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BACKGROUND Early intervention in mental health crises can prevent devastating outcomes. A promising new direction is remote mental health monitoring using smartphone technology to passively collect data from individuals to rapidly detect worsening of SMI. This technology may benefit patients with SMI, but little is known about health IT acceptability among this population or their mental health clinicians. OBJECTIVE We used the Health Information Technology Acceptability Model to analyze the acceptability and usability of passive mobile monitoring and self-tracking among patients with serious mental illness and their mental health clinicians. METHODS Data collection took place between December 2020 and June 2021 in one VA healthcare system. Semi-structured interviews with mental health clinicians (n=16) assessed the acceptability of mobile sensing, its usefulness as a tool to improve clinical assessment and care, and recommendations for program refinements. Focus groups with patients with SMI (n=3 groups) and individual usability tests (n=8) elucidated patient attitudes about engaging in health IT and their perceptions of the usefulness of mobile sensing as a tool for self-tracking and improving mental health assessments. The Health Information Technology Acceptance Model guided our rapid qualitative analysis of data. RESULTS Mental health clinicians discussed the utility of web-based data dashboards to monitor SMI patient health behaviors and receiving alerts about their worsening health. Potential benefits included improving clinical care (e.g., medication management, tailoring treatment), capturing behaviors that patients don’t self-report, and watching trends and receiving alerts. Clinicians’ concerns included increased workloads tied to dashboard data review (e.g., accessing the dashboard, validity and interpretation of data, intersection of burdens from electronic systems and limited appointment times), lack of experience using health IT in clinical care, and how SMI patients’ associated paranoia and financial instability would impact patient uptake. Despite concerns, all mental health clinicians stated that they would recommend it to their SMI patients. Almost all patients with SMI were receptive to using smartphone dashboards for self-monitoring and having behavioral change alerts sent to their mental health clinicians. They found the mobile application easy to navigate and dashboards easy to find and understand. Patient concerns centered on privacy and “government tracking,” and how the app would affect their phone’s battery life and data plans. Despite concerns, most reported that they would use the app. CONCLUSIONS Many people with SMI would like to have mobile, informatics tools that can support their illness and recovery, however, this population presents some challenges to adoption and implementation. Healthcare organizations will need to provide resources to address these and support successful illness management among these populations. Clinicians are also supportive of technological approaches, with adapting to using informatics data into their workflow as the primary challenge. It will be necessary to ensure clinicians operate at the top of their skill set and that they are not overwhelmed by administrative tasks, data summarization or reviewing data that does not indicate a need for their intervention. Limitations include sample size, and that preliminary feedback is based on discussions of proposed tools rather than user experiences. Passive self-tracking has the potential to be a major innovation in the delivery of services for patients with SMI and other mental illnesses, and for patients at risk of mental illness. CLINICALTRIAL ClinicalTrials.gov NCT05023252; https://clinicaltrails.gov/ct2/show/NCT05023252 INTERNATIONAL REGISTERED REPORT RR2-10.2196/39010

BACKGROUND Serious mental illnesses (SMI) are common, disabling, and challenging to treat, requiring years of monitoring and treatment adjustments. Stress or reduced medication adherence can lead to rapid worsening of symptoms and behaviors. Illness exacerbations and relapses generally occur with little or no clinician awareness in real time, leaving limited opportunity to modify treatments. Previous research suggests that passive mobile sensing may be beneficial for individuals with SMI by helping them monitor mental health status, behaviors, and quickly detect worsening mental health for prompt assessment and intervention. However, there is too little research on its feasibility and acceptability in patients with SMI, and the extent to which passive data can predict changes in behaviors and symptoms. OBJECTIVE To study the feasibility, acceptability and safety of passive mobile sensing for tracking behaviors and symptoms of patients in treatment for SMI, as well as developing analytics that utilize passive data to predict changes in behaviors and symptoms. METHODS A mobile application (app) monitors and transmits passive mobile sensor and phone utilization data to track activity, sociability and sleep in patients with SMI. The study consists of a user-centered design phase and a mobile sensing phase. In the design phase, focus groups, interviews and in-lab usability testing inform further app development. In the mobile sensing phase, passive mobile sensing occurs with participants engaging in weekly assessments for up to nine months. Three and nine month interviews study the perceptions of passive mobile sensing and ease of app use. Clinician interviews before and after the mobile sensing phase study the usefulness and feasibility of app utilization in clinical care. Predictive analytic models are built, trained and selected, and make use of machine learning methods. Models use sensor and phone utilization data to predict behavioral changes and symptoms. RESULTS The study was funded in October 2020 and has received IRB approval. The user-centered design phase, consisting of focus groups, usability testing, and pre-intervention clinician interviews has been completed. Recruitment and enrollment for the mobile sensing phase are ongoing. CONCLUSIONS Findings may inform the development of passive sensing apps and self-tracking in patients with SMI, and integration into care to improve assessment, treatment, and patient outcomes. CLINICALTRIAL ClinicalTrials.gov NCT05023252; https://clinicaltrials.gov/ct2/show/NCT05023252

