智能手机自我监测以支持HIV感染者的自我管理：一项混合方法随机试点研究的感知益处与变革理论
Smartphone self-monitoring to support self-management among people living with HIV: perceived benefits and theory of change from a mixed-methods randomized pilot study.
作者信息
Swendeman Dallas, Ramanathan Nithya, Baetscher Laura, Medich Melissa, Scheffler Aaron, Comulada W Scott, Estrin Deborah
机构信息
Departments of *Psychiatry and Biobehavioral Sciences; †Computer Science, University of California, Los Angeles, Los Angeles, CA; and ‡Computer Science, Cornell Tech, New York, NY.
出版信息
J Acquir Immune Defic Syndr. 2015 May 1;69 Suppl 1(0 1):S80-91. doi: 10.1097/QAI.0000000000000570.
BACKGROUND
Self-monitoring by mobile phone applications offers new opportunities to engage patients in self-management. Self-monitoring has not been examined thoroughly as a self-directed intervention strategy for self-management of multiple behaviors and states by people living with HIV (PLH).
METHODS
PLH (n = 50), primarily African American and Latino, were recruited from 2 AIDS services organizations and randomly assigned to daily smartphone (n = 34) or biweekly Web-survey only (n = 16) self-monitoring for 6 weeks. Smartphone self-monitoring included responding to brief surveys on medication adherence, mental health, substance use, and sexual risk behaviors, and brief text diaries on stressful events. Qualitative analyses examine biweekly open-ended user-experience interviews regarding perceived benefits and barriers of self-monitoring, and to elaborate a theoretical model for potential efficacy of self-monitoring to support self-management for multiple domains.
RESULTS
Self-monitoring functions include reflection for self-awareness, cues to action (reminders), reinforcements from self-tracking, and their potential effects on risk perceptions, motivations, skills, and behavioral activation states. Participants also reported therapeutic benefits related to self-expression for catharsis, nonjudgmental disclosure, and in-the-moment support. About one-third of participants reported that surveys were too long, frequent, or tedious. Some smartphone group participants suggested that daily self-monitoring was more beneficial than biweekly due to frequency and in-the-moment availability. About twice as many daily self-monitoring group participants reported increased awareness and behavior change support from self-monitoring compared with biweekly Web-survey only participants.
CONCLUSIONS
Self-monitoring is a potentially efficacious disruptive innovation for supporting self-management by PLH and for complementing other interventions, but more research is needed to confirm efficacy, adoption, and sustainability.
背景
通过手机应用程序进行自我监测为让患者参与自我管理提供了新机会。对于感染艾滋病毒的人（PLH）将自我监测作为一种针对多种行为和状态进行自我管理的自我指导干预策略，尚未进行充分研究。
方法
从2个艾滋病服务组织招募了主要为非裔美国人和拉丁裔的PLH（n = 50），并将他们随机分为每日使用智能手机进行自我监测组（n = 34）或仅每两周进行一次网络调查的自我监测组（n = 16），为期6周。智能手机自我监测包括回答关于药物依从性、心理健康、物质使用和性风险行为的简短调查，以及关于压力事件的简短文本日记。定性分析考察了每两周一次的开放式用户体验访谈，内容涉及自我监测的感知益处和障碍，并阐述了自我监测对多个领域自我管理潜在功效的理论模型。
结果
自我监测功能包括自我意识的反思、行动提示（提醒）、自我跟踪的强化，以及它们对风险认知、动机、技能和行为激活状态的潜在影响。参与者还报告了与自我表达相关的治疗益处，包括宣泄、无评判的披露和即时支持。约三分之一的参与者报告称调查太长、太频繁或太乏味。一些智能手机组的参与者表示，由于频率和即时可用性，每日自我监测比每两周一次更有益。与仅进行每两周一次网络调查的参与者相比，每日自我监测组中报告因自我监测而提高了意识并获得行为改变支持的参与者人数大约是前者的两倍。
结论
自我监测是一种潜在有效的颠覆性创新，可支持PLH进行自我管理并补充其他干预措施，但需要更多研究来证实其有效性、采用率和可持续性。
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