mHealth Services Research Articles

Mobile health (mHealth) application loyalty in young consumers

PurposeThe emergence of mHealth applications has led to the rise of health-based services delivered over smartphones. Younger people are often found to be more innovative toward technology, especially related to smartphones (Rai et al., 2013). Most mHealth application downloaders are continually shifting between applications because of the hyper-competition making achieving loyal consumers challenging (Racherla et al., 2012). The purpose of this paper is to study the determinants that help increase young consumers mHealth application loyalty. This study integrates self-determination theory (SDT), gamification elements and engagement to examine loyalty.Design/methodology/approachA valid sample of 263 college student’s data was obtained for data analysis from a survey conducted in multiple campuses of the Delhi University in India.FindingsThe three psychological needs: need for autonomy, need for competence and need for relatedness, showed a positive impact on intrinsic motivation. From the gamification factors; perceived playfulness, the level of challenge and social interaction, only the first two showed a positive impact on extrinsic motivation. Both motivation factors influence engagement, showing a frequent interaction with the application, leading to loyalty.Originality/valuePrevious studies examined the adoption of mHealth services, this study is one of the first to examine young consumers’ loyalty in using mhealth apps. It sheds light on the existing literature and contributes to research on mHealth applications by determining the factors that lead to loyalty by the young consumers.

Factors influencing mHealth adoption and its impact on mental well-being during COVID-19 pandemic: A SEM-ANN approach

The objectives of this study are to examine the factors affecting the intention and actual usage behavior on mHealth adoption, investigate the effect of actual usage behavior of mHealth on mental well-being of the end-users, and investigate the moderating role of self-quarantine on the intention–actual usage of mHealth under the coronavirus disease (COVID-19) pandemic situation. The required primary data were gathered from the end-users of mHealth in Bangladesh. Using the Unified Theory of Acceptance and Use of Technology (UTAUT2), this study has confirmed that performance expectancy, effort expectancy, social influence, hedonic motivation, and facilitating conditions have a positive influence on behavioral intention whereas health consciousness has an impact on both intention and actual usage behavior. mHealth usage behavior has an affirmative and meaningful effect on the mental well-being of the service users. Moreover, self-quarantine has strong influence on actual usage behavior but does not moderate the intention-behavior relationship. In addition, due to the existence of a non-linearity problem in the data set, the Artificial Neural Network (ANN) approach was engaged to sort out relatively significant predictors acquired from Structural Equation Modeling (SEM). However, this study contributes to the emergent mHealth literature by revealing how the use of the mHealth services elevates the quality of patients' mental well-being under this pandemic situation.

MHealth and Health Care Service Delivery in Africa: A Systematic Review

We conducted a systematic review of studies on mHealth and health care services delivery that were carried out within Africa. Our search process was through MEDLINE, and then on PubMed, we searched key terms based on various keywords: “Whatsapp, health, Africa, Text messages, health impact, Africa, mHealth tools, Africa”. This was done in December of 2018. Only English written articles from journals indexed in Science Citation Index Expanded and Social Science Citation Index were incorporated in this review. In line with our inclusion criteria, only a total of 19 out of 155 studies were relevant. Inferences from these studies showed that mHealth tools are speedy and quality means for health care delivery in Africa. We also found out that there is less usage of internet devices in Africa as suspected. There is a serious need for improvement in the use of other online based mHealth tools as it was found that the use of Short Messaging Service (SMS) has been the nearly the sole mHealth intervention utilized in Africa. This, it is believed would foster better wider intervention and implementation of quality health outcomes in Africa, and other low and middle-income regions of the world.

Towards the Use of Blockchain in Mobile Health Services and Applications.

With the advent of cryptocurrencies and blockchain, the growth and adaptation of cryptographic features and capabilities were quickly extended to new and underexplored areas, such as healthcare. Currently, blockchain is being implemented mainly as a mechanism to secure Electronic Health Records (EHRs). However, new studies have shown that this technology can be a powerful tool in empowering patients to control their own health data, as well for enabling a fool-proof health data history and establishing medical responsibility. Additionally, with the proliferation of mobile health (m-Health) sustained on service-oriented architectures, the adaptation of blockchain mechanisms into m-Health applications creates the possibility for a more decentralized and available healthcare service. Hence, this paper presents a review of the current security best practices for m-Health and the most used and widely known implementations of the blockchain protocol, including blockchain technologies in m-Health. The main goal of this comprehensive review is to further discuss and elaborate on identified open-issues and potential use cases regarding the uses of blockchain in this area. Finally, the paper presents the major findings, challenges and advantages on future blockchain implementations for m-Health services and applications.

