Understanding the predisposing, enabling, and reinforcing factors influencing the use of a mobile-based HIV management app: A real-world usability evaluation

Objective: To conduct an in-depth analysis of users' experiences using an HIV self-management app. Materials and Methods: We conducted four follow-up focus groups at the end of a 3-month randomized feasibility trial. All focus group sessions were audio-recorded and transcribed. A thematic analysis was conducted to explore emerging themes. All of the themes were categorized into three factors of the PRECEDE component of the PRECEDE-PROCEED framework. For a finer granularity of analysis, the codes of each theme were broken into positive, negative, and neutral codes by study group. Results: 36 participants, including 24 from the intervention group and 12 from the control group, participated in the focus group sessions. A total of 14 themes organized by the PRECEDE factors were identified from focus group transcripts. Five themes related to predisposing factors were: 1) ease of app use; 2) user-friendly functionality; 3) self-efficacy for symptom management; 4) design preference of illustrated strategies with videos; and 5) user-control (convenience vs. security). Four themes related to enabling factors were: 1) information needs of symptom management; 2) symptom-tracking; 3) fit in lifestyle/schedule/living conditions; and 4) additional languages (e. g., Spanish). Five themes related to reinforcing factors were: 1) communication with healthcare providers; 2) individual-tailored information visualization; 3) social networking; 4) individual-tailored information quality; and 5) improvement in quality of life. Discussion and Conclusion: Usability evaluation in a real-world setting enabled us to measure users' actual experiences when interacting with the app during their everyday lives. Our work highlights the importance of using mobile technology for persons living with HIV, specifically those with low income/housing instability, and adds to the body of literature on the potential for implementation and dissemination of symptom self-management strategies through a mobile platform.