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The human immunodeficiency virus (HIV) continues to be a major health issue in the United States, and an estimated 1.2 million people in the United States are living with HIV. As part of Healthy People 2020, the Office of Disease Prevention and Health Promotion has targeted the persistent demographic and geographic disparities in HIV prevalence and management. Preliminary evidence suggests that mobile health technology (smartphone apps) may be a promising way to support HIV self-management among vulnerable populations of people living with HIV (PLWH) who lack access to appropriate health care services.
This study examines the association between individual characteristics of PLWH and level of interest in using a free mobile phone app for HIV self-management.
This study was conducted using cross-sectional survey data collected in the Florida Cohort Study between 2014 and 2016 (N=766). Associations between individual characteristics of PLWH and level of interest in using a free mobile phone app for HIV self-management were examined using bivariate analysis and logistic regression.
Overall, 85.5% (655/766) of respondents were interested in using a free mobile phone app that supports HIV self-management. Participants expressed the highest interest in app functions that facilitate communication with health care providers (568/740, 76.8%) or help to identify relevant health care services (556/745 74.6%). Age (OR 0.959, 95% CI 0.936-0.982), education (OR 1.281, 95% CI 1.027-1.598) and disability or inability to work (OR 0.296, 95% CI 0.145-0.606) were all significantly associated with being interested in using a free mobile phone app for HIV self-management.
This study indicates that a majority of PLWH are interested in using a free mobile phone app to self-manage their condition. The findings can inform the development of mobile phone apps that support effective HIV self-management.
Human immunodeficiency virus (HIV) continues to be a major health issue in the United States, and an estimated 1.2 million people are living with the disease [
While HIV was previously a common fatal disease, the advent of antiretroviral therapy (ART) has transformed it to a chronic condition, allowing people to live long lives with HIV infection [
Mobile health (mHealth) interventions have emerged as a promising tool to support disease self-management among PLWH from all demographic groups and geographic areas [
This study was conducted using cross-sectional survey data collected in the Florida Cohort Study between 2014 and 2016. The Florida Cohort Study uses a convenience-sampling frame across several public health settings in Florida to recruit PLWH and collect information about demographic, behavioral, and social factors affecting health outcomes. Any person with HIV older than 18 years of age was eligible to participate in the study. Participants were recruited from a collaborative network of county health department and community clinics throughout Florida, including sites at Lake City, Gainesville, Tampa, Orlando, Sanford, Ft. Lauderdale, and Miami. After written informed consent was obtained, anonymous surveys were self-administered by cohort participants using Research Electronic Data Capture, a secure, Web-based app. Surveys were completed in English or Spanish depending on the preference of the participant. These surveys took approximately 30 to 45 minutes to complete and respondents were provided $25 in compensation in the form of a gift card. The University of Florida, Florida International University, and the Florida Department of Health institutional review boards approved the Florida Cohort Study.
The dependent variable in this study was a binary measure we created that indicates interest in a free mobile phone app for HIV self-management. Level of interest in functions that support self-management using mobile technology was determined using the following set of survey questions: “If available and free, how often would you use a phone app to help you: (1) identify health services relevant to you, (2) track changes in your mood and emotions, (3) provide tips to improve your health, based on information about you, (4) manage alcohol and drug use behavior, (5) communicate with your doctor or clinic, (6) remember to take your medication, or (7) engage in social networking with other people with similar health conditions as you?” Possible answers for these 7 questions were never, rarely, about once a week, a few times a week, and daily. Interest was defined as any response choice other than never.
