JMIR Publications

ABSTRACT

Background:

Post-traumatic stress, alongside comorbid mental health challenges and hazardous alcohol use, disproportionately burden people living with HIV. Drivers of these stressors are both intra-individual, rooted in early life adversity and firsthand violence exposures, and contextual: often place-based. Imparting effective coping skills and distinguishing changeable versus unchangeable stressors can improve stress management proximally with cascading effects on and key HIV continuum of care endpoints such as antiretroviral therapy adherence. But problem- and emotion-based coping skills, delivered via traditional linear in-person group modalities, may falter in the moment. We adapted the evidence-based Living in the Face of Trauma (LIFT) intervention to an iOS- and Android-native app, featuring daily diary–triggered coping skills recommendations, self-guided LIFT psychoeducational sessions, and a personalizable geofencing function.

Objective:

This mixed methods study examined the acceptability, feasibility, and user experiences of NOLA Gem, focusing on user interaction costs relative to geographic ecological momentary assessment (GEMA) alone, and honing future optimization options.

Methods:

People living with HIV (N = 32) were recruited across New Orleans and initially randomized 1:1 to treatment (NOLA Gem+GEMA) versus control (GEMA) for 21 days. Feasibility was assessed via enrollment and attrition rates. At the immediate post assessment, participants completed acceptability and usability measures and a brief structured usability interview. Analyses included descriptive statistics, bivariate logit modeling, and synergistic human-LLM deductive coding.

Results:

N = 30 participants (n = 22 in the GEMA+NOLA Gem treatment arm) completed the pilot: 94% of baseline enrollees. Acceptability was very high across the board: 100% of users considered NOLA Gem “very” or “somewhat” successful in addressing their daily lives, with 91% endorsing increased calm and emotional wellbeing. Fully 50% of NOLA Gem users were “extremely likely” (Net Promoter Score = 10/10) to recommend the app to friends. Eight (27%) of GEMA and GEMA+NOLA Gem users reported privacy concerns. Eleven (50%) NOLA Gem users received geofencing alerts; perceptions of this feature’s helpfulness were mixed. No statistically significant socio-demographic or clinical predictors of disparate acceptability (p ≥ 0.068) or increased privacy concerns (p ≥ 0.171) were found. No additional frictions were evidenced by GEMA+NOLA Gem versus GEMA users (p ≥ 0.132). Qualitatively, NOLA Gem users praised the just-in-time mindfulness, breathing, and problem-solving skills delivery, and broader stress control and self-insight benefits. A subset of users pointed out the burdensome length and sometimes-inconvenient timing of the daily diaries. Recommendations for next-generation personalization included user-specific dynamic daily diary and geofencing prompt tailoring.

Conclusions:

Our small pilot study demonstrated high NOLA Gem acceptability and feasibility, and a rich, beneficial user experience among people living with HIV, with clear and actionable opportunities for improvement.