Ameli Vira, Wong Geoffrey, Barlow Jane, Mohraz Minoo, Meinck Franziska, Taj Leila, Amiri Tayebeh, Boosiraz Abbas, Sabin Lora, Haberer Jessica E
Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Qual Health Res. 2025 Feb;35(2):156-173. doi: 10.1177/10497323241256865. Epub 2024 Aug 6.
Mobile health (mHealth) interventions are increasingly used to address the challenges of living with HIV and engaging with antiretroviral therapy. A wealth of evidence supports the efficacy of mHealth in supporting living with HIV. Yet, there is a dearth of evidence on how mHealth improves outcomes, which features are effective, and why these work in a particular setting. This study uses stakeholder views, including patients, providers, peer supporters, counsellors, and program directors, to conceptualize how specific mHealth features could interact with contexts of living with HIV and mechanisms that shape engagement with treatment. The study is part of an ongoing research project on engagement with HIV care in Iran. We draw on the perspectives of recently diagnosed and more treatment-experienced patients and their providers, using purposive sampling, conducting 9 focus group discussions with a total of 66 participants, in addition to 17 interviews. Our findings suggest that mHealth designs that feature provider connection, proactive care, and privacy and personalization are expected to dilute the harsh contexts of living with HIV. We build on previously identified socioecological pathways that disrupt antiretroviral therapy in Iran and find that mHealth can enhance the relation between the health system and patients. Our findings suggest that personalized mHealth features and provisions can partially mitigate the compounded impacts of harsh socioecological pathways that impede treatment success in Iran. Our social constructivist study was augmented with realist-informed analysis and could have transferability to similar contexts that trigger similar mechanisms of treatment disruption.
移动健康（mHealth）干预措施越来越多地用于应对感染艾滋病毒以及接受抗逆转录病毒治疗所面临的挑战。大量证据支持移动健康在支持艾滋病毒感染者生活方面的有效性。然而，关于移动健康如何改善治疗效果、哪些功能有效以及这些功能在特定环境中为何起作用，却缺乏相关证据。本研究利用包括患者、医护人员、同伴支持者、咨询师和项目主管在内的利益相关者的观点，来构思特定的移动健康功能如何与艾滋病毒感染者的生活环境以及影响治疗参与度的机制相互作用。该研究是伊朗一项正在进行的关于艾滋病毒护理参与度的研究项目的一部分。我们采用目的抽样法，从最近确诊的患者以及治疗经验更丰富的患者及其医护人员的角度出发，除了进行17次访谈外，还开展了9次焦点小组讨论，共有66名参与者。我们的研究结果表明，具有医护人员联系、主动护理以及隐私和个性化等特点的移动健康设计，有望缓解感染艾滋病毒带来的严峻生活环境。我们基于之前确定的在伊朗扰乱抗逆转录病毒治疗的社会生态途径进行研究，发现移动健康可以加强卫生系统与患者之间的关系。我们的研究结果表明，个性化的移动健康功能和服务可以部分减轻阻碍伊朗治疗成功的严峻社会生态途径的综合影响。我们的社会建构主义研究通过基于现实主义的分析得到了加强，并且可能适用于引发类似治疗中断机制的类似环境。