Young men in South Africa are at high-risk for HIV, substance abuse, and gender-based violence. This article presents qualitative results from a pilot study testing soccer leagues and vocational training to engage young-adult township men to deliver preventive interventions, including rapid HIV and alcohol/drug testing, shifting attitudes toward gender-based violence, and promoting other prosocial behaviors. Three groups participated in focus groups and in-depth interviews on experiences with the program: (1) a subset of 15 participants, (2) 15 family members, and (3) five intervention coaches. Results suggest that participants first reduced substance use on tournament days and then gradually reduced to practice days and beyond. Families suggested that “keeping young men occupied” and encouragement of prosocial behaviors was critical to risk reduction and led to increased community respect for the men. Coaches noted that behavioral and attitudinal changes were incremental and slow. The use of incentives was problematic and more research is needed to understand how incentives can be used in interventions of this nature.

Background The natural integration of mobile phones into the daily routines of families provides novel opportunities to study and support family functioning and the quality of interactions between family members in real time. Objective This study aimed to examine user experiences of feasibility, acceptability, and reactivity (ie, changes in awareness and behaviors) of using a smartphone app for self-monitoring of family functioning with 36 participants across 15 family dyads and triads of young adolescents aged 10 to 14 years and their parents. Methods Participants were recruited from 2 family wellness centers in a middle-to-upper income shopping area and a low-income school site. Participants were instructed and prompted by alarms to complete ecological momentary assessments (EMAs) by using a smartphone app over 2 weeks 4 times daily (upon waking in the morning, afternoon, early evening, and end of day at bedtime). The domains assessed included parental monitoring and positive parenting, parent involvement and discipline, parent-child conflict and resolution, positive interactions and support, positive and negative affect, sleep, stress, family meals, and general child and family functioning. Qualitative interviews assessed user experiences generally and with prompts for positive and negative feedback. Results The participants were primarily white and Latino of mixed-income- and education levels. Children were aged 10 to 14 years, and parents had a mean age of 45 years (range 37-50). EMA response rates were high (95% to over 100%), likely because of cash incentives for EMA completion, engaging content per user feedback, and motivated sample from recruitment sites focused on social-emotional programs for family wellness. Some participants responded for up to 19 days, consistent with some user experience interview feedback of desires to continue participation for up to 3 or 4 weeks. Over 80% (25/31) of participants reported increased awareness of their families’ daily routines and functioning of their families. Most also reported positive behavior changes in the following domains: decision making, parental monitoring, quantity and quality of time together, communication, self-regulation of stress and conflict, discipline, and sleep. Conclusions The results of this study support the feasibility and acceptability of using smartphone EMA by young adolescents and parents for assessing and self-monitoring family daily routines and interactions. The findings also suggest that smartphone self-monitoring may be a useful tool to support improvement in family functioning through functions of reflection on antecedents and consequences of situations, prompting positive and negative alternatives, seeding goals, and reinforcement by self-tracking for self-correction and self-rewards. Future studies should include larger samples with more diverse and higher-risk populations, longer study durations, the inclusion of passive phone sensors and peripheral biometric devices, and integration with counseling and parenting interventions and programs.

