Can an HIV health app originally designed with English-speaking Americans in mind provide the same kind of clinical and social support to Spanish-speaking immigrants? According to the findings of a small qualitative study published in Telemedicine Reports, it can, with a few tweaks.
Mobile apps have been said to be the only way to connect with rural people affected by HIV. Apps are increasingly available to track everything from steps taken in a day to minutes of meditation—even to locate a place to pee in an unfamiliar city. In the HIV field, though, they’ve mostly been used to help people remember to take their meds, connect isolated communities and support self-testing.
In this case, the app is PositiveLinks, a combination health clinic portal and community forum that people with HIV receiving care at the University of Virginia Ryan White HIV Clinic can use to track appointments, remember their meds, access lab results and stay in contact with their providers. In addition, it comes with an anonymous message board for people with HIV to talk with one another.
People who have used the English-language version of the app have seen an improvement in their ability to remain engaged in care and on medication—and therefore have better access to the health benefits of an undetectable viral load. But the clinic also has a number of rural Spanish-English bilingual clients and wants to make sure they have access too.
Tabor Flickinger, MD, of the University of Virginia, and colleagues met with 22 Spanish-English bilingual Latinos living with HIV in nonurban parts of western Virginia and outside Washington, DC, during the first half of 2019 for in-depth interviews and feedback. The researchers shared the Spanish-language version of the existing PositiveLinks app with participants.
Ten participants were cisgender men; the other dozen were women, including two transgender women. The mean age was 41. All were born outside the United States (including seven in Honduras, four in El Salvador and four in Mexico), and they had been living in the United States for an average of 12 years. Twenty of 22 participants spoke only Spanish at home, and just over one in three reported good or fluent English proficiency.
The researchers found that most participants hadn’t ever before turned to their phone for healthy behavior and hadn’t used it to connect with others, beyond some using WhatsApp to stay in touch with family members. And like a lot of us, the participants were split on whether the internet was a net good or net bad.
But when it came to this particular app, participants gave the Spanish-language version of PositiveLinks high marks for cultural appropriateness, though a quarter asked for more content relevant to their communities.
Nonetheless, close to half, 41%, said they had trouble navigating the technology and weren’t sure they were doing it right. Plus, poor vision, spotty internet access and low literacy also made the app less useful for some participants. But participants did like the idea of getting appointment and medication reminders from the app, with one noting, “Sometimes we’re involved in a thousand different things and we forget. So a reminder would be very good.”
Indeed, 91% reported that they’d want to use the app if it were available, with some particularly noting how useful the message boards could be for the times they feel discouraged. In fact, they liked it so much, they wanted to be able to connect in Spanish with people with HIV being served at multiple clinics.
As a result, the app launched with announcements translated into Spanish, drop-in sessions available online, access to a Spanish-language contact on the clinic staff and a video introduction in Spanish to explain how to use the app. What’s more, the feedback led to a redesign of the page showing CD4 and viral load results as well as the addition of appointment reminders and customizable medication reminders.
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