Electronic Dose Monitoring Feedback (EMF) with Youth Living with HIV: Qualitative Exploration of Reactions to Viewing Dosing Calendars

Abstract

Electronic dose monitoring with feedback (EMF) offers an opportunity to visualize daily dosing behaviors that can otherwise be difficult to appreciate. Visual displays, including early, on-time, late, or missed doses over time, can foster insights around patterns of dosing. Reactions to seeing these patterns among youth with HIV (YWH) who struggle with adherence are important to consider with EMF. YWH (ages 14–25) participating in the ATN152 TERA intervention were presented withsmart-bottle-generated 1-month EMF calendars as part of their sessions with a remote ‘coach’. To characterize how youth reacted to these visualizations, transcripts from this portion of the coaching sessions were thematically analyzed. A total of 64 youth-coach discussions were characterized across 37 unique participants (22 years old on average, 81% Black/African American, 46% acquired HIV vertically). Six main reactions to EMF calendars were identified: feelings of pride/satisfaction, empowerment/motivation, positive surprise, negative surprise, shame/guilt, and/or neutral reactions. Although most reactions were positive, those with negative reactions tended to be in response to calendars showing low adherence. Over a quarter (28%) of youth ranked the EMF as one of the most beneficial/helpful aspects of the intervention when asked about experiences with intervention tools within the coaching session. A calendar EMF appeared to offer unique opportunities to explore adherence in the context of a supportive counseling session.