Whiteley Laura, Brown Larry, Lally Michelle, Heck Nicholas, van den Berg Jacob J
Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States.
Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States.
JMIR Mhealth Uhealth. 2018 Apr 23;6(4):e96. doi: 10.2196/mhealth.8155.
Highly active combination antiretroviral treatment has been shown to markedly improve the health of HIV-infected adolescents and young adults. Adherence to antiretroviral treatment leads to decreased morbidity and mortality and decreases the number of hospitalizations. However, these clinical achievements can only occur when young persons with HIV are adherent to care. Unfortunately, adolescents and young adults have poorer rates of adherence to antiretroviral medications and poorer rates of retention in care than older adults. Novel and engaging digital approaches are needed to help adolescents and young adults living with HIV be adherent to treatment.
The aim of this study was to develop an immersive, action-oriented iPhone gaming intervention to improve adherence to antiretroviral medication and treatment.
Game development was guided by social learning theory, taking into consideration the perspectives of adolescents and young adults living with HIV. A total of 20 adolescents and young adults were recruited from an HIV care clinic in Rhode Island, and they participated in qualitative interviews guided by the information-motivation-behavioral skills model of behavior change. The mean age of participants was 22 years, 60% (12/20) of the participants identified as male, and 60% (12/20) of the sample reported missing a dose of antiretroviral medication in the previous week. Acceptability of the game was assessed with client service questionnaire and session evaluation form.
A number of themes emerged that informed game development. Adolescents and young adults living with HIV desired informational game content that included new and comprehensive details about HIV, details about HIV as it relates to doctors' visits, and general health information. Motivational themes that emerged were the desire for enhancement of future orientation; reinforcement of positive influences from partners, parents, and friends; collaboration with health care providers; decreasing stigma; and increasing personal relevance of HIV care. Behavioral skills themes centered on self-efficacy and strategies for medical adherence and self-care. On the client service questionnaire, 10 out of the 11 participants indicated they were "satisfied with the game activities," and 9 out of 11 "would recommend it to a friend." On the session evaluation form, 9 out of 11 agreed that they "learned a lot from the game."
We utilized youth feedback, social learning theory (information-motivation-behavioral skills), and agile software development to create a multilevel, immersive, action-oriented iPhone gaming intervention to measure and improve treatment adherence for adolescents and young adults living with HIV. There is a dearth of gaming interventions for this population, and this study is a significant step in working toward the development and testing of an iPhone gaming app intervention to promote adherence to antiretroviral treatment.
ClinicalTrials.gov NCT01887210; http://clinicaltrials.gov/ct2/show/NCT01887210 (Archived by WebCite at http://www.webcitation.org/6xHMW0NI1).
高效抗逆转录病毒联合治疗已被证明能显著改善感染艾滋病毒的青少年和青年的健康状况。坚持抗逆转录病毒治疗可降低发病率和死亡率，并减少住院次数。然而，只有当感染艾滋病毒的年轻人坚持接受治疗时，这些临床成果才能实现。不幸的是，与老年人相比，青少年和青年对抗逆转录病毒药物的依从率较低，在接受治疗方面的留存率也较低。需要新颖且引人入胜的数字方法来帮助感染艾滋病毒的青少年和青年坚持治疗。
本研究的目的是开发一种沉浸式、以行动为导向的iPhone游戏干预措施，以提高对抗逆转录病毒药物和治疗的依从性。
游戏开发以社会学习理论为指导，同时考虑感染艾滋病毒的青少年和青年的观点。从罗德岛的一家艾滋病毒护理诊所招募了20名青少年和青年，他们参与了以行为改变的信息-动机-行为技能模型为指导的定性访谈。参与者的平均年龄为22岁，60%（12/20）的参与者为男性，60%（12/20）的样本报告在前一周漏服了一剂抗逆转录病毒药物。通过客户服务问卷和课程评估表评估游戏的可接受性。
出现了一些为游戏开发提供信息的主题。感染艾滋病毒的青少年和青年希望游戏内容包含有关艾滋病毒的新的全面细节、与就医相关的艾滋病毒细节以及一般健康信息。出现的动机主题包括增强对未来的展望；强化来自伴侣、父母和朋友的积极影响；与医疗保健提供者合作；减少耻辱感；以及增加艾滋病毒护理的个人相关性。行为技能主题集中在自我效能以及医疗依从性和自我护理策略上。在客户服务问卷中，11名参与者中有10名表示他们“对游戏活动满意”，11名中有9名“会向朋友推荐”。在课程评估表中，11名中有9名同意他们“从游戏中学到了很多”。
我们利用青年反馈、社会学习理论（信息-动机-行为技能）和敏捷软件开发，创建了一种多层次、沉浸式、以行动为导向的iPhone游戏干预措施，以测量和提高感染艾滋病毒的青少年和青年的治疗依从性。针对这一人群的游戏干预措施匮乏，本研究朝着开发和测试一款促进抗逆转录病毒治疗依从性的iPhone游戏应用程序干预措施迈出了重要一步。
ClinicalTrials.gov NCT01887210；http://clinicaltrials.gov/ct2/show/NCT01887210（由WebCite存档于http://www.webcitation.org/6xHMW0NI1）
