Tailoring a mobile health text-messaging intervention to promote antiretroviral therapy adherence among African Americans: A qualitative study

Abstract

African Americans are disproportionately affected by HIV and socio-structural barriers that impact antiretroviral (ART) adherence. Two-way text-messaging interventions have shown promise in supporting adherence in US studies of mostly White people living with HIV (PLWH). However, culturally-appropriate tailoring is necessary to maximize intervention effectiveness among other racial/ethnic groups. Thus, to refine an existing text-messaging intervention, we examined barriers and facilitators to ART adherence among African Americans and perspectives on features to integrate into the extant intervention. Three focus groups, two with African American PLWH (n = 5 and n = 7) and one with providers of care (n = 11) were conducted; transcripts of audio-recordings were thematically analyzed. Adherence supports operated at individual, interpersonal, and structural/environmental levels (e.g., using reminders and pill organizers, wanting to protect partners from HIV, and positive interactions with providers). Adherence barriers also operated at multiple ecological levels (e.g., poor mental health, fear of disclosure of HIV status, and unstable housing). Participant-suggested features for refinement included: i) matching content to participants' comfort with receiving messages referencing HIV or medication-taking, ii) culturally-tailoring content for African Americans, iii) tracking adherence, and iv) encouraging adherence interactions between patients and providers. Feedback from both patients and providers is foundational to designing effective ART interventions among African American PLWH.

A Culturally Adapted SMS Text Messaging Intervention to Promote Antiretroviral Therapy Adherence Among African Americans: Protocol for a Single-Arm Trial

“…Previous studies have demonstrated the efficacy of 2-way SMS text messaging interventions in supporting ART adherence; however, these studies primarily enrolled non-Hispanic white PWH despite epidemiological evidence of greater HIV-related burden among African American PWH [ 25 ]. This protocol details the implementation of an intervention that was adapted using feedback from African American PWH and their providers of care [ 26 ]. We anticipate that the tailored iTAB intervention will significantly improve ART adherence among the targeted population and, consequently, could be implemented among other African American PWH across the state of California.…”

“…In formative study phases, issues arose related to integrating community-based participatory research with clinical practice. Focus group discussants suggested that the study facilitate interactions between patients and their providers of clinical care [ 26 ]. Thus, we aimed to provide study participants with the choice to share their iTAB adherence calendars with their providers to promote conversations around adherence.…”

“…The formative phase of our intervention study assessed supports and barriers to ART adherence and solicited opinions among a sample of African American FHCSD patients and their providers of HIV care on how to best tailor the iTAB intervention. Suggestions for modification of the iTAB SMS text messaging system included: (1) matching the degree to which SMS text messages disclose HIV-related content depending on participants’ level of comfort; (2) variability of SMS text messages, incorporating positive, inspirational, entertaining, and culturally tailored content to their health; (3) personalization of SMS text message content and timing of SMS text messages; (4) positively reinforcing SMS text messages to encourage future adherence; and (5) tracking adherence over time using calendars to facilitate conversations between patients and care coordinators [ 26 ]. We also included culturally relevant health messages and trivia factoids (ie, messages including facts and quotes from historical African American figures and trivia pertaining to African Americans, Africa, or the African diaspora) to the extant pool of SMS text messages.…”

#Wematter: Creating culturally tailored health promotion content for Black and Latina college women on Instagram

“…“Culturally sensitive interventions are implicitly multicultural” as they seek to “incorporate and appreciate perspectives of multiple race/ethnic groups"(p. 11). 17 The implementation of culturally tailored content is not new and has proven to be cost-effective in promoting health behavior 32 ; academic literature has acknowledged the effectiveness in targeting minority populations under both positive (antiviral promotion; e.g., Pasipanodya et al 33 ) and negative (consumption of sugary snacks; Backholer et al 34 ) circumstances. Ryan et al 35 found that tailored interventions were more effective in influencing behavioral change and were rated by participants as more personally relevant, helpful, easier to understand, likely to be recommended to others, and novel than those in the non-tailored intervention group.…”

The YGetIt? Program: A Mobile Application, PEEP, and Digital Comic Intervention to Improve HIV Care Outcomes for Young Adults

“…Technologies and innovative approaches are essential to maintaining patient-provider contact and offer a convenient method of communication. Health organizations have been utilizing mHealth platforms to reach and serve their respective communities (Pasipanodya et al, 2020). A review of HIV-focused social media interventions revealed increased access to information and enhanced ability to communicate (Cao et al, 2017).…”