Trust and elderly users' continuance intention regarding mobile health services: the contingent role of health and technology anxieties

PurposeMobile health (mHealth) services are considered an important means of relieving the problems of the aging population. The efficiency of mHealth services can be enhanced by engaging more elderly users and guaranteeing their continued use. However, limited attention has been directed toward investigating elderly users' continuance intention regarding mHealth services. The purpose of this paper is to explain elderly users' continuance intention by investigating the contingent role of technology anxiety and health anxiety on affective trust and cognitive trust.Design/methodology/approachSurvey data were collected from 232 elderly users to verify the research model and hypotheses based on structural equation modeling (SEM).FindingsThis study revealed that both affective and cognitive trust enhance elderly users' continuance intention regarding their use of mHealth services. Health anxiety strengthens the effect of cognitive trust but weakens the effect of affective trust with regard to continuance intention. Furthermore, technology anxiety strengthens the effect of affective trust but not the effect of cognitive trust with regard to continuance intention.Originality/valueThis study is one of the first to examine elderly users' continuance intention regarding mHealth services use from the perspective of affective and cognitive trust, thus enriching the extant literature on the use of mHealth services. Additionally, this study sheds light on the contingent effects of technology anxiety and health anxiety on affective and cognitive trust, which have been neglected by previous research.

A Longitudinal perspective of mHealth Services: The Impact of Trust and Perceived Usefulness

A Longitudinal perspective of mHealth Services: The Impact of Trust and Perceived Usefulness

Mobile health readiness factors: From the perspectives of mobile health users in Indonesia

Abstract Purpose This study aims to analyze the readiness factors and dimensions affecting the use of m-health applications in Indonesia from the users' perspective. In addition, this study could be used as reference for the m-health developers to improve their existing applications. Method This research used a quantitative approach. A total of 624 respondents who have utilized m-health filled out the online questionnaire. The data were collected, analyzed, and processed by covariance-based structural equation modelling methods using AMOS 21.0 tools. Results The most influential dimensions in m -health readiness are technological readiness (i.e., ease of use and affordability) and motivational readiness (i.e., trust, attitude, and perceived usefulness). Conclusions Understanding the users’ perspective on the readiness factors can help m-health service providers to focus more on improving services in accordance with the readiness factors of users to meet user needs and increase user readiness in m-health applications.

A WhatsApp-Based Intervention to Improve Maternal Social Support and Maternal-Child Health in Southern Brazil: The Text-Message Intervention to Enhance Social Support (TIES) Feasibility Study.

Participatory learning and action cycles with women’s groups have been recommended by the WHO to promote maternal and newborn health, but few studies have tested its feasibility and acceptability in mobile health (mHealth) interventions among mothers of toddlers. This was a mixed-method feasibility assessment of an 8-week WhatsApp-based maternal support group for mothers of toddlers (12–18 months of age) enrolled in a birth cohort study in Southern Brazil. Daily messages and weekly activities were sent by moderators to promote maternal–child outcomes: child nutrition, child sleep, nurturing care, and maternal psychosocial well-being (assessed pre- and post-intervention via self-reported questionnaire). The implementation and engagement of the mothers in the program were assessed by message extraction. Acceptability was evaluated through in-depth interviews (n = 5) and open-ended surveys (n = 10). 1481 messages were exchanged in 3 WhatsApp groups (n = 30 mothers). Mothers were most active on weekdays (68.6% of messages sent on Tuesdays and 72.6% on Thursdays), afternoons (2:00–4:00pm), and evenings (9:00–11:00 pm). Engagement was higher at weeks 1–4. Mothers enjoyed and considered topics relevant. Group interaction was perceived as low, which influenced their participation. The prevalence of depression symptoms decreased from pre- to post-intervention (9% to 5%; P = .04). A moderated mobile-based support group for mothers of toddlers was feasible. mHealth services to promote maternal support are a promising strategy to improve maternal–child outcomes, but engagement and use of the service remains a challenge. Program managers should work with community members to identify ways to support engagement and participation throughout the intervention.

