HIV Care Providers’ Attitudes regarding Mobile Phone Applications and Web-Based Dashboards to support Patient Self-Management and Care Coordination: Results from a Qualitative Feasibility Study

Abstract

In-depth qualitative interviews were conducted with healthcare providers (HCPs) from five HIV medical care coordination teams in a large Los Angeles County HIV clinic, including physicians, nurses, and psychosocial services providers. HCPs reported on the potential utility, acceptability, and barriers for patient self-monitoring and notifications via mobile phones, and web-based dashboards for HCPs. Potential benefits included: 1) enhancing patient engagement, motivation, adherence, and self-management; and 2) improving provider-patient relationships and HCP care coordination. Newly diagnosed and patients with co-morbidities were highest priorities for mobile application support. Facilitators included universal mobile phone ownership and use of smartphones or text messaging. Patient-level barriers included concerns about low motivation and financial instability for consistent use by some patients. Organizational barriers, cited primarily by physicians, included concerns about privacy protections, easy dashboard access, non-integrated electronic records, and competing burdens in limited appointment times. Psychosocial services providers were most supportive of the proposed mobile tools.

Recent mobile health interventions to support medication adherence among HIV-positive MSM

“…First, there is interest and acceptability to use mHealth technologies to coordinate care between patients and providers (e.g. dashboards) [42**, 56*]. Dashboards can provide an easily interpretable, real-time overview of a patient’s ART tracking and other health indicators or behaviors (e.g.…”

“…This information can be used to provide tailored feedback to patients both at and between in-office appointments. Barriers to dashboard use include physician concerns about the privacy of patient information, ease of access/use, lack of coordination between dashboards and electronic medical records, and time restrictions both during and between patient visits [56*]. …”

Development of an mHealth platform for HIV Care: Gathering User Perspectives Through Co-Design Workshops and Interviews

“…In the case of newly diagnosed and unstable HIV conditions, direct access to numbers was associated with bringing anxiety and uncertainty into care practices. In the study of Swendeman et al [18], clinicians suggested several ways in which mHealth devices should particularly address newly diagnosed patients and patients with comorbidities. Our data support the view that medication reminders, options to monitor blood results, etc, are particularly useful for these patient populations.…”

“…However, the EmERGE mHeaIth care pathway requires HIV patients to see their consultant face-to-face only every 12 months, while they can continuously monitor their blood results and maintain contact with their clinic through the smartphone app. Previous studies that have investigated the potential of mHealth in HIV care have suggested that such reductions in hospital visits are desirable for increasing the quality of life of PLWH [18]. The EmERGE project, as a whole, aims to validate the acceptability, usability, and effectiveness of the mHealth platform; assess its impact on patient self‐management and empowerment; analyze its cost-effectiveness; and disseminate the mHealth platform across various European health care settings as a sustainable, effective, safe, and economic modality for HIV care.…”

“…Furthermore, in the context of HIV care, clinicians are almost never considered as potential adopters of mHealth technology and so are rarely included in co-design initiatives. So far, only 1 study has assessed HIV clinicians’ attitudes toward mHealth and, thereby, outlined perspectives of how this technology could be integrated into clinical care pathways [18]. Moreover, the involvement of users—most often PLWH—tends to be restricted to the initial mHealth design phase, and only very recently are studies beginning to extend user involvement (focusing on young men who have sex with men) to the implementation phase of mHealth interventions [17,19].…”