Background Consistent with young adults’ penchant for digital communication, young adults living with HIV use digital communication media to seek out health information. Understanding the types of health information sought online and the characteristics of these information-seeking young adults is vital when designing digital health interventions for them. Objective This study aims to describe characteristics of young adults living with HIV who seek health information through the internet. Results will be relevant to digital health interventions and patient education. Methods Young adults with HIV (aged 18-34 years) self-reported internet use during an evaluation of digital HIV care interventions across 10 demonstration projects in the United States (N=716). Lasso (least absolute shrinkage and selection operator) models were used to select characteristics that predicted whether participants reported seeking general health and sexual and reproductive health (SRH) information on the internet during the past 6 months. Results Almost a third (211/716, 29.5%) and a fifth (155/716, 21.6%) of participants reported searching for general health and SRH information, respectively; 26.7% (36/135) of transgender young adults with HIV searched for gender-affirming care topics. Areas under the curve (>0.70) indicated success in building models to predict internet health information seeking. Consistent with prior studies, higher education and income predicted health information seeking. Higher self-reported antiretroviral therapy adherence, substance use, and not reporting transgender gender identity also predicted health information seeking. Reporting a sexual orientation other than gay, lesbian, bisexual, or straight predicted SRH information seeking. Conclusions Young adults living with HIV commonly seek both general health and SRH information online, particularly those exploring their sexual identity. Providers should discuss the most commonly sought SRH topics and the use of digital technology and be open to discussing information found online to better assist young adults with HIV in finding accurate information. Characteristics associated with health information–seeking behavior may also be used to develop and tailor digital health interventions for these young adults.

BACKGROUND Consistent with young adults’ penchant for digital communication, young adults living with HIV use digital communication media to seek out health information. Understanding the types of health information sought online and the characteristics of these information-seeking young adults is vital when designing digital health interventions for them. OBJECTIVE This study aims to describe characteristics of young adults living with HIV who seek health information through the internet. Results will be relevant to digital health interventions and patient education. METHODS Young adults with HIV (aged 18-34 years) self-reported internet use during an evaluation of digital HIV care interventions across 10 demonstration projects in the United States (N=716). Lasso (least absolute shrinkage and selection operator) models were used to select characteristics that predicted whether participants reported seeking general health and sexual and reproductive health (SRH) information on the internet during the past 6 months. RESULTS Almost a third (211/716, 29.5%) and a fifth (155/716, 21.6%) of participants reported searching for general health and SRH information, respectively; 26.7% (36/135) of transgender young adults with HIV searched for gender-affirming care topics. Areas under the curve (>0.70) indicated success in building models to predict internet health information seeking. Consistent with prior studies, higher education and income predicted health information seeking. Higher self-reported antiretroviral therapy adherence, substance use, and not reporting transgender gender identity also predicted health information seeking. Reporting a sexual orientation other than gay, lesbian, bisexual, or straight predicted SRH information seeking. CONCLUSIONS Young adults living with HIV commonly seek both general health and SRH information online, particularly those exploring their sexual identity. Providers should discuss the most commonly sought SRH topics and the use of digital technology and be open to discussing information found online to better assist young adults with HIV in finding accurate information. Characteristics associated with health information–seeking behavior may also be used to develop and tailor digital health interventions for these young adults.

Research Objective External environment is an important factor in the success of large‐scale healthcare initiatives. However, there is limited understanding of how external shocks may shape early implementation. In October 2019, the VHA Office of Primary Care launched national Clinical Resource Hubs (CRHs) to provide staffing gap coverage for primary care and mental health services. Through a “hub” and “spoke” model, providers at 18 regional hubs deliver virtual and in‐person care to patients at spoke clinics. Using CRH implementation as a case study, we consider the impact of Covid‐19 on early implementation efforts. Study Design We conducted semi‐structured interviews about early implementation experiences with eight program office leads and six regional hub directors from June–September 2020. Data were analyzed using a rapid analysis approach, which entailed interview summaries cross‐validated by two project team members. Summaries were synthesized with consensus checks to identify major themes regarding CRH implementation from key interview domains. Data were aggregated across roles. Population Studied National program office leaders and regional hub directors involved in implementation. Principal Findings The Covid‐19 pandemic was perceived as both facilitating and hindering implementation. For example, it accelerated achievement of some goals including telehealth emergency management support which was “fast tracked” in response to the pandemic during the first year of implementation although not required until year two. Hub providers also expanded support for regional nurse advice telephone call centers (a year 3 implementation goal) during March and April. In addition, Covid‐19 was recognized as a “game changer” in terms of increasing the acceptability of telehealth as an effective mode of care among VA national offices and spoke sites during a time of restricted in‐person appointments. The pandemic also posed significant implementation barriers. Hub directors reported difficulty establishing relationships at new spoke sites due to sites' focus on patient care during Covid‐19 surges. Additionally, they faced collaboration challenges, such as the inability of the national program office leaders to travel in person to assist with spoke site set‐up due to travel restrictions. In response to these challenges, leaders made several program modifications. Marketing efforts were broadened through increased outreach to potential spoke sites, in‐person visits to establish new spoke sites were suspended in favor of virtual training, and patient care delivery was modified to include in‐home telehealth visits. Respondents expected that these modifications may become permanent after Covid‐19 has ended, thereby altering CRH processes. Conclusions Our findings demonstrate the complex effects of Covid‐19 on early program implementation, acting as both a facilitator and barrier in service provision, marketing, and training. Because some VA healthcare systems had telehealth pilot programs already in place, they may have been more “ready” to expand virtual visits when Covid‐19 struck. Implications for Policy or Practice The program modifications we identified in response to Covid‐19 carry actionable lessons for healthcare organizations similarly impacted by external environmental factors. Telehealth capacity and specifically the capacity to switch from in‐person to virtual modes of patient care and provider training may facilitate emergency response. Primary Funding Source Department of Veterans Affairs.

