A Realistic Talking Human Embodied Agent Mobile Phone Intervention to Promote HIV Medication Adherence and Retention in Care in Young HIV-Positive African American Men Who Have Sex With Men: Qualitative Study
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Abstract
BACKGROUND: Avatars and embodied agents are a promising innovation for human health intervention because they may serve as a relational agent that might augment user engagement in a behavioral change intervention and motivate behavioral change such as antiretroviral adherence and retention in care. OBJECTIVE: This study aimed to develop a theory-driven talking avatar-like embodied agent mobile phone intervention guided by the information-motivation-behavioral skills model to promote HIV medication adherence and retention in care in young African American men who have sex with men (MSM). METHODS: We performed 5 iterative focus groups in Chicago with HIV-positive African American MSM aged 18-34 years to inform the ongoing development of a mobile phone app. Participants for the focus groups were recruited from 4 University of Illinois at Chicago Community Outreach Intervention Project sites located in different high HIV incidence areas of the city and the University of Illinois at Chicago HIV clinic using fliers and word of mouth. The focus group data analysis included developing an ongoing list of priorities for app changes and discussion between two of the investigators based on the project timeline, resources, and to what extent they served the app's objectives. RESULTS: In this study, 16 men participated, including 3 who participated in two groups. The acceptability for an embodied agent app was universal in all 5 focus groups. The app included the embodied agent response to questions and antiretroviral regimen information, adherence tracking, CD4 count and viral load tracking, motivational spoken messages, and customizability. Concerns that were identified and responded to in the development process included privacy, stigma, avoiding the harsh or commanding tone of voice, avoiding negative motivational statements, and making reminder functions for a variety of health care interactions. CONCLUSIONS: An avatar-like embodied agent mHealth approach was acceptable to young HIV-positive African American MSM. Its relational nature may make it an effective method of informing, motivating, and promoting health behavioral skills. Furthermore, the app's ease of access, stigma-free environment, and audiovisual format may help overcome some adherence barriers reported in this population.
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User-focused evaluation includes evaluation of apps targeting specific user groups, such as adolescents or people with mental health problems, or based on user input such as user reviews.
“This includes evaluation of apps targeting speci c user groups, for instance, adolescents [86] or people with mental health problems [84], or based on user input such as user reviews [64].”
From Security and Privacy of mHealth Applications: A Scoping Review (2020) · cites this paper as [84]
The Methods (Procedures) describe using focus-group feedback to evaluate and refine an app for a specific group. But the Methods (Participants) specify eligible ages of 18–34, and the Results (Participants) report actual ages of 21–34; this paper does not provide an example of evaluating an app for adolescents. The other examples in the citing sentence have separate citations. (LLM, conf=0.88)
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Cites
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Sorted by citations
Security and Privacy of mHealth Applications: A Scoping Review
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“uation of various embodied and non-embodied voice agents were proven to be an effective method of informing, motivating, and promoting health behavioral skills in HIV-positive Black young adults [29].”
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Self-citation
- Authors
- Dworkin, M., Chakraborty, A., Lee, S., Monahan, C., Hightow-Weidman, L., Garofalo, R., Qato, D., & Jimenez, A.
- Affiliations
- University of Illinois Chicago (US)
- Connecticut College (US)
- Northwestern University (US)
- Corresponding author
- Dworkin, Mark
- ORCID
- Venue
- JMIR mHealth and uHealth
- Publisher
- JMIR Publications Inc.
- Published
- 2018-07-31
- Volume
- 6
- Issue
- 7
- Pages
- e10211
- ISSN
- 2291-5222 (ISSN-L)
- PMC
- PMC6092590
- OpenAlex
- W2807760384
- Cited by
- 43
- References
- 5
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 2 · 2023: 8 · 2022: 6 · 2021: 4 · 2020: 8 · 2019: 4 · 2018: 1
- FWCI
- 6.49
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR mhealth and uhealth (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institutes of Health
- National Institute of Nursing Research (R21NR016420)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Social Sciences › Psychology › Social Psychology › Social Robot Interaction and HRI
- Keywords
- HIV treatment adherence, retention in care, embodied agents, talking avatars, mobile health intervention, Black men who have sex with men, information-motivation-behavioral skills model, acceptability, stigma, privacy concerns, antiretroviral therapy, behavior change
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