JMIR Publications

ABSTRACT

Background:

Patient-provider communication can be critical to engaging and retaining people living with HIV in care, especially among medically case-managed patients in need of service coordination and adherence support. Expanding patient-provider communication channels to include mHealth modalities, such as text messaging and video calling, have the potential to facilitate communication and ultimately improve clinical outcomes, yet implementation of these communication modalities in clinical settings has not been well characterized.

Objective:

The purpose of this study was to understand patient and provider perspectives on: 1) the acceptability of and preferences for using text messaging and video calling as a means of communication, 2) perceived factors relevant to adoption, appropriateness, and feasibility; and 3) organizational perspectives on implementation within an HIV clinic in South Carolina.

Methods:

We conducted 26 semi-structured in-depth interviews among patients receiving case-management services (n=12) and clinic providers (n=14) using interview guides and content analysis informed by Proctor’s taxonomy of implementation outcomes and the Consolidated Framework for Implementation Research. Participants were purposefully sampled to obtain maximum variation in terms of age and gender for patients and clinic role for providers. Data were analyzed using quantitative and qualitative content analysis.

Results:

Most patients (92%, n=11/12) and providers (86%, n=12/14) agreed they should have the capacity to text message and/or video call with each other. Although a consensus was not reached, the majority preferred using a secure messaging application rather than standard text messaging due to the enhanced security features. Perceived benefits to adoption included the added convenience of text messaging, and potential barriers included the cost and access of smartphone-based technology for patients. From an organizational prospective, some providers were concerned that offering text messaging could lead to unreasonable expectations of instant access and an increased workload.

Conclusions:

Patients and providers perceived text messaging and video calling as acceptable, appropriate, and feasible and felt these expanded modes of communication could help meet patients’ needs while being safe and not excessively burdensome. While patients and providers mostly agreed on implementation barriers and facilitators, several differences emerged. Taking both perspectives into account when utilizing implementation frameworks is critical for expanding mHealth-based communication, especially as implementation requires active participation from providers and patients.