RESEARCH OBJECTIVE: For most Veterans, telephoning a VA administrative call center is their first step in engaging the Veterans Healthcare System. Recent studies have found that Veterans experience lingering dissatisfaction communicating with their primary care (PC) teams and that telephone access, specifically the average speed of answer, has important consequences for patient satisfaction. This study explores the organizational and work experience factors that may impact communication between Veterans, call centers, and their PC teams. STUDY DESIGN: Cross‐sectional, observational. POPULATION STUDIED: Medical Support Assistants (MSAs) working in call centers and PC clinics, Administrative Staff Chiefs and MSA Supervisors in one regional network. We conducted site observations at call centers (n = 9) and PC clinics (n = 11) and semi‐structured interviews with call center (n = 16) and PC clinics (n = 13) MSAs. Site visits included informal discussions (n = 20) with Administrative Staff Chiefs and MSA Supervisors. We also observed MSA work environments. Our interviews with MSAs focused on communication flows, training, and work experiences. We mapped out communication flows to illustrate where communication breakdown, choke points, and loops occur. PRINCIPAL FINDINGS: Most communication breakdowns occur due to a combination of technology issues, software issues, and protocols that are barriers to regular, open communication between call centers, PC clinics, and other service lines. Organizational factors impacting call center functioning include physical location of call centers (co‐located at a medical center v. offsite), infrastructure (information technology support, facility management support), (high) MSA turnover, lack of standardized training, and communication challenges. MSAs report working at VA for an average of 5 years; as an MSA for 3 years. Almost all reported that they would like to leave their current position within the next year. Most MSAs stated that they are “good at their job” because they “break the rules to help the Veteran.” Contributing factors from work experiences to communication include working as an MSA to “get their foot in the door” to other positions at VA, challenges with call centers being short staffed, high turnover, low pay, limited opportunities for career growth, navigating multiple software programs simultaneously, balancing multiple tasks, and dealing with “angry Vets.” Promising practices used by several call center administrators include offering hands‐on experience/simulations of real‐time work in addition to standard training, mechanisms to destress MSAs after handling difficult calls. One call center created Preceptor positions for experienced MSAs for new MSAs to shadow, allowing personalized mentoring, team building, and task variation. Other notable practices include an open‐door policy with MSA Supervisors, group Skypes, and the use of floor walkers for monitoring any difficulties or queries. Two call centers have negotiated with human resources to streamline the hiring process and fill open positions as soon as possible. CONCLUSIONS: From our interview with MSAs, we identified several communication choke points: technology, software/scheduling processes, administrative protocols, and MSA work experiences. IMPLICATIONS FOR POLICY OR PRACTICE: Our findings demonstrate the task complexity of scheduling and customer service provided in primary care. It also illustrates the complexity of communication flows between Veterans, call centers, and their primary care teams. PRIMARY FUNDING SOURCE: Department of Veterans Affairs.

