"It reminds me and motivates me": Human-centered design and implementation of an interactive, SMS-based digital intervention to improve early retention on antiretroviral therapy: Usability and acceptability among new initiates in a high-volume, public clinic in Malawi
Early retention of people living with HIV (PLHIV) in antiretroviral therapy (ART) programs is critical to improve individual clinical outcomes and viral load suppression. Although many mobile health (mHealth) interventions aim to improve retention in care, there is still lack of evidence on mHealth...
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| Veröffentlicht in: | PloS one 2023-07, Vol.18 (7), p.e0278806-e0278806 |
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| creator | Huwa, Jacqueline Tweya, Hannock Mureithi, Maryanne Kiruthu-Kamamia, Christine Oni, Femi Chintedza, Joseph Chiwaya, Geldert Waweru, Evelyn Kudzala, Aubrey Wasunna, Beatrice Ndhlovu, Dumisani Bisani, Pachawo Feldacker, Caryl |
| description | Early retention of people living with HIV (PLHIV) in antiretroviral therapy (ART) programs is critical to improve individual clinical outcomes and viral load suppression. Although many mobile health (mHealth) interventions aim to improve retention in care, there is still lack of evidence on mHealth success or failure, including from patient's perspectives. We describe the human-centered design (HCD) process and assess patient usability and acceptability of a two-way texting (2wT) intervention to improve early retention among new ART initiates at Lighthouse Trust clinic in Lilongwe, Malawi.
An iterative HCD approach focused on patient and provider users' needs, incorporating feedback from multidisciplinary teams to adapt 2wT for the local, public clinic context. We present mixed-methods usability and acceptability results from 100 participants, 50 at 3-months and 50 at 6-months, post 2wT enrollment, and observations of these same patients completing core tasks of the 2wT system.
Among the 100 usability respondents, 95% were satisfied with visit reminders, and 88% would recommend reminders and motivational messages to friends; however, 17% were worried about confidentiality. In observation of participant task completion, 94% were able to successfully confirm visit attendance and 73% could request appointment date change. More participants in 4-6 months group completed tasks correctly compared to 1-3 months group, although not significantly different (78% vs. 66%, p = 0.181). Qualitative results were overwhelmingly positive, but patients did note confusion with transfer reporting and concern that 2wT would not reach patients without mobile phones or with lower literacy.
The 2wT app for early ART retention appears highly usable and acceptable, hopefully creating a solid foundation for lifelong engagement in care. The HCD approach put the local team central in this process, ensuring that both patients' and Lighthouse's priorities, policies, and practices were forefront in 2wT optimization, raising the likelihood of 2wT success in other routine program contexts. |
| doi_str_mv | 10.1371/journal.pone.0278806 |
| format | Article |
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An iterative HCD approach focused on patient and provider users' needs, incorporating feedback from multidisciplinary teams to adapt 2wT for the local, public clinic context. We present mixed-methods usability and acceptability results from 100 participants, 50 at 3-months and 50 at 6-months, post 2wT enrollment, and observations of these same patients completing core tasks of the 2wT system.
Among the 100 usability respondents, 95% were satisfied with visit reminders, and 88% would recommend reminders and motivational messages to friends; however, 17% were worried about confidentiality. In observation of participant task completion, 94% were able to successfully confirm visit attendance and 73% could request appointment date change. More participants in 4-6 months group completed tasks correctly compared to 1-3 months group, although not significantly different (78% vs. 66%, p = 0.181). Qualitative results were overwhelmingly positive, but patients did note confusion with transfer reporting and concern that 2wT would not reach patients without mobile phones or with lower literacy.
