Patient/Client Engagement and Activation Using Smartphone Apps, Text-Messaging, Interactive Voice Response, and Mobile/Web Case Management Platforms

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Abstract

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The massive proliferation of mobile phones and internet-based technologies are creating opportunities for unprecedented levels of engagement with patients and clients to support their activation toward health and prevention priorities. This presentation will provide an overview of several technology platforms from teams with development support in Los Angeles, with examples of their applications in HIV/AIDS prevention and treatment support. The presentation will focus on responding to the most common questions that service providers and organizations have when considering adoption of technology-based innovations, such as, “What can technologies do realistically?”, “How much will it cost?”, “Is it feasible and acceptable with our clients or patients”; and “How can service organizations and researchers partner to leverage our complementary expertise and goals to fund, design, test, and refine technology support tools.” The presentation will also focus on client/patient feedback on their user experiences rather than statistical evidence of efficacy, which is notably lacking in this field and frequently cited as needing much more research to demonstrate efficacy. Specific technologies and projects presented will include: 1) Interactive Voice Response (IVR) and text-messaging (SMS) for adherence and appointment reminders, and supporting coping and mental health support with people living with HIV (PLH); 2) smartphone application for daily self-monitoring of physical and mental health symptoms, stress, substance use and triggers, sexual behaviors, and adherence, for both self-management and supporting treatment and intervention programs; 3) mobile phone and web applications to support supervisors and frontline field workers for case management, intervention delivery, outcome/evaluation monitoring, and fidelity monitoring and support.

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Socially Optimized Learning in Virtual Environments (SOLVE): Developing, Evaluating, and Disseminating A Game HIV Prevention Intervention Nationally Over the Web

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Abstract

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Young men (18–24) who have sex with men (YMSM) are at high risk for contracting HIV. Most existing HIV prevention interventions focus on changing intervening cognitive and deliberative processes or outcomes (e.g., beliefs, norms, self-efficacy, intentions) to change behavior. Many MSM, however, guided by contextual cues in emotionally arousing scenarios, make more automatic risky decisions they later regret. One emotion in a sexual narrative that might precipitate more automatic risky choices for young MSM may be shame (e.g., in one’s sexual desires). But, HIV prevention interventions are not designed to reduce MSM’s shame. SOLVE (Socially Optimized Learning in Virtual Environments), as demonstrated by an NIAID-funded randomized control trial, used a sex-positive game to reduce MSM’s shame, increase traditional immediate cognitive outcomes, and reduce unprotected anal intercourse for young Black, Latino, and White MSM (18–24) over 3 months. Could interactive interventions be delivered more broadly over the web? In prior CHRP funded work, a SOLVE interactive video (IAV) intervention was streamed over the web throughout California. However, an IAV approach limits the amount of user interaction, risk challenges users receive, and intervention tailoring to MSM’s decisions. This is addressed using a nationally deliverable 3D animated intelligent agents/interactive digital storytelling game in UNITY. MSM design their own characters, make choices for them on dates and sexual interactions, and are scaffolded by the user character’s virtual future self (participant’s older chosen self-character) to enhance self-regulation when risky. The NIMH-funded SOLVE-IT game development process for young MSM is discussed. Preliminary results from a 6-month randomized controlled trial conducted nationally, over the web, are promising.

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*A similar abstract was published in a previous version of your journal.

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Innovative Use of Technology for HIV Prevention and Care: Evidence, Challenges and the Way Forward

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Abstract

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Use of mobile technologies for HIV prevention and care is no longer a promise, but a reality. From 2006 to 2009, a simple search of technology-related HIV studies yielded 1,147 results on PubMed and 274 results on PsycINFO. The number of technology-related HIV studies grew substantially in the next four years, as from 2010 to 2013 there were 1629 on PubMed and 407 studies on PsycINFO. These findings suggest a surge of interest in the field of technology use in HIV prevention and care research.

In response to this growth, the Center for HIV Identification, Prevention, and Treatment Services (CHIPTS) at the University of California, Los Angeles (UCLA) hosted the “Innovative Use of Technology for HIV Prevention and Care: Evidence, Challenges and the Way Forward” conference on January 23^rd, 2014. Bringing together interdisciplinary researchers, community practitioners, clinicians, policy makers, technologists, and representatives from governmental and funding agencies, the conference sought to establish a collaborative framework for individuals to share their knowledge and experience in technology-based HIV prevention and care with each other.

Although the conference included information on different types of technologies, there was a particular emphasis on the role of mobile technology in HIV prevention and care. Popular mobile technologies are typically described as belonging to one or more the following categories: 1) cell phones, 2) native and cloud-based applications, 3) social media, and 4) mobile websites. Individuals differ in the way they use mobile technologies to communicate with each other, making it important to study the various ways in which mobile technologies can be used for HIV prevention and care. For example, cell phones facilitate multiple forms of communication, such as phone calls, short message services (SMS)/texts, and multimedia messaging services (e.g. video and picture texts)¹. In the U.S., Youth (ages 18 to 29) communicate with each other predominately through SMS², and recent HIV interventions targeting youth have utilized SMS to reduce substance use and increase HIV testing^3,4.