BACKGROUND The natural integration of mobile phones into the daily routines of families provides novel opportunities to study and support family functioning and the quality of interactions between family members in real time. OBJECTIVE This study aimed to examine user experiences of feasibility, acceptability, and reactivity (ie, changes in awareness and behaviors) of using a smartphone app for self-monitoring of family functioning with 36 participants across 15 family dyads and triads of young adolescents aged 10 to 14 years and their parents. METHODS Participants were recruited from 2 family wellness centers in a middle-to-upper income shopping area and a low-income school site. Participants were instructed and prompted by alarms to complete ecological momentary assessments (EMAs) by using a smartphone app over 2 weeks 4 times daily (upon waking in the morning, afternoon, early evening, and end of day at bedtime). The domains assessed included parental monitoring and positive parenting, parent involvement and discipline, parent-child conflict and resolution, positive interactions and support, positive and negative affect, sleep, stress, family meals, and general child and family functioning. Qualitative interviews assessed user experiences generally and with prompts for positive and negative feedback. RESULTS The participants were primarily white and Latino of mixed-income- and education levels. Children were aged 10 to 14 years, and parents had a mean age of 45 years (range 37-50). EMA response rates were high (95% to over 100%), likely because of cash incentives for EMA completion, engaging content per user feedback, and motivated sample from recruitment sites focused on social-emotional programs for family wellness. Some participants responded for up to 19 days, consistent with some user experience interview feedback of desires to continue participation for up to 3 or 4 weeks. Over 80% (25/31) of participants reported increased awareness of their families’ daily routines and functioning of their families. Most also reported positive behavior changes in the following domains: decision making, parental monitoring, quantity and quality of time together, communication, self-regulation of stress and conflict, discipline, and sleep. CONCLUSIONS The results of this study support the feasibility and acceptability of using smartphone EMA by young adolescents and parents for assessing and self-monitoring family daily routines and interactions. The findings also suggest that smartphone self-monitoring may be a useful tool to support improvement in family functioning through functions of reflection on antecedents and consequences of situations, prompting positive and negative alternatives, seeding goals, and reinforcement by self-tracking for self-correction and self-rewards. Future studies should include larger samples with more diverse and higher-risk populations, longer study durations, the inclusion of passive phone sensors and peripheral biometric devices, and integration with counseling and parenting interventions and programs.

There is growing interest in engaging men and boys in health and development programmes targeting the intersection of HIV risk, substance abuse, and violence. Understanding the conceptualisations of masculinities or masculine identities that shape both behaviours and opportunities for intervention is central to advancing the global agenda to engage men inhealth and development interventions. This paper examines an intervention using soccer and job training to engage and deliver activities for HIV prevention, substance abuse, and gender-based violence in a South African township. A literature review provides theoretical, historical and social context for the intersection of gender, masculinity, soccer, violence, and sexual relationships. Qualitative data from in-depth interviews and focus groups is analysed using theoretical and contextual frames to elucidate the negotiation of shifting, contradictory, and conflicting masculine roles. Results highlight how changing risky, normative behaviours among young men is a negotiated process entailing men’s relationships with women and with other men.Keywords: HIV/AIDS; South Africa; masculinity; soccer; drugs; gender; violence

BACKGROUND In the United States, disparities in the rates of HIV care among youth and young adults result from the intersections of factors that include stigma, substance use, homelessness or marginal housing, institutional neglect, and mental health issues. Novel interventions are needed that are geared to youth and young adults. OBJECTIVE In this paper, we aim to describe the interventions used by participating sites for Using Social Media initiative, the process for classifying the intervention components, and the methods for conducting a comprehensive evaluation of the interventions. METHODS In 2015, the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau, Special Projects of National Significance (SPNS) funded the Evaluation and Technical Assistance Center (ETAC) at the University of California, Los Angeles and 10 demonstration projects at sites across the United States that incorporated innovative approaches using a variety of social media and mobile technology strategies designed specifically for youth and young adults living with HIV. The ETAC developed a typology, or a classification system, that systematically summarizes the principal components of the interventions into broader groups and developed a multisite, mixed-methods approach to evaluate them based on the Department of Health and Human Services HIV health outcomes along the HIV care continuum. The mixed-methods approach is key to remove potential biases in assessing the effectiveness of demonstration projects. RESULTS This SPNS project was funded in September 2015, and enrollment was completed on May 31, 2018. A total of 984 participants have been enrolled in the multisite evaluation. Data collection will continue until August 2019. However, data analysis is currently underway, and the first results are expected to be submitted for publication in 2019. CONCLUSIONS This HRSA-funded initiative seeks to increase engagement in HIV medical care, improve health outcomes for people living with HIV, and reduce HIV-related health disparities and health inequities that affect HIV-positive youth and young adults. INTERNATIONAL REGISTERED REPORT RR1-10.2196/10681