The 2wT app for early ART retention appears highly usable and acceptable, hopefully creating a solid foundation for lifelong engagement in care. The HCD approach put the local team central in this process, ensuring that both patients' and Lighthouse's priorities, policies, and practices were forefront in 2wT optimization, raising the likelihood of 2wT success in other routine program contexts.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0278806</identifier><identifier>PMID: 37471383</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acceptability ; Acquired immune deficiency syndrome ; Adaptation ; AIDS ; Antiretroviral agents ; Antiretroviral drugs ; Antiretroviral therapy ; Biology and Life Sciences ; Care and treatment ; Cell Phone ; Cell phones ; Cellular telephones ; Collaboration ; Complications and side effects ; Computer and Information Sciences ; Diagnosis ; Drug therapy ; Engineering and Technology ; Enrollments ; Health care access ; Highly active antiretroviral therapy ; HIV ; HIV (Viruses) ; HIV Infections - drug therapy ; Human immunodeficiency virus ; Humans ; Innovations ; Intervention ; Lighthouses ; Malawi ; Medicine and Health Sciences ; Motivation ; Optimization ; Patient outcomes ; Patients ; People and Places ; Retention ; Telemedicine ; Text Messaging ; Usability ; User satisfaction ; Workloads</subject><ispartof>PloS one, 2023-07, Vol.18 (7), p.e0278806-e0278806</ispartof><rights>Copyright: © 2023 Huwa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2023 Public Library of Science</rights><rights>2023 Huwa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2023 Huwa et al 2023 Huwa et al</rights><rights>2023 Huwa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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Although many mobile health (mHealth) interventions aim to improve retention in care, there is still lack of evidence on mHealth success or failure, including from patient's perspectives. We describe the human-centered design (HCD) process and assess patient usability and acceptability of a two-way texting (2wT) intervention to improve early retention among new ART initiates at Lighthouse Trust clinic in Lilongwe, Malawi.
An iterative HCD approach focused on patient and provider users' needs, incorporating feedback from multidisciplinary teams to adapt 2wT for the local, public clinic context. We present mixed-methods usability and acceptability results from 100 participants, 50 at 3-months and 50 at 6-months, post 2wT enrollment, and observations of these same patients completing core tasks of the 2wT system.
Among the 100 usability respondents, 95% were satisfied with visit reminders, and 88% would recommend reminders and motivational messages to friends; however, 17% were worried about confidentiality. In observation of participant task completion, 94% were able to successfully confirm visit attendance and 73% could request appointment date change. More participants in 4-6 months group completed tasks correctly compared to 1-3 months group, although not significantly different (78% vs. 66%, p = 0.181). Qualitative results were overwhelmingly positive, but patients did note confusion with transfer reporting and concern that 2wT would not reach patients without mobile phones or with lower literacy.
The 2wT app for early ART retention appears highly usable and acceptable, hopefully creating a solid foundation for lifelong engagement in care. The HCD approach put the local team central in this process, ensuring that both patients' and Lighthouse's priorities, policies, and practices were forefront in 2wT optimization, raising the likelihood of 2wT success in other routine program contexts.</description><subject>Acceptability</subject><subject>Acquired immune deficiency syndrome</subject><subject>Adaptation</subject><subject>AIDS</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral therapy</subject><subject>Biology and Life Sciences</subject><subject>Care and treatment</subject><subject>Cell Phone</subject><subject>Cell phones</subject><subject>Cellular telephones</subject><subject>Collaboration</subject><subject>Complications and side effects</subject><subject>Computer and Information Sciences</subject><subject>Diagnosis</subject><subject>Drug therapy</subject><subject>Engineering and Technology</subject><subject>Enrollments</subject><subject>Health care access</subject><subject>Highly active antiretroviral therapy</subject><subject>HIV</subject><subject>HIV (Viruses)</subject><subject>HIV Infections - drug therapy</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Innovations</subject><subject>Intervention</subject><subject>Lighthouses</subject><subject>Malawi</subject><subject>Medicine and Health Sciences</subject><subject>Motivation</subject><subject>Optimization</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>People