Since its introduction in 1996, combined anti-retroviral therapy (cART) has led to enormous improvements in the health and survival of HIV positive (HIV+) persons. However, the success of cART is intrinsic upon patient adherence to therapy; something that many individuals struggle with due to a myriad of structural and psychosocial barriers encompassing the social determinants of health.
There is mounting evidence that interventions using mobile phone technology to deliver health care (mHealth) can improve cART adherence and HIV viral load in HIV+ persons. However, there remains a paucity of data on factors influencing success of mHealth strategies, and even less data regarding health care provider (HCP) experiences and perceived usefulness of mHealth interventions in clinical care.
The WelTel study at Oak Tree Clinic
The WelTel BC1 pilot study, conducted by Dr. Murray, and Dr. Richard Lester, involved 25 patients attending the Oak Tree clinic at BC Women’s Hospital. Participants belonged to one of five groups: youth (aged 14-24), mature adults (aged 50 and over), English as a second language, remote from care (commuting 3 or more hours to appointments), and advanced HIV with detectable HIV viral load.
Patients consenting to participate received a weekly text message asking “How are you?” from a computer platform (lasting 6 months), and were asked to respond weekly within 48 hours either that they were doing well or had a problem. No responsen or negative responses cued study nurse follow up.
Data was collected pertaining tofor all HCP-participant interactions throughout the study. Patients and HCP were interviewed prior to study start (to inform the intervention) and at study end. HCP interviews identified benefits and concerns related to the intervention. These were coded using the Technology Acceptance Model, which states that the perceived usefulness and ease of use of a technology will influence how and when an individual will use it.
Results of provider interviews
HCPs identified an improvement in the organization of outreach efforts to ensure that no one is forgotten. They also felt that their own privacy would be preserved while enabling them to provide enhanced patient care.
Beliefs that work load would increase were validated (with approximately 7 “problem” responses per week), though HCP identified that this increase “up-front” may decrease cases of patient crisis over time.
Regarding perceived patient benefits, it was felt that the intervention resulted in an increase in “agency” of participants – allowing patients to direct their own care, and meet their own needs. Indeed, it was felt that the intervention empowered patients, improved their access to services, and built relationships with care providers; all factors important in addressing the social determinants of health that affect outcomes.
As one HCP commented: “….I think that’s (WelTel) what contributed to people feeling like they had a connection with the clinic, like they had a connection with myself… that they felt like their voice was heard …”
Overall, HCPs identified that the WelTel intervention improved engagement, built relationships and streamlined outreach efforts. It was believed that intervention benefits were many and went far beyond simply improving HIV viral load.
For further information
For information on the results of this study: Murray et. al. AIDS Behav. 2015 Oct;19(10):1875-87. doi: 10.1007/s10461-015-1151-6.
For further information about the WelTel intervention at the Oak Tree Clinic, please contact Dr. Melanie Murray.
For more general inquires about WelTel projects, please contact Dr. Richard Lester.