Abstract
BackgroundAvatars and embodied agents are a promising innovation for human health intervention because they may serve as a relational agent that might augment user engagement in a behavioral change intervention and motivate behavioral change such as antiretroviral adherence and retention in care.ObjectiveThis study aimed to develop a theory-driven talking avatar-like embodied agent mobile phone intervention guided by the information-motivation-behavioral skills model to promote HIV medication adherence and retention in care in young African American men who have sex with men (MSM).MethodsWe performed 5 iterative focus groups in Chicago with HIV-positive African American MSM aged 18-34 years to inform the ongoing development of a mobile phone app. Participants for the focus groups were recruited from 4 University of Illinois at Chicago Community Outreach Intervention Project sites located in different high HIV incidence areas of the city and the University of Illinois at Chicago HIV clinic using fliers and word of mouth. The focus group data analysis included developing an ongoing list of priorities for app changes and discussion between two of the investigators based on the project timeline, resources, and to what extent they served the app’s objectives.ResultsIn this study, 16 men participated, including 3 who participated in two groups. The acceptability for an embodied agent app was universal in all 5 focus groups. The app included the embodied agent response to questions and antiretroviral regimen information, adherence tracking, CD4 count and viral load tracking, motivational spoken messages, and customizability. Concerns that were identified and responded to in the development process included privacy, stigma, avoiding the harsh or commanding tone of voice, avoiding negative motivational statements, and making reminder functions for a variety of health care interactions.ConclusionsAn avatar-like embodied agent mHealth approach was acceptable to young HIV-positive African American MSM. Its relational nature may make it an effective method of informing, motivating, and promoting health behavioral skills. Furthermore, the app’s ease of access, stigma-free environment, and audiovisual format may help overcome some adherence barriers reported in this population.
Highlights
Young HIV-positive men who have sex with men (MSM) are an important population who may benefit from intervention on the HIV Continuum of Care
An avatar-like embodied agent mHealth approach was acceptable to young HIV-positive African American MSM
Participants affirmed that the idea of a talking instructional avatar was a welcome innovation: He looks so real, and he’s a nice attractive man, and I’m going to ask him a lot of questions about medication! This is genius idea! Thank you! People can go on their phone
Summary
Young HIV-positive men who have sex with men (MSM) are an important population who may benefit from intervention on the HIV Continuum of Care. The largest subgroup within this population comprises African American MSM. In a national study of HIV-positive MSM reported by the Centers for Disease Control and Prevention, both young MSM (aged 18-34 years) and African American MSM had the lowest viral suppression and retention in care compared with MSM in other age or racial or ethnic groups [2]. African Americans represent 13% of the US population, they account for >50% of deaths from HIV or AIDS [3]. African Americans have lower proficient health literacy than Caucasians [4], which is especially important because health literacy is associated with the antiretroviral adherence [5]. Avatars and embodied agents are a promising innovation for human health intervention because they may serve as a relational agent that might augment user engagement in a behavioral change intervention and motivate behavioral change such as antiretroviral adherence and retention in care
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