Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Dec 22, 2019
Date Accepted: Sep 22, 2020
Development and acceptability of a tablet-based app to support men to link to HIV care: a mixed methods approach
ABSTRACT
Background:
Men’s poor engagement with HIV care is attributed to a number of factors: fear of stigma, masculine representations, concerns related to confidentiality and time commitment needed to attend public health clinics. Digital technologies are emerging as one approach to support men’s engagement with care.
Objective:
The aim of this study was to deliver a usable and engaging tablet-based application to support men to make an informed decision about engaging with HIV care in rural KwaZulu Natal, South Africa.
Methods:
We used a combination of self-determination theory, person-based approach and human computer interaction techniques. The multi-phased development process included: 1) gathering the app content requirements and conceptual design by the research team and community advisory board, 2) iterative testing and refinement with target users, and 3) acceptability testing with actual users.
Results:
In phase one, we identified key learning points to be incorporated in the content of EPIC-HIV 2 to persuade men to attend clinic and to start antiretroviral therapy. Particularly, that the long-term health benefits to men and their families of starting antiretroviral therapy early and remaining on it outweigh the social costs of attending and being seen at a clinic. Using self-determination theory we designed the content and features of the app to support the need for autonomy, competence and relatedness. Based on the input from the community advisory board and target users, we adapted the app to address local perceptions of HIV care for men. In phase two, we modified the app and used simple text with images to help users to understand and navigate the app. In surveys and in-depth interviews, men reported finding the app acceptable and that the app encouraged them to link to care.
Conclusions:
Iteratively developing the app with target users using local narratives ensured that the EPIC-HIV 2 is usable, engaging, as well as acceptable Clinical Trial: EPIC-HIV 2 is part of the HITS trial registered on https://clinicaltrials.gov/ identifier NCT03757104
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