ObjectiveMobile phones can replace traditional self-monitoring tools through cell phone-based ecological momentary assessment (CEMA) of lifestyle behaviours and camera phone-based images of meals, i.e. photographic food records (PFR). Adherence to mobile self-monitoring needs to be evaluated in real-world treatment settings. Towards this goal, we examine CEMA and PFR adherence to the use of a mobile app designed to help mothers self-monitor lifestyle behaviours and stress.Design/SettingIn 2012, forty-two mothers recorded CEMA of diet quality, exercise, sleep, stress and mood four times daily and PFR during meals over 6 months in Los Angeles, California, USA.SubjectsA purposive sample of mothers from mixed ethnicities.ResultsAdherence to recording CEMA at least once daily was higher compared with recording PFR at least once daily over the study period (74v. 11 %); adherence to both types of reports decreased over time. Participants who recorded PFR for more than a day (n31) were more likely to be obesev. normal- to overweight and to have higher blood pressure, on average (allPPP=0·04). CEMA adherence was highest in the morning (PConclusionsVariations in population and temporal characteristics should be considered for mobile assessment schedules. Neither CEMA nor PFR alone is ideal over extended periods.

Background Despite years of growing concern about poor provider attitudes and women experiencing mistreatment during facility based childbirth, there are limited interventions that specifically focus on addressing these issues. The Heshima project is an evidence-based participatory implementation research study conducted in 13 facilities in Kenya. It engaged a range of community, facility, and policy stakeholders to address the causes of mistreatment during childbirth and promote respectful maternity care. Methods We used the consolidated framework for implementation research (CFIR) as an analytical lens to describe a complex, multifaceted set of interventions through a reflexive and iterative process for triangulating qualitative data. Data from a broad range of project documents, reports, and interviews were collected at different time points during the implementation of Heshima. Assessment of in-depth interview data used NVivo (Version 10) and Atlas.ti software to inductively derive codes for themes at baseline, supplemental, and endline. Our purpose was to generate categories of themes for analysis found across the intervention design and implementation stages. Results The implementation process, intervention characteristics, individual champions, and inner and outer settings influenced both Heshima’s successes and challenges at policy, facility, and community levels. Implementation success stemmed from readiness for change at multiple levels, constant communication between stakeholders, and perceived importance to communities. The relative advantage and adequacy of implementation of the Respectful Maternity Care (RMC) resource package was meaningful within Kenyan politics and health policy, given the timing and national promise to improve the quality of maternity care. Conclusion We found the CFIR lens a promising and flexible one for understanding the complex interventions. Despite the relatively nascent stage of RMC implementation research, we feel this study is an important start to understanding a range of interventions that can begin to address issues of mistreatment in maternity care; replication of these activities is needed globally to better understand if the Heshima implementation process can be successful in different countries and regions.

BACKGROUND In the United States, disparities in the rates of HIV care among youth and young adults result from the intersections of factors that include stigma, substance use, homelessness or marginal housing, institutional neglect, and mental health issues. Novel interventions are needed that are geared to youth and young adults. OBJECTIVE In this paper, we aim to describe the interventions used by participating sites for Using Social Media initiative, the process for classifying the intervention components, and the methods for conducting a comprehensive evaluation of the interventions. METHODS In 2015, the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau, Special Projects of National Significance (SPNS) funded the Evaluation and Technical Assistance Center (ETAC) at the University of California, Los Angeles and 10 demonstration projects at sites across the United States that incorporated innovative approaches using a variety of social media and mobile technology strategies designed specifically for youth and young adults living with HIV. The ETAC developed a typology, or a classification system, that systematically summarizes the principal components of the interventions into broader groups and developed a multisite, mixed-methods approach to evaluate them based on the Department of Health and Human Services HIV health outcomes along the HIV care continuum. The mixed-methods approach is key to remove potential biases in assessing the effectiveness of demonstration projects. RESULTS This SPNS project was funded in September 2015, and enrollment was completed on May 31, 2018. A total of 984 participants have been enrolled in the multisite evaluation. Data collection will continue until August 2019. However, data analysis is currently underway, and the first results are expected to be submitted for publication in 2019. CONCLUSIONS This HRSA-funded initiative seeks to increase engagement in HIV medical care, improve health outcomes for people living with HIV, and reduce HIV-related health disparities and health inequities that affect HIV-positive youth and young adults. INTERNATIONAL REGISTERED REPORT RR1-10.2196/10681

