Google Home. Budgeting and investment apps. Social networking sites. Technology is becoming more and more integrated with our daily lives, so why not our health care as well? With some illnesses, such as HIV/AIDS, that require daily medication adherence and regular engagement in care, a technology-based intervention could be an ideal and efficient solution to support patients in maintaining good health. Dr. Kate Muessig, an assistant professor in the Department of Health Behavior at the UNC Gillings School of Global Public Health, states that “we have started to talk about technology interventions, not as an alternative or as a new thing, but rather as part of a broader toolkit for HIV prevention and care.”1 An investigator with the Behavior and Technology (BAT) Lab, directed by Dr. Lisa Hightow-Weidman at UNC-CH, Dr. Muessig studies how we can utilize electronic and mobile health (eHealth and mHealth) interventions to “alleviate stigma, increase social support, and reduce barriers to care,” specifically in vulnerable populations.2
Currently, she’s working on AllyQuest, a mobile app designed to engage sexual and gender minority youth living with HIV.3 The app – built on Ayogo’s EMPOWER platform - is meant to help individuals who’re living with HIV to “connect with others going through the same things… build positive health habits of taking their medication every day, learn more about their health, stay in regular contact with their health care providers… all those things that come along with living with HIV.”1,4
The following screenshots are of the AllyQuest app:
A distinguishing feature of the AllyQuest app is its ability to tailor the intervention to individual users; for example, users can “select the areas of health that are most interesting to them… [they’ll] get more information and challenges within the app that are targeted towards [their] interests.”1 The way in which the intervention is delivered may also determine its effectiveness. Dr. Muessig and her team are testing an approach that involves the app plus access to an individual counselor who can answer questions through the app and “help users identify what their health goals are and strategies to help them work through them.”1 Study participants will be randomized into two groups: access to the app, and access to the app plus a counselor. While the latter method provides users with additional support, it also requires more resources. Because public health researchers always need to consider the issue of limited resources, it’s important to identify what works and for whom in order to “deliver an optimal intervention that best meets individual and public health needs.”1
With any intervention, especially those that heavily involve the participant in their own care, it’s crucial to “always include the end user as part of the development.”1 The research team at the BATLab uses a variety of methods to involve users and obtain feedback, including focus groups, interviews, and crowdsource approaches. For one of the other mHealth studies Dr. Muessig is currently leading, she plans to build a youth advisory group, which will involve paid individuals who will help to design the study and actively participate in certain parts once it’s implemented. Not only will this engage the intervention’s target population, it can also serve as a “professional development activity” to provide opportunities for youth and young adults to gain useful and transferable skills.1
Participant confidentiality, safety, and privacy are also major priorities for Dr. Muessig in her research. Because HIV/AIDS is a stigmatized illness in much of the world, researchers must always be aware of local contexts and think through how to safely include participants. This can be a particular challenge when working with young sexual and gender minority participants, who may not be out to their families or communities. When working to develop interventions targeting youth and adolescents, Dr. Muessig notes recognizing that “they’re still very much in the position where they’re discovering their own identities and priorities.”1 Additionally, she states, “typically, minors require parental permission to participate in research studies. However, for the type of research the BATLab conducts, our team often considers the option of seeking a waiver of parental consent so that youth can make their own decisions about whether or not to participate in a research study. This is a research ethics question that always aims to balance the importance of including youth in developing interventions for them with maintaining their safety and confidentiality.”1
The concept of resilience is closely tied with stigma. Present at both the individual and institutional levels, stigma is rooted in “fear… lack of understanding, discomfort with things that are difficult.”1 Dr. Muessig is interested in how to use promoting resilience and empowerment as a “mechanism [to build] on existing strengths to allow people to push back against stigma and dispel the fears and myths that exist around HIV or around being gay or transgender.”1 One intervention she has participated in creating, Tough Talks, helps individuals to think through the process of disclosing their HIV status while maintaining their values and relationships, and to build the communication and interpersonal skills for having these conversations.5 The Tough Talks intervention – led by BATLab Director, Dr. Lisa Hightow-Weidman and built by Virtually Better Inc. – utilizes artificial intelligence to simulate conversations, guiding young, HIV positive males in decision-making about disclosing their status to their sexual partners.5,6 Through these types of interventions, Dr. Muessig and her team hope to “create spaces that improve communication, break silence, and bring light to places where discrimination is happening.”1
The futures for eHealth and mHealth are bright; they have much potential in transforming the way health care is delivered and how patients are brought into their own treatment and care. There is a lot to look forward to with Dr. Muessig’s and the BATLab’s research.
To learn more about the BATLab and their innovative projects, visit their site: http://batlab.web.unc.edu/
The Spring 2019 issue of Carolina Scientific has been released! If you’d like a copy, please stop by the UL or Davis Library! It can also be accessed online here: https://issuu.com/uncsci/docs/sp19_compilation_final
1. Interview with Kate Muessig, PhD. 02/22/19.
2. Kate Muessig, PhD. Gillings School Directory. Retrieved from https://sph.unc.edu/adv_profile/kate-muessig-phd/.
3. AllyQuest. Behavior and Technology Lab at UNC. Retrieved from http://batlab.web.unc.edu/allyquest/. 4. Ayogo. Retrieved from https://ayogo.com.
5. Tough Talks. Behavior and Technology Lab at UNC. Retrieved from http://batlab.web.unc.edu/tough-talks/ 6. Virtually Better Inc. Retrieved from https://www.virtuallybetter.com/.