Engagement in mHealth behavioral interventions for HIV prevention and care: making sense of the metrics

BACKGROUND: Engagement is the primary metric by which researchers can assess whether participants in a mHealth intervention used and interacted with the intervention's content as intended over a pre-specified period to result in behavior change. Paradata, defined as the process data documenting users' access, participation, and navigation through a mHealth intervention, have been associated with differential treatment outcomes in mHealth interventions. Within behavioral mHealth interventions, there has been an increase in the number of studies addressing the HIV prevention and care continuum in recent years, yet few have presented engagement metrics or examined how these data could inform design modifications, promote continued engagement, and supplement primary intervention efficacy and scale-up efforts. METHODS: We review common paradata metrics in mHealth interventions (e.g., amount, frequency, duration and depth of use), using case studies from four technology-driven HIV interventions to illustrate their utility in evaluating mHealth behavioral interventions for HIV prevention and care. Across the four case studies, participants' ages ranged between 15 and 30 years and included a racially and ethnically diverse sample of youth. The four case studies had different approaches for engaging young men who have sex with men: a tailored brief intervention, an interactive modular program, a daily tool to monitor and self-regulate treatment adherence, and an online platform promoting social engagement and social support. Each focused on key outcomes across the HIV prevention and care continuum [e.g., safer sex behaviors, HIV testing, antiretroviral therapy (ART) adherence] and collected paradata metrics systematically. RESULTS: Across the four interventions, paradata was utilized to identify patterns of use, create user profiles, and determine a minimum engagement threshold for future randomized trials based on initial pilot trial data. Evidence of treatment differences based on paradata analyses were also observed in between-arm and within-arm analyses, indicating that intervention exposure and dosage might influence the strength of the observed intervention effects. Paradata reflecting participants' engagement with intervention content was used to suggest modifications to intervention design and navigation, to understand what theoretically-driven content participants chose to engage with in an intervention, and to illustrate how engagement was linked to HIV-related outcomes. CONCLUSIONS: Paradata monitoring and reporting can enhance the rigor of mHealth trials. Metrics of engagement must be systematically collected, analyzed and interpreted to meaningfully understand a mHealth intervention's efficacy. Future mHealth trials should work to identify suitable engagement metrics during intervention development, ensure their collection throughout the trial, and evaluate their impact on trial outcomes

Neighborhood Context and Perceptions of Stress Over Time: An Ecological Model of Neighborhood Stressors and Intrapersonal and Interpersonal Resources

We examine the association between neighborhood socio‐economic disadvantage and perceived stress during middle and late adolescence among African American youth (N = 665; 51 % female; M = 15.9 years at baseline). In addition, we explored the ways through which neighborhood stressors interacted with an individual’s intra‐ and interpersonal resources (e.g., coping, social support and substance use), to affect their perceived stress trajectories during adolescence. First, we tested a neighborhood stressors model and found that youth who lived in neighborhoods with greater socioeconomic disadvantage had higher baseline stress and a steeper increase in stress over time. When we included individual‐level risk and promotive factors in the model, however, the effect of neighborhood disadvantage on perceived stress was no longer significant, and the stress trajectory was explained by adolescent substance use, social support and perceptions of the neighborhood. Our results support theories of stress and coping, and the importance of proximal intra‐ and interpersonal factors in either amplifying or mitigating perceptions of stress. We discuss implications of the neighborhood context and how our findings may inform future prevention and intervention related to adolescent stress and development.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/117087/1/ajcp9571.pd

Psychosocial Influences on Engagement in Care Among HIV-Positive Young Black Gay/Bisexual and Other Men Who Have Sex with Men

Young black gay/bisexual and other men who have sex with men (YB-GBMSM) living with HIV are at risk for poor engagement in HIV care. Relatively little is known about factors that impact engagement outcomes at various stages along the HIV care continuum in this specific population. The purpose of this analysis was to examine associations between various psychosocial factors and likelihood of engagement at each stage of the care continuum, among a geographically diverse sample of 132 YB-GBMSM living with HIV. Negative self-image, a component of HIV stigma, had an inverse association with early care seeking after HIV diagnosis (OR=1.05; 95% CI 1.01?1.10). Negative self-image was also inversely associated with adherence to medical appointments (OR=0.95; 95% CI 0.91?0.99), while employment (OR=0.30; 95% CI 0.12?0.75) and ethnic identity affirmation (OR=0.28; 95% CI 0.12?0.68) were both positively associated with appointment adherence. HIV-positive identity salience was associated with a higher likelihood of being on antiretroviral therapy (OR=1.06; 95% CI 1.02, 1.09). These findings highlight the importance of processes related to identity development, as both barriers and facilitators of engagement in care for HIV-positive YB-GBMSM.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140188/1/apc.2014.0117.pd

Trajectories of organized activity participation among urban adolescents: Associations with young adult outcomes

Organized activity participation provides opportunities for adolescents to develop assets that may support favorable outcomes in young adulthood. Activity participation may be especially beneficial for marginalized youth because they are likely to face stressors that increase risk of negative outcomes. We used growth mixture modeling to identify activity participation trajectories among African American adolescents in an urban, disadvantaged community (Wave 1: mean age = 14.86 years, standard deviation = 0.64; 49% male, N = 681). We also investigated if young adult outcomes differed by participation trajectory subgroups, the results of which suggested that a 3‐class model best fit the data: low initial and decreasing levels of participation (74%); moderate initial and consistent (21%); and moderate initial and increasing (5%). Adolescents in the increasing class reported higher life satisfaction and lower substance use in young adulthood compared to the decreasing class. Youth who increase participation in activities over time may experience greater opportunities for building assets related to positive development that support health and well‐being into young adulthood.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136459/1/jcop21863.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136459/2/jcop21863_am.pd