Individual characteristics that were analyzed included age and amount of schooling completed, which ranged from: (1) elementary school or below, (2) some high school, (3) high school graduate or general education diploma (GED), (4) some college or technical/trade school, (5) college or trade school graduate, or (6) graduate degree or professional degree after graduating college. Additional individual characteristics that were analyzed included sex at birth, ethnicity, race, being in a long-term partnership, sexual orientation, and employment status. Ethnicity was categorized as being Hispanic versus not Hispanic based on whether the respondent self-reported being of Hispanic/Latino origin or descent. Race was categorized as white, Black/African American, or other race. The category of other race included Native American, Asian, multiracial, and other responses by participants. Being in a long-term partnership was a binary variable that indicated marriage or living with a long-term partner versus the state of being divorced, widowed, separated, or never married/single. Sexual orientation was categorized as heterosexual, gay or lesbian, and other sexual orientation. The other sexual orientation category included options of bisexual, asexual, and other. Employment status was determined by asking respondents to select from types of current employment: employed for wages, self-employed, out of work for more than 1 year, out of work for less than 1 year, homemaker, student, retired, or unable to work/disabled. These employment statuses were collapsed into 3 categories: employed, unemployed, and unable to work/disabled. The employed category included all respondents that selected employed for wages or self-employed. The unemployed category included all of the remaining respondents except for those who were unable to work/disabled.
At the time of the analysis, we included all 766 participants in the Florida Cohort Study. Statistical analysis was performed using SAS software, version 9.4 (SAS Institute Inc). Univariate descriptive statistics were calculated including the mean, median, and range for continuous variables and counts and percentages for categorical variables. All variables were examined as categorical variables to determine bivariate relationships using chi-square analysis. Individual characteristics with
The individual characteristics of respondents in the sample are presented in
Demographic characteristics (N=766).
Demographic variable | N | Frequency, n (%) | Mean (SD) | Median | Range | |
766 | ||||||
Male | 504 (65.8) | |||||
Female | 262 (34.2) | |||||
Age | 760 | 45.99 (11.27) | 48.00 | 19.00-77.00 | ||
765 | ||||||
Hispanic | 116 (15.2) | |||||
Not Hispanic | 649 (84.8) | |||||
765 | ||||||
Other racea | 70 (9.2) | |||||
Black/African American | 452 (59.1) | |||||
White | 243 (31.8) | |||||
Schooling completedb | 764 | 3.14 (1.15) | 3.00 | 1.00-6.00 | ||
764 | ||||||
Yes | 155 (20.3) | |||||
No | 609 (79.7) | |||||
744 | ||||||
Heterosexual | 392 (52.7) | |||||
Gay or lesbian | 262 (35.2) | |||||
Other sexual preferenced | 90 (12.1) | |||||
749 | ||||||
Employed | 186 (24.8) | |||||
Unable to work/disabled | 365 (48.7) | |||||
Unemployed | 198 (26.4) |
aOther race includes Native American, Asian, multiracial, and other.
bSchool completed ranges from 1-6: 1=elementary school or below, 2=some high school, 3=high school graduate or general education diploma, 4=some college or technical/trade school, 5=college or trade school graduate, 6=graduate degree or professional degree after graduating college.
cLong-term partnership includes married or living with long-term partner.
dOther sexual preference includes bisexual, asexual, and other.
Respondents’ level of interest in using a free mobile phone app to support HIV self-management is shown in
Interest in mobile phone app functions to support HIV self-management.
Mobile app function | N | Never |
Rarely |
About once a week |
Few times a week |
Daily |
Interesteda |
Not Interestedb |
Identify health servicesa | 745 | 25.4 | 20.4 | 16.0 | 14.4 | 23.9 | 74.6 | 25.4 |
Track mood or emotionsb | 744 | 46.2 | 17.3 | 7.8 | 9.0 | 19.6 | 53.8 | 46.2 |
Provide health tipsc | 745 | 32.3 | 18.4 | 11.4 | 13.2 | 24.7 | 67.7 | 32.3 |
Manage alcohol and drug used | 741 | 68.4 | 11.2 | 4.7 | 4.3 | 11.3 | 31.6 | 68.4 |
Communicate with your doctore | 740 | 23.2 | 18.0 | 19.5 | 16.1 | 23.2 | 76.8 | 23.2 |
Remember to take your medicationf | 743 | 39.3 | 11.6 | 4.7 | 5.1 | 39.3 | 60.7 | 39.3 |
Engage in social networkingg | 741 | 40.8 | 15.1 | 9.6 | 11.5 | 23.1 | 59.2 | 40.8 |
aConsidered interested if answered rarely, about once a week, a few times a week, or daily.
bConsidered not interested if answered never.
cIdentify health services relevant to you.
dTrack changes in your mood or emotions.
eProvide tips to improve your health, based on information about you.
fManage alcohol and drug use behavior.
gCommunicate with your doctor or clinic.
hRemember to take your medication.
iEngage in social networking with other people with similar health conditions as you.
