Secure Messaging Through PositiveLinks: Examination of Electronic Communication in a Clinic-Affiliated Smartphone App for Patients Living with HIV

Abstract

Purpose: Secure messaging between patients and their health care team can facilitate chronic care management. Positive-Links Ò (PL) is a clinic-affiliated smartphone application designed for patients living with HIV that includes a secure messaging feature for patients, PL staff, and clinic providers to communicate. Our aim was to examine the content and function of messaging within PL. Methodology: We examined messages exchanged through PL from November 2017 through January 2018. Qualitative analysis included categorization of topics as: related to the app, medical care, or social needs. Messaging functions were categorized as information exchange or rapport building. Results: Of the 1,474 PL messages analyzed, 44% were sent by PL staff, 38% by patients, and 18% by providers, whereas 61% were received by patients, 22% by providers, and 17% by PL staff. Message topics included app-related (57.6%), medical care (34.3%), and social concerns (12.4%). Apprelated messages addressed technical difficulties, software updates, or coordinating phone payments. Medical messages included medical information, medications, appointments, outreach, and care coordination for physical and mental health. Social messages related to insurance, transportation, housing, food, utilities, disability, finances, and work absences. Message function coding showed that 87.3% of messages contained information exchange and 33.8% contained rapport building. Messages sent by providers were most likely to contain rapport building at 54.8%. Conclusion: PL messaging was used to handle medical and social needs with potential impact on patients' health and offers an opportunity to strengthen patient-provider relationships through responsiveness and rapport building. Secure messaging through a clinic-affiliated smartphone app could enhance patient-centered care between clinical visits.

PositiveLinks and the COVID-19 Response: Importance of Low-Barrier Messaging for PLWH in Non-urban Virginia in a Crisis

“…By contrast, the secure, low-barrier messaging feature in PL was regularly employed by patients to seek and participate more fully in care, forging or repairing relationships with their care team. Patients elected to utilize in-app PL messaging for self-advocacy and empowerment in the time of COVID-19, similar to observations in our prior work [ 6 , 12 ].…”

“…The PL messaging feature was used to address medical and social topics as well as app-related issues. For comparison, our prior analysis of PL messages sent November 2017–January 2018 were categorized as 57.6% app-related, 34.3% medical, and 12.4% social [ 12 ]. By contrast, our qualitative 2020 dataset contained more medical (53.3%) and social (21.3%) messages and fewer app-related messages (30.0%).…”

“…Of note, the rapport was often reciprocal, with patients not only receiving rapport from providers but also expressing concern for providers' wellbeing and appreciation for the care team. For comparison, our prior analysis of PL messages sent November 2017–January 2018 were categorized as information exchange (87.3%) and rapport-building (33.8%) [ 12 ]. Overall, there was more rapport-building (41%) in 2020 and, notably, the COVID-related messages demonstrated more rapport-building (50%) than seen in the earlier 2020 dataset.…”

“…Utilizing Dedoose (Dedoose Version 8.0.35, web application for managing, analyzing, and presenting qualitative and mixed method research data (2018); Los Angeles, CA: SocioCulturalResearchConsultants, LLC www.dedoose.com ), we analyzed a subset of the messages to determine what topics were discussed by members, administrators, and providers during the observed time frames. We adapted a codebook from a prior study of PL messaging [ 12 ] to include additional codes capturing COVID-related themes, coding messages from 02/01/2020 to 02/29/2020 (the qualitative "Pre-COVID" dataset) and 03/01/2020 to 03/31/2020 (the qualitative "early COVID" dataset). These qualitative datasets were 4-week subsets within the 7-week time periods of the quantitative analysis.…”

“…Figure 1 displays the hierarchy of qualitative codes. Topic categories were app-related or care-related, as developed in our prior work [ 12 ]. App-related messages included those about managing the PL app or membership, technical difficulties, phone payment coordination, setting up meetings with PL administrators for phone or app support, and feedback about the app.…”