COVID-19-Related Disruptions and Increased mHealth Emergency Use Intention: Experience Sampling Method Study.

BackgroundThe COVID-19 pandemic has become a global public health event, which has raised concerns regarding individuals’ health. Individuals need to cope with the COVID-19 pandemic with guidelines on symptom recognition, home isolation, and maintain mental health. Besides routine use of mobile health (mHealth) such as accessing information to keep healthy, individuals can use mHealth services in situations requiring urgent medical care, which is defined as mHealth emergency use. It is not known whether individuals have increased their daily mHealth services emergency use as a result of disruptions caused by the COVID-19 pandemic.ObjectiveThe purpose of this diary analysis study is to assess the influences of daily disruptions related to the COVID-19 pandemic on individuals’ mHealth emergency use. The secondary purpose of this study is to explore the mediating role of COVID-19–induced strain and the moderating role of promotion regulatory focus in the relationship between daily disruptions of COVID-19 and mHealth emergency use. Drawing from the cognitive activation theory of stress, we investigated the underlying mechanism and boundary condition of the influence of COVID-19–related disruptions on daily mHealth emergency use.MethodsTo test the proposed model, this study adopts the experience sampling method to collect daily data. The experience sampling method helps researchers to capture participants’ fluctuations in emotions, mental engagement in an activity, and experienced stress. This study collected 550 cases nested in 110 samples in mainland China to test the conceptual model. In addition, we employed hierarchical linear modeling analysis to test the effect of COVID-19–related disruptions on mHealth emergency use.ResultsWe found that COVID-19–related disruptions increased COVID-19–induced strain (γ=0.24, P<.001) and mHealth emergency use on a daily basis (γ=0.28, P<.001). COVID-19–induced daily strain mediated this relationship (effect=0.09, 95% CI 0.05-0.14). Promotion regulatory focus moderated the relationship between COVID-19–induced strain and mHealth emergency use (γ=0.35, P=.02). In addition, the indirect relationship between disruptions and mHealth emergency use intentions through COVID-19–induced strain is contingent upon promotion regulatory focus: this relationship was stronger in those with high promotion regulatory focus (effect=0.12, 95% CI 0.06-0.19) than in those with low promotion regulatory focus (effect=0.06, 95% CI 0.02-0.11).ConclusionsEvent disruption of the COVID-19 pandemic induced mHealth emergency use intention through increased psychological strain. Furthermore, individuals’ promotion regulatory focus amplified this indirect relationship. Our findings extend our understanding of the factors underlying mHealth emergency use intention and illustrate the potential contingent role of promotion regulatory focus in the cognitive activation theory of stress. This study also opens avenues for future research on mHealth emergency use intention in other countries and cultural settings.

Building Standardized and Secure Mobile Health Services Based on Social Media

Mobile devices and social media have been used to create empowering healthcare services. However, privacy and security concerns remain. Furthermore, the integration of interoperability biomedical standards is a strategic feature. Thus, the objective of this paper is to build enhanced healthcare services by merging all these components. Methodologically, the current mobile health telemonitoring architectures and their limitations are described, leading to the identification of new potentialities for a novel architecture. As a result, a standardized, secure/private, social-media-based mobile health architecture has been proposed and discussed. Additionally, a technical proof-of-concept (two Android applications) has been developed by selecting a social media (Twitter), a security envelope (open Pretty Good Privacy (openPGP)), a standard (Health Level 7 (HL7)) and an information-embedding algorithm (modifying the transparency channel, with two versions). The tests performed included a small-scale and a boundary scenario. For the former, two sizes of images were tested; for the latter, the two versions of the embedding algorithm were tested. The results show that the system is fast enough (less than 1 s) for most mHealth telemonitoring services. The architecture provides users with friendly (images shared via social media), straightforward (fast and inexpensive), secure/private and interoperable mHealth services.

