Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Apr 6, 2020
Date Accepted: Mar 23, 2021
An implementation strategy to expand mHealth use in HIV care settings: A rapid evaluation using the Consolidated Framework for Implementation Research
ABSTRACT
Background:
Mobile health (mHealth) applications can provide support to people living with a chronic disease by offering resources for communication, self-management and social support. PositiveLinks (PL) is a clinic-deployed mHealth application designed to improve the health of people with HIV. In a pilot study, PL users experienced significant improvements in care engagement and viral load suppression. To promote its expansion to other HIV clinics, we developed an implementation strategy consisting of training resources and on-demand program support.
Objective:
The objective of our study was to conduct an interim analysis of barriers and facilitators to PL implementation at early adopting sites to guide optimization of our implementation strategy.
Methods:
Semi-structured interviews with stakeholders at PL expansion sites were conducted. Interviews underwent template analysis; facilitators and barriers were mapped to 22 constructs of the Consolidated Framework for Implementation Research. Common facilitators and barriers to PL implementation were identified and served as the basis to revise the PL implementation strategy.
Results:
Four Ryan White HIV clinics were included. Interviews were conducted with 1 healthcare provider, 2 clinic managers, and 5 individuals who coordinated implementing site PL activities. Ten common facilitators and seven common barriers were identified. Facilitators to PL implementation included PL’s fit with patient and clinic needs, PL training resources, and sites’ early engagement with their information technology personnel. Most barriers were specific to mHealth, including access to Wi-Fi networks, maintaining patient smartphone access, patient privacy concerns, and lack of clarity on how to obtain approvals for mHealth use.
Conclusions:
The CFIR is a useful framework for evaluating mHealth interventions. Although PL training resources were viewed favorably, we identified important barriers to PL implementation in a sample of Ryan White Clinics. This enabled our team to expand guidance on identifying information technology stakeholders and procuring and managing mobile resources. Ongoing evaluation results continue to inform improvements to the PL implementation strategy, facilitating PL access for future expansion sites. Clinical Trial: Not applicable
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