Poorer mental health is associated with cognitive deficits in old age

Few studies have examined the association between within-person (WP) reaction time (RT) variability and mental health (depression, anxiety, and social dysphoria) in old age. Therefore, we investigated mental health (using the General Health Questionnaire) and cognitive function (mean RT or WP variability) in 257 healthy, community-dwelling adults aged 50-90 years (M = 63.60). The cognitive domains assessed were psychomotor performance, executive function, visual search, and recognition. Structural equation models revealed that for WP variability, but not mean RT, poorer mental health was associated with visual search and immediate recognition deficits in older persons and that these relationships were partially mediated by executive function. The dissociation between mean RT and WP variability provides evidence that the latter measure may be particularly sensitive to the subtle effects of mental health on cognitive function in old age

A Systematic Review of Recent Smartphone, Internet and Web 2.0 Interventions to Address the HIV Continuum of Care

eHealth, mHealth and “Web 2.0” social media strategies can effectively reach and engage key populations in HIV prevention across the testing, treatment, and care continuum. To assess how these tools are currently being used within the field of HIV prevention and care, we systematically reviewed recent (2013–2014) published literature, conference abstracts, and funded research. Our searches identified 23 published intervention studies and 32 funded projects underway. In this synthesis we describe the technology modes applied and the stages of the HIV care cascade addressed, including both primary and secondary prevention activities. Overall trends include use of new tools including social networking sites, provision of real-time assessment and feedback, gamification and virtual reality. While there has been increasing attention to use of technology to address the care continuum, gaps remain around linkage to care, retention in care, and initiation of antiretroviral therapy

Youth, Technology, and HIV: Recent Advances and Future Directions

Technology, including mobile technologies and social media, offers powerful tools to reach, engage, and retain youth and young adults in HIV prevention and care interventions both in the United States and globally. In this report we focus on HIV, technology, and youth, presenting a synthesis of recently published (Jan 2014-May 2015) observational and experimental studies relevant for understanding and intervening on HIV risk, prevention and care. We present findings from a selection of the 66 relevant citations identified, highlighting studies that demonstrate a novel approach to technology interventions among youth in regard to content, delivery, target population or public health impact. We discuss current trends globally and in the US in how youth are using technology, as well as emergent research issues in this field – including the need for new theories for developing technology-based HIV interventions and new metrics of engagement, exposure, and evaluation

Extremely Inefficient Star Formation in the Outer Disks of Nearby Galaxies

(Abridged) We combine data from The HI Nearby Galaxy Survey and the GALEX Nearby Galaxy Survey to study the relationship between atomic hydrogen (HI) and far-ultraviolet (FUV) emission outside the optical radius (r25) in 17 spiral and 5 dwarf galaxies. In this regime, HI is likely to represent most of the ISM and FUV emission to trace recent star formation with little bias due to extinction, so that the two quantities closely trace the underlying relationship between gas and star formation rate (SFR). The azimuthally averaged HI and FUV intensities both decline with increasing radius in this regime, with the scale length of the FUV profile typically half that of the HI profile. Despite the mismatch in profiles, there is a significant spatial correlation (at 15" resolution) between local FUV and HI intensities; near r25 this correlation is quite strong, in fact stronger than anywhere inside r25, and shows a decline towards larger radii. The star formation efficiency (SFE) - defined as the ratio of FUV/HI and thus the inverse of the gas depletion time - decreases with galactocentric radius across the outer disks, though much shallower than across the optical disks. On average, we find the gas depletion times to be well above a Hubble time (~10^11 yr). We observe a clear relationship between FUV/HI and HI column in the outer disks, with the SFE increasing with increasing HI column. Despite observing systematic variations in FUV/HI, we find no clear evidence for step-function type star formation thresholds. When compared with results from inside r25, we find outer disk star formation to be distinct in several ways: it is extremely inefficient (depletion times of many Hubble times) with column densities and SFRs lower than found anywhere inside the optical disks. It appears that the HI column is one of, perhaps even the key environmental factor in setting the SFR in outer galaxy disks.Comment: Accepted for Publication in The Astronomical Journa

An Introduction to Gas Accretion onto Galaxies

Evidence for gas accretion onto galaxies can be found throughout the universe. In this chapter, I summarize the direct and indirect signatures of this process and discuss the primary sources. The evidence for gas accretion includes the star formation rates and metallicities of galaxies, the evolution of the cold gas content of the universe with time, numerous indirect indicators for individual galaxies, and a few direct detections of inflow. The primary sources of gas accretion are the intergalactic medium, satellite gas and feedback material. There is support for each of these sources from observations and simulations, but the methods with which the fuel ultimately settles in to form stars remain murky.Comment: 14 pages, 5 figures, Invited review to appear in Gas Accretion onto Galaxies, Astrophysics and Space Science Library, eds. A. J. Fox & R. Dav\'e, to be published by Springe