Brown Shan-Estelle, Krishnan Archana, Ranjit Yerina S, Marcus Ruthanne, Altice Frederick L
Department of Anthropology, Rollins College, Winter Park, FL, USA.
Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.
Mhealth. 2020 Jan 5;6:4. doi: 10.21037/mhealth.2019.09.12. eCollection 2020.
Mobile health (mHealth) can provide innovative, cost-effective strategies to improve medication adherence and optimize HIV treatment outcomes. Very little, however, is known about the acceptability and feasibility of mHealth among people with HIV (PWH) who use drugs. Our study objective was to assess feasibility, acceptability, and barriers and facilitators of implementing an mHealth intervention among PWH who are cocaine users, a group for whom no pharmacological treatment to reduce cocaine use is available.
Five focus groups (FGs) (N=20) were conducted with PWH who self-reported cocaine use in the past 30 days, with 3 groups (N=8) of healthcare providers. Topics included previous experience with smartphones; barriers and facilitators of mobile technology for health purposes; and attitudes toward receiving types of feedback about adherence.
Patients preferred text reminders over phone calls for reasons of privacy, accessibility and economizing phone minutes. Direct communication via text messages and phone calls was considered more appropriate for social workers and case managers, who have greater frequency of communication and deeper relationships with patients, and less so for doctors, who see patients less regularly than community health workers. Patients seem particular about who has what information, and overall, they seem to prefer that their medical information, especially HIV-related, stay within the confines of patient-provider relationships.
HIV still provokes stigma and makes health information particularly sensitive for both providers and patients. The rise of mobile technology and related applications such as mHealth, means that new norms have to be established for its use. Participants' suggestions and feedback informed the design of a subsequent mHealth pilot randomized control trial to improve medication adherence.
移动健康（mHealth）可以提供创新且具成本效益的策略，以提高药物依从性并优化艾滋病毒治疗效果。然而，对于吸毒的艾滋病毒感染者（PWH）而言，mHealth的可接受性和可行性却知之甚少。我们的研究目标是评估在可卡因使用者（这一群体尚无减少可卡因使用的药物治疗方法）中实施mHealth干预的可行性、可接受性、障碍及促进因素。
对过去30天内自我报告使用过可卡因的PWH进行了5个焦点小组（FGs）（N = 20）访谈，并对3组（N = 8）医疗服务提供者进行了访谈。主题包括以往使用智能手机的经历；用于健康目的的移动技术的障碍及促进因素；以及对接受依从性反馈类型的态度。
出于隐私、可及性和节省通话时长的原因，患者更喜欢短信提醒而非电话提醒。对于与患者沟通频率更高且关系更密切的社会工作者和个案管理员而言，通过短信和电话进行直接沟通被认为更为合适，而对于看诊频率低于社区卫生工作者的医生来说则不然。患者似乎对谁掌握哪些信息很在意，总体而言，他们似乎更希望自己的医疗信息，尤其是与艾滋病毒相关的信息，保持在医患关系范围内。
艾滋病毒仍然会引发污名化，使得健康信息对提供者和患者来说都特别敏感。移动技术及诸如mHealth等相关应用的兴起，意味着必须为其使用建立新的规范。参与者的建议和反馈为后续旨在提高药物依从性的mHealth试点随机对照试验的设计提供了参考。
