JMIR Publications

ABSTRACT

Background:

People living with HIV and substance use disorders (SUD) have complex healthcare needs that require effective support systems. While online platforms and mobile health applications have played a pivotal role in providing support, there is limited research on the specific dynamics within these communities, particularly regarding participant engagement and social support enhancement.

Objective:

Investigate the formation of a virtual community on the Addiction Comprehensive Health Enhancement Support System (A-CHESS) message board, a mobile health application designed to improve engagement in HIV care for individuals with HIV and SUD.

Methods:

Computer-mediated discourse analysis quantitively and qualitatively examined structure, interaction patterns, and engagement behaviors to understand how staff and participants used the A-CHESS app to create a supportive virtual community.

Results:

Among the 208 study participants, 41% (87 individuals) actively engaged on the A-CHESS message board. The majority identified as male and Black, with a mean age of 45. Between April 2019 and May 2021, 1,834 messages were posted on the message board, Most participants (70%) posted between 1 to 10 messages, reflecting diverse levels of engagement within the community. The A-CHESS community had three distinct messaging types: premeditated, adlib, and participant-driven messages. Initially, staff engaged in premeditated messaging, which included predetermined sharing of HIV and SUD-related information such as recovery stories, HIV transmission risks, health awareness, and inspirational "Thought of the Day" (TOTD) messages. Participants responded mainly to the TOTD messages by aligning, interpreting, or applying them to their recovery journey. This collective response highlighted the formation of a virtual community characterized by mirrored social behavior and an implicit agreement on the messages' significance. Ablib messaging was created by research staff and case managers as time progressed to encourage participant engagement by sharing personalized stories when disseminating health information and utilizing polls to share entertaining content. This approach proved more effective in fostering engagement beyond responses to the TOTD messages. The participant-driven messages demonstrated the community's active agency in tailoring and shaping the content. Participants adapted the premeditated and adlib message styles to meet their personal needs, creating their own polls and motivational messages inspired by TOTD but also incorporating Alcohol Anonymous literature. Participants engaged in discussions on various topics, sought advice, shared legal matters, planned activities outside the A-CHESS app, and even played a role in developing new app features such as medication check-ins to support HIV medication adherence.

Conclusions:

Online interaction often occurs through social discourse where staff adapt message types to enhance engagement. The inclusion of personal information about themselves led to increased engagement. On the other hand, participants engage in discourses that are more relevant to their lived experiences, calling for health applications to encourage opportunities for participants to adapt the platform to their own goals and motivations, promoting a sense of ownership and support.