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Behavioral Predictors of Intention to Use a Text Messaging Reminder System Among People Living With HIV in Rural Uganda: Survey Study
BACKGROUND: The expansion of cellular phones in sub-Saharan Africa spurred the development of SMS text message–based mobile health (mHealth) technology. Numerous SMS text message–based interventions have attempted to increase retention in care for people living with HIV in sub-Saharan Africa. Many o...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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JMIR Publications
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10199388/ https://www.ncbi.nlm.nih.gov/pubmed/37145834 http://dx.doi.org/10.2196/42952 |
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author | Campbell, Jeffrey I Aturinda, Isaac Mwesigwa, Evans Habinka, Annabella Kanyesigye, Michael Holden, Richard J Siedner, Mark J Kraemer, John D |
author_facet | Campbell, Jeffrey I Aturinda, Isaac Mwesigwa, Evans Habinka, Annabella Kanyesigye, Michael Holden, Richard J Siedner, Mark J Kraemer, John D |
author_sort | Campbell, Jeffrey I |
collection | PubMed |
description | BACKGROUND: The expansion of cellular phones in sub-Saharan Africa spurred the development of SMS text message–based mobile health (mHealth) technology. Numerous SMS text message–based interventions have attempted to increase retention in care for people living with HIV in sub-Saharan Africa. Many of these interventions have failed to scale. Understanding theory-grounded factors leading to mHealth acceptability is needed to create scalable, contextually appropriate, and user-focused interventions to improve longitudinal HIV care for people living with HIV in sub-Saharan Africa. OBJECTIVE: In this study, we aimed to understand the relationship between constructs from the Unified Theory of Acceptance and Use of Technology (UTAUT), constructs identified in previous qualitative research, and behavioral intention to use a novel SMS text message–based mHealth intervention designed to improve care retention among people living with HIV initiating treatment in rural Uganda. METHODS: We conducted a survey of people living with HIV who were newly initiating HIV care in Mbarara, Uganda, and had agreed to use a novel SMS text message–based system that notified them of abnormal laboratory results and reminded them to return to the clinic. Survey items assessed behavioral intention to use the SMS text messaging system; constructs from UTAUT; and demographics, literacy, SMS text messaging experience, HIV status disclosure, and social support. We used factor analysis and logistic regression to estimate the relationships between UTAUT constructs and the behavioral intention to use the SMS text messaging system. RESULTS: A total of 249 participants completed the surveys, of whom 115 (46.2%) expressed high behavioral intention to use the SMS text messaging intervention. In a multivariable analysis, we found that performance expectancy (adjusted odds ratio [aOR] of the scaled factor score 5.69, 95% CI 2.64-12.25; P<.001), effort expectancy (aOR of the scaled factor score 4.87, 95% CI 1.75-13.51; P=.002), and social influence (measured as a 1-unit Likert score increase in the perception that clinical staff have been helpful in the use of the SMS text messaging program; aOR 3.03, 95% CI 1.21-7.54; P=.02) were significantly associated with high behavioral intention to use the SMS text messaging program. SMS text messaging experience (aOR/1-unit increase 1.48, 95% CI 1.11-1.96; P=.008) and age (aOR/1-year increase 1.07, 95% CI 1.03-1.13; P=.003) were also significantly associated with increased odds of high intention to use the system. CONCLUSIONS: Performance expectancy, effort expectancy, and social influence, as well as age and SMS experience, were drivers of high behavioral intention to use an SMS text messaging reminder system among people living with HIV initiating treatment in rural Uganda. These findings highlight salient factors associated with SMS intervention acceptability in this population and indicate attributes that are likely to be key to the successful development and scaling of novel mHealth interventions. |
format | Online Article Text |
