Tailoring mHealth HIV Interventions Is Key for Equity of Access in Latinx Patients

Equity of access in patients and populations of limited English proficiency can be improved through more tailored mobile health (mHealth) interventions, as there is currently an identifiable gap in the use and tailoring of applications for Latinx people living with HIV, according to a study published in JAMIA Open.

Latinx people living in the United States make up 30% of all new HIV cases in the country and also experience health disparities due to challenges associated with social and economic factors. mHealth, the use of smartphones and other mobile devices to support health care, has been a new way to address these disparities. ConexionesPositivas (CP), an application for self-monitoring mood and stress check-ins and medication reminders, is an mHealth intervention aimed at Latinx people with HIV (PWH).

This study aimed to provide insight into the challenges faced by Spanish-speaking PWH and get feedback on their experiences with CP to inform optimization of the CP platform.

Hand of woman using smartphone on wooden table | Image credit: THE YOOTH - stock.adobe.com

The study utilized a user-centered design approach to improve CP for the priority population and involved individual interviews about CP to ensure comfort in answering questions. All participants were Spanish-speaking Latinx CP users and needed to be active with CP for at least 1 month, be diagnosed with HIV, be over 18 years old, and be native Spanish speakers. Participants were both monolingual Spanish speakers and bilingual English and Spanish speakers. Interviews were conducted from February to March of 2021.

All participants completed the 10-item System Usability Scale (SUS) to assess usability of the mHealth app. Interviews assessed the experiences of users with the application and ranged from 13 to 56 minutes total. Transcripts were created for each interview.

There were 20 participants in this study. All participants were born outside of the United States and were likely 45% male, 45% female, 10% transgender, and had a mean (SD) age of 41 (11.6) years based in prior studies. Individual-level demographic information was not collected, as researchers wanted to prioritize patient privacy.

The composite score for SUS was 75 for this cohort. The SUS score was 68 in a study for Spanish digital health applications, indicating above average usability and is comparable to other mHealth applications for PWH. Participants stated that the application was easy to use, was consistent, had well-integrated features, felt confident using it, and would like to use CP frequently.

There were 4 themes: client context, strengths of CP, barriers to use and dislikes, and suggestions of improvements that were identified after coding interviews. Mental health struggles and stigma were found to be highly prevalent in code applications within the context of the client and were common in interviews due to being referenced by 40% of all participants.

Challenges in managing care effectively made up the client context theme. Mental health struggles (19.4%), facing stigma due to HIV diagnosis (12.6%), life stressors (10.6%), and lack of support system (8.7%) were among the most commonly reported barriers to consistent care. The strengths of CP were reported 125 times in the 20 interviews. These included access to information/education (19.2%), privacy (15%), and the connection to professional care (12.7%). A total of 47.1%, 41.1%, and 11.8% reported a positive effect on medication adherence, mood/stress, and client-provider communication, respectively.

Privacy (14.9%), low educational level/general literacy (14.9%), and lack of personal connection (13.8%) were among the barriers and dislikes of CP that were mentioned 73 times. More information about HIV and stigma (11.8%) and more interactive application elements (11.8%) were the most frequent requests for improvement in the app.

There were some limitations to this study. All participants were recruited from a single site in Virginia, which could limit generalizability of results. Selection bias could also be present due to those being more active with CP being more likely to participate in research study.

The researchers concluded that there is a gap in both the tailoring and use of mHealth technology targeting Latinx PWH. CP was determined to be effective and easy to use in PWH who primarily speak Spanish. Future improvements to CP could help to further address areas that participants in this study pinpointed as areas of weakness.

Reference

Petros De Guex K, Flickinger TE, Mayevsky L, et al. Optimizing usability of a mobile health intervention for Spanish-speaking Latinx people with HIV through user-centered design: a post-implementation study. JAMIA Open. 2023;6(3):ooad083. doi:10.1093/jamiaopen/ooad083