Abstract
BackgroundMobile health (mHealth) apps can provide support to people living with a chronic disease by offering resources for communication, self-management, and social support. PositiveLinks (PL) is a clinic-deployed mHealth app designed to improve the health of people with HIV. In a pilot study, PL users experienced considerable improvements in care engagement and viral load suppression. To promote its expansion to other HIV clinics, we developed an implementation strategy consisting of training resources and on-demand program support.ObjectiveThe objective of our study was to conduct an interim analysis of the barriers and facilitators to PL implementation at early adopting sites to guide optimization of our implementation strategy.MethodsSemistructured interviews with stakeholders at PL expansion sites were conducted. Analysis of interviews identified facilitators and barriers that were mapped to 22 constructs of the Consolidated Framework for Implementation Research (CFIR). The purpose of the analysis was to identify the facilitators and barriers to PL implementation in order to adapt the PL implementation strategy. Four Ryan White HIV clinics were included. Interviews were conducted with one health care provider, two clinic managers, and five individuals who coordinated site PL activities.ResultsTen common facilitators and eight common barriers were identified. Facilitators to PL implementation included PL’s fit with patient and clinic needs, PL training resources, and sites’ early engagement with their information technology personnel. Most barriers were specific to mHealth, including access to Wi-Fi networks, maintaining patient smartphone access, patient privacy concerns, and lack of clarity on how to obtain approvals for mHealth use.ConclusionsThe CFIR is a useful framework for evaluating mHealth interventions. Although PL training resources were viewed favorably, we identified important barriers to PL implementation in a sample of Ryan White clinics. This enabled our team to expand guidance on identifying information technology stakeholders and procuring and managing mobile resources. Ongoing evaluation results continue to inform improvements to the PL implementation strategy, facilitating PL access for future expansion sites.
Highlights
People living with HIV achieve positive health outcomes more effectively when they establish and maintain primary HIV care and have high adherence to their antiretroviral therapy [1,2,3]
Most barriers were specific to Mobile health (mHealth), including access to Wi-Fi networks, maintaining patient smartphone access, patient privacy concerns, and lack of clarity on how to obtain approvals for mHealth use
The Consolidated Framework for Implementation Research (CFIR) is a useful framework for evaluating mHealth interventions
Summary
People living with HIV achieve positive health outcomes more effectively when they establish and maintain primary HIV care and have high adherence to their antiretroviral therapy [1,2,3]. Mobile health (mHealth) apps can support chronic disease self-management in this population by providing a platform for communication, self-monitoring, and social support. Improved outcomes have been reported for mHealth users with chronic diseases including asthma, diabetes, and HIV [4,5,6,7,8]. Because of their potential for improving health outcomes, health systems are beginning to leverage mHealth interventions to engage people with HIV in self-management behaviors [9]. Mobile health (mHealth) apps can provide support to people living with a chronic disease by offering resources for communication, self-management, and social support. To promote its expansion to other HIV clinics, we developed an implementation strategy consisting of training resources and on-demand program support
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