Do mobile health (mHealth) services ensure the quality of health life? An integrated approach from a developing country context

ABSTRACT Though the acceptance behavior of health technology has been investigated by several studies from different theoretical perspectives, a unified understanding is still lacking in the literature particularly addressing the Generation Y (Gen Y). Thus, the current study aims to explore the factors affecting the adoption of mHealth services among Gen Yers and how does mHealth adoption influence their quality of health life along with trust and satisfaction. With this intention, the conceptual framework was developed integrating UTAUT2 and D&M IS Success Models to predict the mHealth adoption and consequently trust, satisfaction, and quality of health life. Data were collected from existing mHealth users in Bangladesh. Results demonstrate that performance expectancy, effort expectancy, facilitating condition, social influence, hedonic motivation, system quality, and services quality had a significant impact on mHealth adoption which in turn leads to building trust, satisfaction, and improve quality of health life. Research implications are also provided for the mHealth services providers, top marketing communication managers, and policymakers in formulating and implementing effective marketing strategies to increase the acceptability of mHealth.

Interdisciplinary Mobile Health Model to Improve Clinical Care After Heart Transplantation: Implementation Strategy Study.

BackgroundSolid organ transplantation could be the only life-saving treatment for end-stage heart failure. Nevertheless, multimorbidity and polypharmacy remain major problems after heart transplant. A technology-based behavioral intervention model was established to improve clinical practice in a heart transplant outpatient setting. To support the new strategy, the mHeart app, a mobile health (mHealth) tool, was developed for use by patients and providers.ObjectiveThe primary objective of this study was to describe the implementation of the mHeart model and to outline the main facilitators identified when conceiving an mHealth approach. The secondary objectives were to evaluate the barriers, benefits, and willingness to use mHealth services reported by heart transplant recipients and cardiology providers.MethodsThis was an implementation strategy study directed by a multidisciplinary cardiology team conducted in four stages: design of the model and the software, development of the mHeart tool, interoperability among systems, and quality and security requirements. A mixed methods study design was applied combining a literature review, several surveys, interviews, and focus groups. The approach involved merging engineering and behavioral theory science. Participants were chronic-stage heart transplant recipients, patient associations, health providers, stakeholders, and diverse experts from the legal, data protection, and interoperability fields.ResultsAn interdisciplinary and patient-centered process was applied to obtain a comprehensive care model. The heart transplant recipients (N=135) included in the study confirmed they had access to smartphones (132/135, 97.7%) and were willing to use the mHeart system (132/135, 97.7%). Based on stakeholder agreement (>75%, N=26), the major priorities identified of the mHealth approach were to improve therapy management, patient empowerment, and patient-provider interactions. Stakeholder agreement on the barriers to implementing the system was weak (<75%). Establishing the new model posed several challenges to the multidisciplinary team in charge. The main factors that needed to be overcome were ensuring data confidentiality, reducing workload, minimizing the digital divide, and increasing interoperability. Experts from various fields, scientific societies, and patient associations were essential to meet the quality requirements and the model scalability.ConclusionsThe mHeart model will be applicable in distinct clinical and research contexts, and may inspire other cardiology health providers to create innovative ways to deal with therapeutic complexity and multimorbidity through health care systems. Professionals and patients are willing to use such innovative mHealth programs. The facilitators and key strategies described were needed for success in the implementation of the new holistic theory–based mHealth strategy.

Effects of mHealth-based interventions on health literacy and related factors: A systematic review.

To evaluate the effects of mobile health (mHealth)-based interventions on health literacy and related factors. Few reviews exist on the effects of mHealth-based interventions on the improvement and changes in health literacy and related factors. A systematic review was conducted using the Mixed Methods Appraisal Tool to evaluate the quality of articles. Outcome variables included eHealth literacy, mHealth literacy and health literacy. Two studies showed that health literacy was significantly enhanced after mHealth application use, particularly among those with low education and health literacy levels. Two articles reported that health information seeking and health information appraisal improved after mHealth-based interventions, thereby increasing health literacy levels. In one article, no significant relationship was found between health literacy levels and mHealth literacy. mHealth can enhance health literacy; furthermore, mobile applications effectively improve patient health literacy. However, measurement tools used for evaluating health literacy indicators are inconsistent, with the concept and components of these tools being not specifically designed for evaluating health literacy indicators. To successfully and effectively overcome health problems in diverse clinical settings, the theory-based mHealth services should be adopted while considering their intensity, frequency, duration and credibility.

Using mHealth to Provide Mobile App Users With Visualization of Health Checkup Data and Educational Videos on Lifestyle-Related Diseases: Methodological Framework for Content Development.