id | pubmed-10199388 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | JMIR Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-101993882023-05-21 Behavioral Predictors of Intention to Use a Text Messaging Reminder System Among People Living With HIV in Rural Uganda: Survey Study Campbell, Jeffrey I Aturinda, Isaac Mwesigwa, Evans Habinka, Annabella Kanyesigye, Michael Holden, Richard J Siedner, Mark J Kraemer, John D JMIR Hum Factors Original Paper BACKGROUND: The expansion of cellular phones in sub-Saharan Africa spurred the development of SMS text message–based mobile health (mHealth) technology. Numerous SMS text message–based interventions have attempted to increase retention in care for people living with HIV in sub-Saharan Africa. Many of these interventions have failed to scale. Understanding theory-grounded factors leading to mHealth acceptability is needed to create scalable, contextually appropriate, and user-focused interventions to improve longitudinal HIV care for people living with HIV in sub-Saharan Africa. OBJECTIVE: In this study, we aimed to understand the relationship between constructs from the Unified Theory of Acceptance and Use of Technology (UTAUT), constructs identified in previous qualitative research, and behavioral intention to use a novel SMS text message–based mHealth intervention designed to improve care retention among people living with HIV initiating treatment in rural Uganda. METHODS: We conducted a survey of people living with HIV who were newly initiating HIV care in Mbarara, Uganda, and had agreed to use a novel SMS text message–based system that notified them of abnormal laboratory results and reminded them to return to the clinic. Survey items assessed behavioral intention to use the SMS text messaging system; constructs from UTAUT; and demographics, literacy, SMS text messaging experience, HIV status disclosure, and social support. We used factor analysis and logistic regression to estimate the relationships between UTAUT constructs and the behavioral intention to use the SMS text messaging system. RESULTS: A total of 249 participants completed the surveys, of whom 115 (46.2%) expressed high behavioral intention to use the SMS text messaging intervention. In a multivariable analysis, we found that performance expectancy (adjusted odds ratio [aOR] of the scaled factor score 5.69, 95% CI 2.64-12.25; P<.001), effort expectancy (aOR of the scaled factor score 4.87, 95% CI 1.75-13.51; P=.002), and social influence (measured as a 1-unit Likert score increase in the perception that clinical staff have been helpful in the use of the SMS text messaging program; aOR 3.03, 95% CI 1.21-7.54; P=.02) were significantly associated with high behavioral intention to use the SMS text messaging program. SMS text messaging experience (aOR/1-unit increase 1.48, 95% CI 1.11-1.96; P=.008) and age (aOR/1-year increase 1.07, 95% CI 1.03-1.13; P=.003) were also significantly associated with increased odds of high intention to use the system. CONCLUSIONS: Performance expectancy, effort expectancy, and social influence, as well as age and SMS experience, were drivers of high behavioral intention to use an SMS text messaging reminder system among people living with HIV initiating treatment in rural Uganda. These findings highlight salient factors associated with SMS intervention acceptability in this population and indicate attributes that are likely to be key to the successful development and scaling of novel mHealth interventions. JMIR Publications 2023-05-05 /pmc/articles/PMC10199388/ /pubmed/37145834 http://dx.doi.org/10.2196/42952 Text en ©Jeffrey I Campbell, Isaac Aturinda, Evans Mwesigwa, Annabella Habinka, Michael Kanyesigye, Richard J Holden, Mark J Siedner, John D Kraemer. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 05.05.2023. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Human Factors, is properly cited. The complete bibliographic information, a link to the original publication on https://humanfactors.jmir.org, as well as this copyright and license information must be included. |
spellingShingle | Original Paper Campbell, Jeffrey I Aturinda, Isaac Mwesigwa, Evans Habinka, Annabella Kanyesigye, Michael Holden, Richard J Siedner, Mark J Kraemer, John D Behavioral Predictors of Intention to Use a Text Messaging Reminder System Among People Living With HIV in Rural Uganda: Survey Study |
title | Behavioral Predictors of Intention to Use a Text Messaging Reminder System Among People Living With HIV in Rural Uganda: Survey Study |
title_full | Behavioral Predictors of Intention to Use a Text Messaging Reminder System Among People Living With HIV in Rural Uganda: Survey Study |
title_fullStr | Behavioral Predictors of Intention to Use a Text Messaging Reminder System Among People Living With HIV in Rural Uganda: Survey Study |
title_full_unstemmed | Behavioral Predictors of Intention to Use a Text Messaging Reminder System Among People Living With HIV in Rural Uganda: Survey Study |
title_short | Behavioral Predictors of Intention to Use a Text Messaging Reminder System Among People Living With HIV in Rural Uganda: Survey Study |
title_sort | behavioral predictors of intention to use a text messaging reminder system among people living with hiv in rural uganda: survey study |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10199388/ https://www.ncbi.nlm.nih.gov/pubmed/37145834 http://dx.doi.org/10.2196/42952 |
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