Principal Findings
communication behaviors
DISORDER
In this study, we conducted a process evaluation of an app-based intervention for HIV-positive MSM. We found no statistically significant difference in medication adherence between the intervention and control groups at the month-1 follow-up. The intervention components were well received, especially web-based communication and educational articles delivery. The uptake of educational articles was associated with better adherence. Guided by the IMB model, we found that the app-based intervention helped maintain the motivation score among the participants, whereas the motivation score showed a decreasing trend in the control group. However, web-based communication was associated with lower motivation scores in the intervention group.Detecting null results of medication adherence between the intervention and control groups is not uncommon in app-based interventional studies, in which studies investigate the efficacy of an app in addition to usual care, as in this study. In a small (N=50) RCT conducted among HIV-positive people with substance use disorder, DeFulio et al [Compared with previous studies, we hypothesized that one of the reasons for our null result may be the so-called Key intervention components were well-received, with 69.8% (120/172) participants engaging in web-based communication and 91.9% (158/172) participants accessing educational articles. Most of the web-based conversations revolved around problem-oriented content, which echoes the most frequently visited themes of educational articles, such as medicine taking, side effects of ART medication, and hospital visits. Together with the decreases in information score in both groups (Figure S3 in Under the IMB framework, we examined the potential mechanisms of our key intervention components, and several unexpected findings are worth our attention. First, the hypothesis that the association between reading engagement and adherence is through the information-behavioral skills-adherence pathway (Figure S4 in It is encouraging that the majority (124/144, 86.1%) of participants in the intervention group rated the intervention as helpful or very helpful to their life in the month-1 survey. Nevertheless, the well-received web-based conversation cannot be achieved without the dedication of case managers. The timeliness of web-based conversation is an advantage of our app-based intervention compared with other prevalent contact channels, such as email. During our training for case managers, the timeliness of web-based conversation was emphasized, as previous studies showed that timely responses from health care workers for web-based inquiries were highly valued by patients [This study had several limitations. First, process evaluation can only be conducted at month-1 follow-up, which is short and may lead to our null findings. This was because of the discontinued collaboration with the technology company. Therefore, month-1 adherence, which can be used for investigating mechanisms, was used as a proxy for short-term efficacy measures. However, according to ART guidelines, the first month after ART initiation is critical for adequate adherence to medicine-taking behavior [The strength of this study was the objective measures for intervention uptake rather than self-reported measures, which could yield more reliable evidence regarding the uptake of web-based conversations and reading of educational articles. In particular, web-based communication data in this study were collected and analyzed in a quantitative manner, guided by a self-designed framework. Previous studies on web-based communication usually included self-reported web-based communication behaviors or beliefs, and the findings were therefore subject to recall or measurement bias. The increasing popularity of web-based medical consultation in China [