BackgroundThe number of people with lifestyle-related diseases continues to increase worldwide. Improving lifestyle behavior with health literacy may be the key to address lifestyle-related diseases. The delivery of educational videos using mobile health (mHealth) services can replace the conventional way of educating individuals, and visualization can replace the provision of health checkup data.ObjectiveThis paper aimed to describe the development of educational content for MIRAMED, a mobile app aimed at improving users’ lifestyle behaviors and health literacy for lifestyle-related diseases.MethodsAll videos were based on a single unified framework to provide users with a consistent flow of information. The framework was later turned into a storyboard. The final video contents were created based on this storyboard and further discussions with leading experts and specialist physicians on effective communication with app users about lifestyle-related diseases.ResultsThe app uses visualization of personal health checkup data and educational videos on lifestyle-related diseases based on the current health guidelines, scientific evidence, and expert opinions of leading specialist physicians in the respective fields. A total of 8 videos were created for specific lifestyle-related diseases affecting 8 organs: (1) brain–cerebrovascular disorder, (2) eyes–diabetic retinopathy, (3) lungs–chronic obstructive pulmonary disease, (4) heart–ischemic heart disease, (5) liver–fatty liver, (6) kidneys–chronic kidney disease (diabetic kidney disease), (7) blood vessels–peripheral arterial disease, and (8) nerves–diabetic neuropathy.ConclusionsProviding enhanced mHealth education using novel digital technologies to visualize conventional health checkup data and lifestyle-related diseases is an innovative strategy. Future studies to evaluate the efficacy of the developed content are planned.

Overview of current research in Mobile Health

In recent years, there has been a significant increase in attention to such a topic as e-Health, as well as one of its main areas - mobile e-health (mHealth). This is due to global trends, such as the increased attention of state institutions to the health of their citizens, the desire of people to maintain their health and improve the quality of life, digitalization and qualitative growth in the level of medical services, the development and dissemination of personal wearable electronic equipment and ICT technologies. The article discusses a typical architecture of a network for providing mHealth services, which includes a user's smart phone or tablet with specialized software, various mHealth devices, such as an analyzer of the composition of food and drugs or a wearable biometric sensor, as well as a remote cloud server for processing and long-term storage of user data, for connection to Internet is used. The article provides an overview of works on the mHealth topic. In particular, it is noted that at present, Russian and foreign scientists are actively studying the architecture of networks, the characteristics of the generated mHealth network traffic. Peculiarities of using mHealth mobile applications for collecting and analyzing primary data on the user's health are considered. Active research is underway on the performance of mHealth devices, such as portable personal infrared micro spectrometers, which are capable of highly efficient field analysis of food and drug composition. It is noted that such devices and related services may become quite popular in the very near future.

Examining the Effect of Overload on the MHealth Application Resistance Behavior of Elderly Users: An SOR Perspective.

Aging has increased the burden of social medical care. Mobile health (mHealth) services provide an effective way to alleviate this pressure. However, the actual usage of mHealth services for elderly users is still very low. The extant studies mainly focused on elderly users’ mHealth adoption behavior, but resistance behavior has not been sufficiently explored by previous research. A present study tried to remedy this research gap by examining the effect of overload factors on the mHealth application resistance behavior based on the stimulus-organism-response (SOR) framework. The results indicated that information overload and system feature overload of an mHealth application increased the fatigue and technostress of the elderly user, which further increased their resistance behavior. Meanwhile, we integrated the intergeneration support with the SOR model to identify the buffer factor of the elderly user’s resistance behavior. The results showed that intergenerational support not only directly decrease the elderly user’s mHealth application resistance behavior, but also moderates (weaken) the effects of fatigue and technostress on resistance behavior. The present study also provided several valuable theoretical and practical implications.

Healthcare at Your Fingertips: The Acceptance and Adoption of Mobile Medical Treatment Services among Chinese Users.

Mobile health (mHealth) services have recently been receiving increasing attention. However, there is a lack of knowledge about how users accept and adopt mobile medical treatment (MMT) services, some of the most promising mHealth services that aim to extend the patient–physician relationship beyond the conventional clinic environment. To fill this research gap, this study proposes a research model for predicting consumers’ acceptance behavior toward MMT services based on the Technology Acceptance Model (TAM). A survey was conducted among 303 Chinese MMT service users to evaluate the proposed model and relevant hypotheses using partial least squares. Several key findings were summarized from the results: (1) the attitude toward using MMT, technology anxiety, and trust are significantly associated with users’ behavioral intention to use MMT services; (2) the perceived ease of use, perceived usefulness, and trust significantly influence users’ attitude toward using MMT services; (3) the perceived interactivity, perceived personalization, and privacy concerns have significant impacts on users’ perceptions of ease of use, usefulness, and trust toward MMT services. The current findings have both theoretical and practical implications that may guide practitioners and researchers to better understand consumers’ acceptance of MMT services.