In the United States, disparities in the rates of HIV care among youth and young adults result from the intersections of factors that include stigma, substance use, homelessness or marginal housing, institutional neglect, and mental health issues. Novel interventions are needed that are geared to youth and young adults.In this paper, we aim to describe the interventions used by participating sites for Using Social Media initiative, the process for classifying the intervention components, and the methods for conducting a comprehensive evaluation of the interventions.In 2015, the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau, Special Projects of National Significance (SPNS) funded the Evaluation and Technical Assistance Center (ETAC) at the University of California, Los Angeles and 10 demonstration projects at sites across the United States that incorporated innovative approaches using a variety of social media and mobile technology strategies designed specifically for youth and young adults living with HIV. The ETAC developed a typology, or a classification system, that systematically summarizes the principal components of the interventions into broader groups and developed a multisite, mixed-methods approach to evaluate them based on the Department of Health and Human Services HIV health outcomes along the HIV care continuum. The mixed-methods approach is key to remove potential biases in assessing the effectiveness of demonstration projects.This SPNS project was funded in September 2015, and enrollment was completed on May 31, 2018. A total of 984 participants have been enrolled in the multisite evaluation. Data collection will continue until August 2019. However, data analysis is currently underway, and the first results are expected to be submitted for publication in 2019.This HRSA-funded initiative seeks to increase engagement in HIV medical care, improve health outcomes for people living with HIV, and reduce HIV-related health disparities and health inequities that affect HIV-positive youth and young adults.DERR1-10.2196/10681.

In-depth qualitative interviews were conducted with healthcare providers (HCPs) from five HIV medical care coordination teams in a large Los Angeles County HIV clinic, including physicians, nurses, and psychosocial services providers. HCPs reported on the potential utility, acceptability, and barriers for patient self-monitoring and notifications via mobile phones, and web-based dashboards for HCPs. Potential benefits included: 1) enhancing patient engagement, motivation, adherence, and self-management; and 2) improving provider-patient relationships and HCP care coordination. Newly diagnosed and patients with co-morbidities were highest priorities for mobile application support. Facilitators included universal mobile phone ownership and use of smartphones or text messaging. Patient-level barriers included concerns about low motivation and financial instability for consistent use by some patients. Organizational barriers, cited primarily by physicians, included concerns about privacy protections, easy dashboard access, non-integrated electronic records, and competing burdens in limited appointment times. Psychosocial services providers were most supportive of the proposed mobile tools.

BackgroundSelf-monitoring by mobile phone applications offers new opportunities to engage patients in self-management. Self-monitoring has not been examined thoroughly as a self-directed intervention strategy for self-management of multiple behaviors and states by people living with HIV (PLH).MethodsPLH (n = 50), primarily African American and Latino, were recruited from 2 AIDS services organizations and randomly assigned to daily smartphone (n = 34) or biweekly Web-survey only (n = 16) self-monitoring for 6 weeks. Smartphone self-monitoring included responding to brief surveys on medication adherence, mental health, substance use, and sexual risk behaviors, and brief text diaries on stressful events. Qualitative analyses examine biweekly open-ended user-experience interviews regarding perceived benefits and barriers of self-monitoring, and to elaborate a theoretical model for potential efficacy of self-monitoring to support self-management for multiple domains.ResultsSelf-monitoring functions include reflection for self-awareness, cues to action (reminders), reinforcements from self-tracking, and their potential effects on risk perceptions, motivations, skills, and behavioral activation states. Participants also reported therapeutic benefits related to self-expression for catharsis, nonjudgmental disclosure, and in-the-moment support. About one-third of participants reported that surveys were too long, frequent, or tedious. Some smartphone group participants suggested that daily self-monitoring was more beneficial than biweekly due to frequency and in-the-moment availability. About twice as many daily self-monitoring group participants reported increased awareness and behavior change support from self-monitoring compared with biweekly Web-survey only participants.ConclusionsSelf-monitoring is a potentially efficacious disruptive innovation for supporting self-management by PLH and for complementing other interventions, but more research is needed to confirm efficacy, adoption, and sustainability.