Formative Work to Develop a Tailored HIV Testing Smartphone App for Diverse, At-Risk, HIV-Negative Men Who Have Sex With Men: A Focus Group Study

Abstract

BackgroundAlthough gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by human immunodeficiency virus (HIV) infection, few test for HIV at regular intervals. Smartphone apps may be an ideal tool to increase regular testing among MSM. However, the success of apps to encourage regular testing among MSM will depend on how frequently the apps are downloaded, whether they continue to be used over months or years, and the degree to which such apps are tailored to the needs of this population.ObjectiveThe primary objectives of this study were to answer the following questions. (1) What features and functions of smartphone apps do MSM believe are associated with downloading apps to their mobile phones? (2) What features and functions of smartphone apps are most likely to influence MSM’s sustained use of apps over time? (3) What features and functions do MSM prefer in an HIV testing smartphone app?MethodsWe conducted focus groups (n=7, with a total of 34 participants) with a racially and ethnically diverse group of sexually active HIV-negative MSM (mean age 32 years; 11/34 men, 33%, tested for HIV ≥10 months ago) in the United States in Miami, Florida and Minneapolis, Minnesota. Focus groups were digitally recorded, transcribed verbatim, and deidentified for analysis. We used a constant comparison method (ie, grounded theory coding) to examine and reexamine the themes that emerged from the focus groups.ResultsMen reported cost, security, and efficiency as their primary reasons influencing whether they download an app. Usefulness and perceived necessity, as well as peer and posted reviews, affected whether they downloaded and used the app over time. Factors that influenced whether they keep and continue to use an app over time included reliability, ease of use, and frequency of updates. Poor performance and functionality and lack of use were the primary reasons why men would delete an app from their phone. Participants also shared their preferences for an app to encourage regular HIV testing by providing feedback on test reminders, tailored testing interval recommendations, HIV test locator, and monitoring of personal sexual behaviors.ConclusionsMobile apps for HIV prevention have proliferated, despite relatively little formative research to understand best practices for their development and implementation. The findings of this study suggest key design characteristics that should be used to guide development of an HIV testing app to promote regular HIV testing for MSM. The features and functions identified in this and prior research, as well as existing theories of behavior change, should be used to guide mobile app development in this critical area.

Developing Sustainable and Impactful Mobile Phone HIV Testing Interventions for Spanish-Speaking Men Who Have Sex With Men in the United States: Lessons Learned From Informative Interviews (Preprint)

“…Overall, this study showed that Spanish-speaking MSM reported many of the same considerations (e.g., ease of use, perceived usefulness, security) that impacted their adoption and use of mobile apps and other technologies as shown in prior studies of primarily English-speaking MSM [11,15]. In addition, Spanish-speaking MSM noted that having a strong personal interest in the content of the mobile app strengthened their motivation to download the app on their phone.…”

“…Smart phones, which include global positioning systems (GPS), short messaging services (SMS), and applications (apps) features, have become almost ubiquitous among Hispanic adults, including MSM as they tend to be early adopters of newer technologies [8]. Preliminary work, much of which is qualitative, has begun to understand how best to optimize content, design, and delivery features of mHealth technologies for HIV prevention and testing [9][10][11][12]. In the study by Goldenberg and colleagues, MSM preferred their HIV prevention app to: 1) have an educational component to guide their decisions for which test is best for them and prevention options; 2) be interactive and engaging with personalized feedback about their own sexual behaviors; 3) provide a social networking component with other MSM; 4) use language that is simple and understandable to the community; and 5) address privacy concerns by ensuring that the app is from a credible source and having secure messaging features [10].…”

“…In the study by Mitchell et al, focus groups were conducted with English-speaking MSM (N=34; 68% White; 27% Hispanic) from Minneapolis, Minnesota and Miami, Florida to better understand what features and functions of a mobile apps they believe is related to whether they download and continue to stay engaged with apps on their mobile device [11]. Men stated that they tend to download apps that they perceive to be low cost (e.g., free), secure, and efficient in helping them save time and for adding convenience to their lives [11].…”

“…Men stated that they tend to download apps that they perceive to be low cost (e.g., free), secure, and efficient in helping them save time and for adding convenience to their lives [11]. Features and functions that increased men's willingness to remain engaged with apps on their mobile device over time (some of which were also related to downloading the app initially) included how useful and necessary the app was to them, reviews from other users and recommendations from friends, and how reliable, ease of use, and frequently the app was updated [11]. When asked about their preferences for a HIV testing app, men stated that they would like an app that contained a tailored (to their sexual activity) testing interval recommendation, an HIV test locator, and a way to monitor their personal sexual behaviors [11].…”

“…To our knowledge, no studies have asked primarily Spanish-speaking MSM in the US about their app use, attitudes and motivations for downloading and sustaining use of mobile apps, and preferences with respect to HIV prevention. Building on previously published work (e.g., [11]), we conducted individual interviews with Spanish-speaking, HIV-negative MSM to explore what features and functions of mobile apps that participants believed was related to downloading and continuing to use apps on their mobile device, which could then be applied toward development of an app to promoting regular HIV testing. We recruited Hispanic, Study flyers were displayed at establishments that MSM frequent (e.g., bars and nightclubs) and at community-based organizations and health clinics that provide HIV testing in the Miami, Florida metro area.…”