mHealth and social mediation: Mobile support among stigmatized people living with HIV and substance use disorder

Abstract

The social mediation role of mobile technology is typified by mHealth apps designed to connect individuals to others and support substance use disorder (SUD) recovery. In this study, we examined the use and utility of one such app designed to support people living with HIV (PLWH) and SUD. Drawing on Ling’s emphasis on reciprocity and micro-coordination in mobile telephony as a social mediation technology, we gathered digital trace data from app logs to construct two metrics, initiation (i.e. whether a particular feature is engaged on a given day) and intensity (i.e. degree of involvement in the activity when engaged on that day), at three levels of communication—networked (one-to-many), dyadic (one-to-one), and intraindividual (self-to-self). We consider these system features alongside use of information resources, games and relaxation links, a meeting and events calendar, and support tools to address use urges. We found few differences in patterns of use by race, sex, and age, though African Americans were less likely to engage in intraindividual expression, whereas women and older users were more likely to make use of this feature. The initiation and intensity of network and dyadic reception, as well as the intensity of network expression, predicts recovery outcomes as measured on a weekly “check-in” survey, suggesting the utility of mobile log data for digital phenotyping in mHealth. By implementing this app during the COVID-19 pandemic, the study also found the disruption caused by national lockdown was negatively related to the app use.

Connecting to Support: How Use of an mHealth App Explains Antiretroviral Medication Adherence among People with HIV and Substance Use Disorders (Preprint)

“…Our study contributes to the growing body of mHealth research by disentangling system use along several significant dimensions, including message expression versus reception, communication levels, and initiation versus intensity, as noted in previous literature 14,16 . The findings regarding the overall participants highlight the critical role of message intensity, rather than initiation, in shaping mHealth engagement and its impact on medication adherence.…”

“…The "anytime-anyplace" mobile access enables wide reach and improves how we coordinate and communicate [7][8][9][10] . In addition, mobile log data help identify evidence-based strategies for health intervention and message delivery [11][12][13][14][15] . Researchers have conducted studies that differentiate message expression from message reception across various communication levels, and found composing one-on-one messages is associated with greater perceived bonding and drafting public forum posts is linked to decreased risky drinking behaviors 16 .…”

Using Machine Learning of Online Expression to Explain Recovery Trajectories: Content Analytic Approach to Studying a Substance Use Disorder Forum

“…Given that SUDs are serious and stigmatized conditions, bolstering online peer-to-peer communication can play a crucial role in recovery, offering an accessible and comfortable social context within which to discuss challenges, give and receive social support, and build a positive social identity around recovery [ 4 , 5 ]. Smartphone-based support apps are increasingly used to sustain peer support for recovery and prevent relapse [ 6 , 7 ]. These apps can also unobtrusively collect rich data about participants’ communication with peers, including the content of messages exchanged and surrounding metadata.…”