and Places</subject><subject>Retention</subject><subject>Telemedicine</subject><subject>Text Messaging</subject><subject>Usability</subject><subject>User 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Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huwa, Jacqueline</au><au>Tweya, Hannock</au><au>Mureithi, Maryanne</au><au>Kiruthu-Kamamia, Christine</au><au>Oni, Femi</au><au>Chintedza, Joseph</au><au>Chiwaya, Geldert</au><au>Waweru, Evelyn</au><au>Kudzala, Aubrey</au><au>Wasunna, Beatrice</au><au>Ndhlovu, Dumisani</au><au>Bisani, Pachawo</au><au>Feldacker, Caryl</au><au>Dulli, Lisa Suzanne</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>"It reminds me and motivates me": Human-centered design and implementation of an interactive, SMS-based digital intervention to improve early retention on antiretroviral therapy: Usability and acceptability among new initiates in a high-volume, public clinic in Malawi</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2023-07-20</date><risdate>2023</risdate><volume>18</volume><issue>7</issue><spage>e0278806</spage><epage>e0278806</epage><pages>e0278806-e0278806</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Early retention of people living with HIV (PLHIV) in antiretroviral therapy (ART) programs is critical to improve individual clinical outcomes and viral load suppression. Although many mobile health (mHealth) interventions aim to improve retention in care, there is still lack of evidence on mHealth success or failure, including from patient's perspectives. We describe the human-centered design (HCD) process and assess patient usability and acceptability of a two-way texting (2wT) intervention to improve early retention among new ART initiates at Lighthouse Trust clinic in Lilongwe, Malawi.
An iterative HCD approach focused on patient and provider users' needs, incorporating feedback from multidisciplinary teams to adapt 2wT for the local, public clinic context. We present mixed-methods usability and acceptability results from 100 participants, 50 at 3-months and 50 at 6-months, post 2wT enrollment, and observations of these same patients completing core tasks of the 2wT system.
Among the 100 usability respondents, 95% were satisfied with visit reminders, and 88% would recommend reminders and motivational messages to friends; however, 17% were worried about confidentiality. In observation of participant task completion, 94% were able to successfully confirm visit attendance and 73% could request appointment date change. More participants in 4-6 months group completed tasks correctly compared to 1-3 months group, although not significantly different (78% vs. 66%, p = 0.181). Qualitative results were overwhelmingly positive, but patients did note confusion with transfer reporting and concern that 2wT would not reach patients without mobile phones or with lower literacy.
The 2wT app for early ART retention appears highly usable and acceptable, hopefully creating a solid foundation for lifelong engagement in care. The HCD approach put the local team central in this process, ensuring that both patients' and Lighthouse's priorities, policies, and practices were forefront in 2wT optimization, raising the likelihood of 2wT success in other routine program contexts.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>37471383</pmid><doi>10.1371/journal.pone.0278806</doi><tpages>e0278806</tpages><orcidid>https://orcid.org/0000-0002-4599-8973</orcidid><orcidid>https://orcid.org/0000-0001-8786-2487</orcidid><orcidid>https://orcid.org/0000-0002-8152-6754</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2023-07, Vol.18 (7), p.e0278806-e0278806 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2840217109 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Acceptability Acquired immune deficiency syndrome Adaptation AIDS Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Biology and Life Sciences Care and treatment Cell Phone Cell phones Cellular telephones Collaboration Complications and side effects Computer and Information Sciences Diagnosis Drug therapy Engineering and Technology Enrollments Health care access Highly active antiretroviral therapy HIV HIV (Viruses) HIV Infections - drug therapy Human immunodeficiency virus Humans Innovations Intervention Lighthouses Malawi Medicine and Health Sciences Motivation Optimization Patient outcomes Patients People and Places Retention Telemedicine Text Messaging Usability User satisfaction Workloads |
| title | "It reminds me and motivates me": Human-centered design and implementation of an interactive, SMS-based digital intervention to improve early retention on antiretroviral therapy: Usability and acceptability among new initiates in a high-volume, public clinic in Malawi |
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