Development of an mHealth platform for HIV Care: Gathering User Perspectives Through Co-Design Workshops and Interviews.

Benjamin Marent,Mary Darking,Flis Henwood

doi:10.2196/mhealth.9856

Abstract

BackgroundDespite advances in testing and treatment, HIV incidence rates within European countries are at best stable or else increasing. mHealth technology has been advocated to increase quality and cost-effectiveness of health services while dealing with growing patient numbers. However, studies suggested that mHealth apps are rarely adopted and often considered to be of low quality by users. Only a few studies (conducted in the United States) have involved people living with HIV (PLWH) in the design of mHealth.ObjectiveThe goal of this study was to facilitate a co-design process among PLWH and clinicians across 5 clinical sites in the European Union to inform the development of an mHealth platform to be integrated into clinical care pathways. We aimed to (1) elicit experiences of living with HIV and of working in HIV care, (2) identify mHealth functionalities that are considered useful for HIV care, and (3) identify potential benefits as well as concerns about mHealth.MethodsBetween January and June 2016, 14 co-design workshops and 22 semistructured interviews were conducted, involving 97 PLWH and 63 clinicians. Data were analyzed thematically and iteratively, drawing on grounded theory techniques.ResultsFindings were established into 3 thematic clusters: (1) approaching the mHealth platform, (2) imagining the mHealth platform, and (3) anticipating the mHealth platform’s implications. Co-design participants approached the mHealth platform with pre-existing concerns arising from their experiences of receiving or providing care. PLWH particularly addressed issues of stigma and questioned how mHealth could enable them to manage their HIV. Clinicians problematized the compatibility of mHealth with existing information technology systems and questioned which patients should be targeted by mHealth. Imagining the potential of mHealth for HIV care, co-design participants suggested medical functionalities (accessing test results, managing medicines and appointments, and digital communication channels), social functionalities (peer support network, international travel, etc), and general features (security and privacy, credibility, language, etc). Co-design participants also anticipated potential implications of mHealth for self-management and the provision of care.ConclusionsOur approach to co-design enabled us to facilitate early engagement in the mHealth platform, enabling patient and clinician feedback to become embedded in the development process at a preprototype phase. Although the technologies in question were not yet present, understanding how users approach, imagine, and anticipate technology formed an important source of knowledge and proved highly significant within the technology design and development process.

Highlights

Since the availability of effective antiretroviral therapy (ART) by the end of the 1990s, HIV has transformed, in developed countries at least, from a fatal to a chronic disease
At the start of the co-design workshops and interviews, we introduced the aim of the co-design study, namely, to explore the concept of an mHealth platform to participants
Throughout the data analysis, it became evident that these general experiences formed the ways in which people living with HIV (PLWH) and clinicians were reflecting upon possible functionalities, opportunities, and drawbacks of an mHealth platform

Summary

Introduction

Since the availability of effective antiretroviral therapy (ART) by the end of the 1990s, HIV has transformed, in developed countries at least, from a fatal to a chronic disease. People living with HIV (PLWH) who have access to testing, treatment, and care can enjoy a good quality of life and the same life expectancy as the general population [1]. Self-management is understood as care that is led, owned, and undertaken by patients’ themselves To this end, mHealth tools can provide patients with ubiquitous access to health data, information, and counseling beyond the face-to-face clinical encounter, which might reduce the need for routine clinical appointments and lower both the impact of HIV on patients’ lives and health care expenditure. Imagining the potential of mHealth for HIV care, co-design participants suggested medical functionalities (accessing test results, managing medicines and appointments, and digital communication channels), social functionalities (peer support network, international travel, etc), and general features (security and privacy, credibility, language, etc). The technologies in question were not yet present, understanding how users approach, imagine, and anticipate technology formed an important source of knowledge and proved highly significant within the technology design and development process

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