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Focus groups were conducted with stimulant-using HIV-positive MSM (24-57 years of age; mostly non-Hispanic white; 42% once a week or more frequent stimulant drug use) in San Francisco and Minneapolis. Our aim was to explore the mobile phone app features and functions that they considered when deciding to download and sustain their use of general apps over time, as well as specific features and functions that they would like to see incorporated into an ART adherence mobile app. Focus groups were audiorecorded and transcribed verbatim. Thematic analysis was applied to transcripts using line-by-line open coding and organizing codes into meaningful themes.
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Men reported that they currently had a variety of health and wellness, social media and networking, gaming and entertainment, and utility apps on their mobile phones. Downloading apps to their mobile phones was influenced by the cost of the app, recommendations by a trusted source, and the time it takes to download. In addition, downloading and sustained use of apps was more likely to occur when men had control over most features of the app and apps were perceived to be useful, engaging, secure, and credible. Participants suggested that ART adherence mobile phone apps include social networking features, connections to local resources and their medical chart, and breaking HIV news and updates. Although some men expressed concerns about daily self-monitoring of HIV medication doses, many appreciated receiving a summary of their medication adherence over time and suggested that feedback about missed doses be delivered in an encouraging and humorous manner.
All procedures were approved by the University of Minnesota Institutional Review Board. Focus group questions were developed by the research team and guided by the Technology Adoption Model (TAM) . The TAM is a conceptual model to capture how persons will come to accept and use a new technology, such as the perceived usefulness of the technology and how easy the technology is to navigate. Participants were asked to describe what apps they currently have on their mobile phone. Next, men were asked to reflect on features and functions of mobile phone apps in general that they believed contributed to their decision to download, initiate use of, and continue to use apps. Although focus group members often spontaneously mentioned many features (eg, perceived usefulness) of their general app downloading and use that were relevant to the TAM conceptual model, we probed men to reflect on factors of the TAM conceptual model that were not mentioned. Finally, men were also asked to describe features and functions that they would like to see in ART adherence apps.
The successful dissemination and uptake of mobile phone app interventions addressing the HIV prevention and treatment continuum of care requires that persons are willing to download and sustain use of the app, as well as providing content and features that are culturally relevant for the target population. In this study, we explored the features and functions of mobile phone apps that stimulant-using HIV-positive MSM considered when deciding to download and sustain their use of apps in general over time, as well as specific features and functions that they would like to see incorporated into an app to help them manage ART adherence more effectively.