The recent explosion in the use of social media can have a tremendous impact on HIV research, because these technologies can serve as platforms not only to reach a large number of at risk individuals but also to gather data on the behaviors of these individuals. Social media is defined as technologies, platforms, and services that enable individuals to engage in communication from one-to-one, one-to-many, and many-to-many⁵. In 2013, 73% of adults and 80% of teens used some form of social media^6,7. There are many different types of social media, including 1) social networking sites (e.g. Facebook and MySpace), 2) blogs (e.g. Word Press or Tumblr), 3) microblogs of real-time communication (e.g. Twitter), 4) forum/bulletin boards (e.g. WebMD and Yahoo Answers), 5) social games (e.g. FarmVille and Mafia Wars), 6) media sharing (e.g. YouTube and Instagram), and 7) geosocial networking (e.g. Grindr and Jack’d). There exist different patterns of social media use based on socioeconomic, regional, and language factors, and before incorporating these technologies, researchers should understand these trends and how they impact HIV risk. For example, in the U.S., racial/ethnic (African Americans and Latinos) and sexual (e.g. gay and bisexual) minority individuals were found to be the most avid social media users^8,9. Moreover, many African American and Latino men who have sex with men (MSM) have also used online social networks/geosocial networking apps to meet sexual partners to avoid potential stigma^10,11. Taking into account information on patterns of social media use is important in learning how to craft HIV interventions and studies using social media among at-risk groups.

This conference served as an opportunity to introduce individuals to the latest mobile and social media technologies, and demonstrate research on how technologies can be used to study and address HIV among at-risk communities, along with a focus on the ethical and business-related issues associated with these approaches. The objectives of the conference were: 1) to present the most recent research findings and trends in HIV/AIDS and technology, 2) to increase the capacity of participants to develop, to implement, and to evaluate effective and evidence-based HIV/AIDS interventions with technology in clinical, research and community settings, and 3) to bring together researchers, clinicians, and technologists and to foster interdisciplinary collaborations on innovative way to improve HIV/AIDS prevention among at-risk communities.

The following topics emerged from the conference that can be used as a reference for the current state of the field, including research, community-based practice, and ethical considerations: 1) Social media and mobile technologies are increasingly being used by HIV researchers: A number of presentations focused on the use of mobile technologies, including using them as methods for recruitment, interventions, and data collection. Because of the increasing use of social media among populations at risk for HIV and highly-affected by HIV (e.g., minority MSM), researchers should continue exploring innovative ways to make use of these technologies for HIV prevention and care. 2) Community-based organizations and clinics are receptive and interested in applying social media and mobile technologies to HIV prevention and care: We heard from clinic senior management who described their interest and enthusiasm in using mobile technologies to address disparities in HIV prevention and care. Local organizations are interested and willing to partner with academic researchers on this work. 3) The ethical considerations around using these technologies for HIV prevention and care are only beginning to be explored: Our ethics panel conversation was focused primarily on a mobile application related to individuals affected by HIV and the ethical concerns of using mobile applications for HIV prevention and care. It was an initial step in providing a conversation on this needed topic and highlighted the interest and importance in establishing guidelines¹² for safety and confidentiality in technologies that might increase HIV risk, as well as those that are used for HIV prevention and care. This special issue of the journal is dedicated to providing the readers with the abstracts from the presenters of the conference.

References

1. Maximizing Mobile. Washington D.C.: The World Bank, 2012.

2. Duggan M. Cell Phone Activities 2013. PEW Research Center, 2013.

3. Reback C, Grant D, Fletcher J, Branson C, Shoptaw S, Bowers J, et al. Text Messaging Reduces HIV Risk Behaviors Among Methamphetamine-Using Men Who Have Sex with Men. AIDS and behavior. 2012 2012/10/01;16(7):1993–2002. English.

4. Cornelius JB, Dmochowski J, Boyer C, St. Lawrence J, Lightfoot M, Moore M. Text-Messaging-Enhanced HIV Intervention for African American Adolescents: A Feasibility Study. Journal of the Association of Nurses in AIDS Care. 2013 5//;24(6):256–67.

5. Social Media [cited 2013]. Available from: http://www.britannica.com/EBchecked/topic/1425043/media-convergence/310798/Social-media.

6. Duggan M, Smith A. Social Media update 2013. Washington, D.C.: Pew Research Center, 2013.

7. Madden M, Lenhart A, Cortesi S, Gasser U, Duggan M, Smith A, et al. Teens, social media, and privacy. Washington, D.C.: Pew Research Center, 2013.

8. Smith A. Technology Trends Among People of Color. Pew Research Center, 2010.

9. Harris Interactive. Gays, Lesbians and Bisexuals Lead in Usage of Online Social Networks2007 October 24, 2008. Available from: http://www.witeckcombs.com/news/releases/20070102_socialnetworks.pdf.

10. Young SD, Szekeres G, Coates T. The Relationship between Online Social Networking and Sexual Risk Behaviors among Men Who Have Sex with Men (MSM). PLoS ONE. 2013;8(5):e62271.

11. Rice E, Holloway I, Winetrobe H, Rhoades H, Barman-Adhikari A, Gibbs J, et al. Sex Risk among Young Men who have Sex with Men who use Grindr, a Smartphone Geosocial Networking Application. Journal of AIDS & Clinical Research. 2012;3.

12. Young, SD. Recommended guidelines for using social networking for HIV prevention research. AIDS and Behavior. 2012; 16(7), 1743–5.

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