agreement scores for clarity and acceptability (ICC-2 = .08-.49). Qualitative feedback from expert referees and PLWH was incorporated into SMS. A final set of 41 highest-rated SMS was obtained. Careful validation of SMS could increase the effectiveness of mHealth interventions.
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    Mobile health interventions for cancer care and support: A systematic literature review (Preprint)
    Amandeep Dhir
    UNSTRUCTURED The use of mobile health (mHealth) interventions for improving quality of life (QoL) is increasing. There is a clear surge in the number of mHealth interventions for cancer patients, but the related research findings are fragmented. There is an urgent need to amalgamate the extant findings, particularly those related to reviews of the effects of mHealth interventions on cancer awareness and screening. The current study systematically review the available literature on mHealth interventions for cancer patients and survivors with a view to synthesizing the outcomes and the effects of these interventions on disease management: from awareness to survival. The study utilizes systematic literature review (SLR) and examined of 57 published studies (number of participants = 112,196) that described mHealth interventions for various types of cancer. Most of the studies found that mHealth interventions had positive effects on cancer survivors, caregiver teams, and family members. Several randomized controlled trials (RCTs) suggested that mHealth provides person-centered care in the clinical management of cancer and improves survivorship care. The SLR findings suggest that mHealth interventions should be based on theory and defined frameworks.
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    Assessment of mHealth Interventions: Need for New Studies, Methods, and Guidelines for Study Designs (Preprint)
    Roxana Ologeanu-Taddeï
    UNSTRUCTURED This viewpoint argues that the clinical effects of mobile health (mHealth) interventions depends on the acceptance and adoption of these interventions and their mediators, such as usability of the mHealth software, software performance and features, training and motivation of patients and health care professionals to participate in the experience, or characteristics of the intervention (eg, personalized feedback).
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