Challenges of and Solutions for Developing Tailored Video Interventions That Integrate Multiple Digital Assets to Promote Engagement and Improve Health Outcomes: Tutorial

Abstract

Background Video is a versatile and popular medium for digital health interventions. As mobile device and app technology advances, it is likely that video-based interventions will become increasingly common. Although clinic waiting rooms are complex and busy environments, they offer the opportunity to facilitate engagement with video-based digital interventions as patients wait to see their providers. However, to increase efficiency in public health, leverage the scalability and low cost of implementing digital interventions, and keep up with rapidly advancing technology and user needs, more design and development guidance is needed for video-based tailored interventions. Objective We provide a tutorial for digital intervention researchers and developers to efficiently design and develop video-based tailored digital health interventions. We describe the challenges and solutions encountered with Positive Health Check (PHC), a hybrid app used to deliver a brief, interactive, individually tailored video-based HIV behavioral counseling intervention. PHC uses video clips and multimedia digital assets to deliver intervention content, including interactive tailored messages and graphics, a repurposed animated video, and patient and provider handouts generated in real time by PHC. Methods We chronicle multiple challenges and solutions for the following: (1) using video as a medium to enhance user engagement, (2) navigating the complexity of linking a database of video clips with other digital assets, and (3) identifying the main steps involved in building an app that will seamlessly deliver to users individually tailored messages, graphics, and handouts. Results We leveraged video to enhance user engagement by featuring “video doctors,” full-screen video, storyboards, and streamlined scripts. We developed an approach to link the database of video clips with other digital assets through script coding and flow diagrams of algorithms to deliver a tailored user experience. We identified the steps to app development by using keyframes to design the integration of video and digital assets, using agile development methods to gather iterative feedback from multidisciplinary teams, and creating an intelligent data-driven back-end solution to tailor message delivery to individual users. Conclusions Video-based digital health interventions will continue to play an important role in the future of HIV prevention and treatment, as well as other clinical health practices. However, facilitating the adoption of an HIV video intervention in HIV clinical settings is a work in progress. Our experience in designing and developing PHC presented unique challenges due to the extensive use of a large database of videos tailored individually to each user. Although PHC focuses on promoting the health and well-being of persons with HIV, the challenges and solutions presented in this tutorial are transferable to the design and development of video-based digital health interventions focused on other areas of health.

Effectiveness of an Interactive, Highly Tailored “Video Doctor” Intervention to Suppress Viral Load and Retain Patients With HIV in Clinical Care: A Randomized Clinical Trial

“…The details of the formative research and technical development of PHC are described elsewhere. 25,26 Those assigned to the intervention arm used PHC at baseline during an initial clinical visit when randomization occurred and could use PHC up to 2 more times over the study period. Participants chose the video doctor they would interact with as part of the PHC intervention experience.…”

A Clinical Preventive Strategy Based on a Digital Tool to Improve Access to Endocrine Disruptors Exposure Prevention: The MEDPREVED Study

“…Moreover, they are sometimes anxietyprovoking [52]. While different supports, such as video-based digital health interventions (video clips), interactive tailored messages, graphics, are now possible, digital health education should follow the health education guidelines [60], with positive messages and video intervention in clinical settings [61]. For example, parents are five times less attentive to their child's request for attention when using a telephone [62] and its use in a waiting room is a counter-productive message of reasoned smartphone utilization.…”

Cost Analysis of the Positive Health Check Intervention to Suppress HIV Viral Load and Retain Patients in HIV Clinical Care

“…Positive Health Check (PHC) is a brief, highly tailored, interactive video-counseling intervention developed for PWH in clinical care that can be used on laptops, tablets, and desktop computers 13,14. Expanding the scope of previous video-based interventions, PHC aims to improve ART adherence, virologic suppression, and retention in care by providing tailored patient education on early ART initiation and sexual risk reduction.…”

“…12 Positive Health Check (PHC) is a brief, highly tailored, interactive video-counseling intervention developed for PWH in clinical care that can be used on laptops, tablets, and desktop computers. 13,14 Expanding the scope of previous video-based interventions, PHC aims to improve ART adherence, virologic suppression, and retention in care by providing tailored patient education on early ART initiation and sexual risk reduction. To assess the effectiveness of the PHC intervention, we conducted a type 1 hybrid effectiveness-implementation randomized trial among patients who were receiving care in HIV primary care clinics in the United States.…”