Development of a Computer-Based Tailored Information Application to Improve HIV-Related Treatment Adherence
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Abstract
Background
Advances in antiretroviral (ARV) therapy have greatly improved the health status of individuals with HIV infection. Adherence to ARV, however, has emerged as a critical issue, since patients may only take medications at rates of 50-60%. Optimal clinical outcomes in HIV treatment and the prevention of the development of antiretroviral resistant viral strains may depend on medication adherence at much higher levels, as high as 95%. Previous studies have shown that while providing patients with generic health information may have limited effects on their health-related behaviors, providing information to patients when it is individually tailored to their characteristics or interests can have a much greater impact. Tailoring is thus a promising strategy but requires substantial effort for assessment and tailoring. Computer-based assessments combined with algorithms for tailoring allow the creation of automated applications to provide healthcare-related information. We previously showed that a tailored information application improved medication adherence in persons treated for memory problems. The purpose of the current study is to develop and evaluate a computer-based tailored information application targeted at improving medication adherence among persons treated for HIV infection.
Methods
To date, the application has been developed in Adobe Captivate. Of the elements of the Previous studies have shown that interventions based on the IMB model are effective in improving health-related behaviors in persons with HIV infection. The computer-based application focuses on each element of the Information-Motivation-Behavioral Skills (IMB) model in an interactive teach and quiz format in which information is presented verbally and graphically and then the user’s understanding is evaluated with multiple choice questions. When users don’t understand, they are provided with a branching review process that reteaches the key information. Phase I of our study focused on intervention development and usability testing with potential consumers (HIV+ individuals 18 years of age or older). Consumer reaction was positive on the application’s overall content and mode of delivery. Usability assessment led to modifications in the intervention’s interface and content prior to phase II. In Phase II we are evaluating the intervention’s impact on elements of the elements of the IMB model and medication adherence in potential users. Users’ reactions to the intervention are evaluated through their responses to a questionnaire based on the Technology Acceptance Model.
Results
A total of 66 participants have been enrolled to date. Results show that participants have provided strongly positive ratings of the applications (average ratings across TAM usability factor questions on a 1 to 7 scale greater than 5.5, in the positive direction). Preliminary data analyses show that participants’ performances on the Information subscale of the IMB model measure increased significantly (p < 0.05), while other measures have changed in a positive direction (indicating increased motivation and behavioral skills for treatment adherence). Analyses of electronically-assessed medication adherence shows significant increases in medication adherence among those with less than 90% adherence at baseline.
Conclusions
A computer-based tailored information application is acceptable to potential users who have in usability testing been positive about its content and format. Further evaluation will allow an assessment of its effects on patient behavior.
Advances in antiretroviral (ARV) therapy have greatly improved the health status of individuals with HIV infection. Adherence to ARV, however, has emerged as a critical issue, since patients may only take medications at rates of 50-60%. Optimal clinical outcomes in HIV treatment and the prevention of the development of antiretroviral resistant viral strains may depend on medication adherence at much higher levels, as high as 95%. Previous studies have shown that while providing patients with generic health information may have limited effects on their health-related behaviors, providing information to patients when it is individually tailored to their characteristics or interests can have a much greater impact. Tailoring is thus a promising strategy but requires substantial effort for assessment and tailoring. Computer-based assessments combined with algorithms for tailoring allow the creation of automated applications to provide healthcare-related information. We previously showed that a tailored information application improved medication adherence in persons treated for memory problems. The purpose of the current study is to develop and evaluate a computer-based tailored information application targeted at improving medication adherence among persons treated for HIV infection.
Methods
To date, the application has been developed in Adobe Captivate. Of the elements of the Previous studies have shown that interventions based on the IMB model are effective in improving health-related behaviors in persons with HIV infection. The computer-based application focuses on each element of the Information-Motivation-Behavioral Skills (IMB) model in an interactive teach and quiz format in which information is presented verbally and graphically and then the user’s understanding is evaluated with multiple choice questions. When users don’t understand, they are provided with a branching review process that reteaches the key information. Phase I of our study focused on intervention development and usability testing with potential consumers (HIV+ individuals 18 years of age or older). Consumer reaction was positive on the application’s overall content and mode of delivery. Usability assessment led to modifications in the intervention’s interface and content prior to phase II. In Phase II we are evaluating the intervention’s impact on elements of the elements of the IMB model and medication adherence in potential users. Users’ reactions to the intervention are evaluated through their responses to a questionnaire based on the Technology Acceptance Model.
Results
A total of 66 participants have been enrolled to date. Results show that participants have provided strongly positive ratings of the applications (average ratings across TAM usability factor questions on a 1 to 7 scale greater than 5.5, in the positive direction). Preliminary data analyses show that participants’ performances on the Information subscale of the IMB model measure increased significantly (p < 0.05), while other measures have changed in a positive direction (indicating increased motivation and behavioral skills for treatment adherence). Analyses of electronically-assessed medication adherence shows significant increases in medication adherence among those with less than 90% adherence at baseline.
Conclusions
A computer-based tailored information application is acceptable to potential users who have in usability testing been positive about its content and format. Further evaluation will allow an assessment of its effects on patient behavior.
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