Multivariate logistic regression (N=708, 58 missing).
Demographic variable | Odds ratio (95% CI) | |||
Age | 0.959 (0.936-0.982) | <.001 | ||
Hispanic | 2.313 (0.920-5.814) | .07 | ||
White | 1 | — | ||
Black/African American | 1.011 (0.592-1.727) | .97 | ||
Other race | 1.491 (0.458-4.854) | .51 | ||
Schooling completed | 1.281 (1.027-1.598) | .03 | ||
Long-term partnership | 0.905 (0.523-1.565) | .72 | ||
Heterosexual | 1 | — | ||
Gay or lesbian | 0.798 (0.460-1.385) | .42 | ||
Other sexual preference | 0.640 (0.329-1.245) | .19 | ||
Employed | 1 | — | ||
Unable to work/disabled | 0.296 (0.145-0.606) | <.001 | ||
Unemployed | 0.736 (0.319-1.696) | .47 |
This study found that a vast majority of respondents were interested in using a free mobile phone app that supports HIV self-management. In addition, respondents expressed a strong preference for app functions that could help identify relevant health services, enhance communication with health care providers, provide tips to improve health based on personalized information, supply reminders to take medication, and enable social networking with individuals with similar health conditions. Respondents who were younger and better educated were more likely to express interest in using a phone app for HIV self-management. Conversely, respondents who were disabled or unable to work were significantly less likely to express interest in using a free mobile phone app for HIV self-management. Finally, although Hispanic participants were more than twice as likely to be interested in using a free mobile phone app for HIV self-management than non-Hispanic participants, the association was not statistically significant.
This study provides important insights into PLWH’s level of interest in using a free mobile phone app to support HIV self-management. However, there are limitations to this study. First, the measures are all self-reported by PLWH. This may increase social desirability bias, which occurs when respondents simply provide answers that will be viewed favorably by others. However, this effect was minimized through the use of anonymous surveys. Second, other resources for HIV self-management were not examined in this study. Thus, it is unclear whether respondents who lacked interest in using a free mobile phone app used other resources to self-manage their disease and whether these resources affect their level of interest. However, because a vast majority (approximately 86%) of respondents expressed interest in using a free mobile phone app to support HIV self-management, it is unlikely that this potential limitation had a strong effect on the study.
While little previous work exists examining interest in using free mobile phone apps to support HIV self-management among PLWH, several studies have examined common barriers to HIV self-management in this population. PLWH frequently report barriers related to accessing appropriate medical care, navigating complex medication regimens, and discussing their self-management challenges with providers comfortable with an HIV diagnosis [
This study revealed that PLWH have a high level of interest in using a free mobile phone app to self-manage their disease. Our findings can be used to inform the development of a mobile phone app that improves PLWH’s ability to self-manage HIV as well as access health care services, communicate with health care providers, and network with individuals with similar conditions. The unique needs of PLWH who are disabled or unable to work should be considered in the adoption and development of technology-based self-management tools and interventions.
antiretroviral therapy
human immunodeficiency virus
National Institutes of Health
odds ratio
people living with human immunodeficiency virus
RJL, JAF, CC, JPM, GI, and RLC were involved in the conceptualization and design of the study. RJL, JAF, EAF, MTW, and RLC contributed to the data management and analysis and results. RJL led JAF, EAF, RIB, and MTW to prepare the manuscript and multiple iterations. CC, FM, MHR, JPM, GI, and RLC reviewed the versions of the manuscript and provided comments and made editorial suggestions.
Research reported in this publication was supported by National Institutes of Health (NIH) grant U24AA022002 (Cook, RL, Principal Investigator) and the University of Florida Clinical and Translational Science Institute, which is supported in part by the NIH National Center for Advancing Translational Sciences under award number UL1TR001427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. We thank Debra McDonald (Editor, University of Florida, College of Nursing Office of Research Support) for assistance on editorial revisions.
None declared.