Development and Usability Test of an Ecological Momentary Assessment Smartphone Application for High-Risk HIV Populations in Peru (Preprint)

BACKGROUND HIV incidence has continued to increase among men who have sex with men (MSM) in Peru, despite intervention efforts. Addressing stigma, risky behaviors, and low medication adherence is key to reducing incidence rates. Ecological momentary assessment (EMA) allows for collection of discrete, real-time data of stigmatized, risky behaviors while reducing recall bias. OBJECTIVE The aim of this study was to develop and assess the usability of an EMA smartphone app among HIV+ MSM in Peru which tracks daily health risk behaviors to determine ease of use, usefulness, and satisfaction with the app. METHODS A mixed-method three-phase study was conducted which included a usability test, 10-day field testing, and a debriefing focus group. Quantitative survey data and user analytics allowed for assessments of acceptability and user compliance. Qualitative interview and focus group data were thematically analyzed for in-depth assessments of user satisfaction. RESULTS Acceptability of the EMA app was high with a mean usability rating of 6.4/7.0, indicating high user satisfaction, ease of use, and usefulness. 10-day field testing demonstrated a high average compliance rate of 93%, which suggests high feasibility of the app for daily tracking of health risk behaviors among HIV+ MSM. Interview and focus group findings indicated that the app was navigable, time-efficient, and holds promise for long-term use, particularly with the inclusion of daily reminders and incentives for prolonged use. CONCLUSIONS EMA apps can provide valuable real-time data while protecting users’ privacy. This formative work lays the foundation for future larger-scale EMAs of substance use and sexual risk behaviors among high-risk HIV populations, and in developing just-in-time (JIT) interventions to address stigma, improve medication adherence, and reduce risky behaviors. CLINICALTRIAL NA