Provider Perspectives on Sexual Health Services Used by Bangladeshi Women with mHealth Digital Approach: A Qualitative Study.

Cases of sexually transmitted infections (STIs) are underreported in Bangladesh. Women in general suffer from poor sexual health outcomes due to a lack of access to sexual health services. mHealth, a digital approach to STI services, is an easier and cheaper way to disseminate health information in Bangladesh. However, women have less autonomy in accessing STI services and it is important to learn if, how and/or why women use mHealth. A qualitative study was conducted with 26 medical doctors to explore their perceptions of the mHealth STI services used by Bangladeshi women. Themes were grouped under four categories: (1) provider perceptions of mHealth for sexual healthcare; (2) the health literacy of women clients; (3) cost and maintaining timeliness in providing mHealth services; (4) mHealth service accessibility. Data suggest that mHealth can play a significant role in improving the awareness and utilization of STI services in Bangladeshi women. Successful opportunities for STI service expansion using mHealth were identified, depending on the quality and type of service delivery options, awareness of challenges related to health literacy framework, cost, accessibility to information and availability of culturally competent health experts to disseminate health information. We identify the need to increase access and use of mHealth services for sexual health, as it provides an innovative platform to bridge the health communication gaps in sexual health for Bangladeshi women.

Predictors of Smartphone Ownership Among Post-Stroke Community-Dwelling Adults: Implications for Future Mobile Health in Rehabilitation

Abstract Date Presented 03/28/20 Increasing ownership of smartphones among adults in the United States who are living with and without disabilities enables access to valued activities, including mobile health (mHealth) services. However, little is known about factors that impact smartphone ownership among poststroke community-dwelling adults. Therefore, this study describes factors that predict smartphone ownership among poststroke community-dwelling adults and the potential application of mHealth services to rehabilitation research and practice. Primary Author and Speaker: Ryan Walsh Contributing Authors: Carolyn Baum, Alex Wong

Protect MSM from HIV and other sexually transmitted diseases by providing mobile health services of partner notification: protocol for a pragmatic stepped wedge cluster randomized controlled trial

BackgroundRecently, more and more men who have sex with men (MSM) look for casual partners through online dating platforms in China. However, most are unable to know their partners’ HIV and other sexually transmitted diseases (STD) statuses, leading to the rapid increase in HIV infection among Chinese MSM. Effective partner notification is urgently needed to increase the risk awareness of MSM and prevent HIV and other STDs transmission. However, the traditional intervention mainly targets to the HIV-positive MSM and the effect is not promising. Our study aims to provide Internet-based partner notification, along with a series of health services for HIV-negative MSM to protect them from HIV and other STDs.MethodsA pragmatic stepped wedge cluster randomized controlled trial design is used to evaluate the effectiveness of a new intervention paradigm, which aims to reduce HIV and other STDs incidences among MSM in China. Through integrating a mobile health (mHealth) service application (app) to the current HIV and other STDs prevention and control methods, the new paradigm provides partner notification of HIV, syphilis, hepatitis B, and hepatitis C statuses. A total of 6172 MSM in 16 districts of Beijing, China will be recruited and randomized to sequentially receive partner notification intervention through the app at 6-month intervals. The primary outcomes are HIV incidence and the additional cost of the intervention. The secondary outcomes include incidences of syphilis, hepatitis B, and hepatitis C, disease transmission social networks, testing adherence, knowledge of HIV and STDs control, health self-responsibility awareness, changes of high risk behaviors and other related outcomes. The generalized linear mixed models (GLMM) will be used to analyze the differences of outcomes in the control period and in the intervention period.DiscussionWe expect that the HIV incidence will be significantly lower and the secondary outcomes will also be improved with providing health service of partner notification through mhealth intervention. The feasible and affordable public health intervention paradigm will have implications for HIV and STDs prevention and control among MSM and other key populations.Trial registrationClinicalTrials.gov, NCT04349748. Registered on 16 April 2020.