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. 2025 Apr 17:9:e65185.
doi: 10.2196/65185.

Creating a Usable and Effective Digital Intervention to Support Men to Test for HIV and Link to Care in A Resource-Constrained Setting: Iterative Design Based on A Person-Based Approach and Human Computer Interaction Methods

Anya Zeitlin #  1 , Thulile Mathenjwa #  2   3 , Thembelihle Zuma  2   4 , Sally Wyke  5 , Philippa Matthews  2 , Nuala McGrath  2   4   6 , Janet Seeley  2   7 , Maryam Shahmanesh  2   8 , Ann Blandford  1
Affiliations

Creating a Usable and Effective Digital Intervention to Support Men to Test for HIV and Link to Care in A Resource-Constrained Setting: Iterative Design Based on A Person-Based Approach and Human Computer Interaction Methods

Anya Zeitlin et al. JMIR Form Res. .

Abstract

Background: It is challenging to design usable and effective digital health interventions (DHIs). The person-based approach (PBA) has been proposed to incorporate users' perspectives for the design of DHIs. However, it does not explicitly describe the iterative stages of design and evaluation that are essential in moving from early planning to deployment. For this, we draw on methods from human computer interaction (HCI) that have been developed for various situations.

Objective: This study aimed to reflect on the adaptation and synthesis of PBA and HCI approaches to developing DHIs. We present a case study applying both approaches to develop Empowering People through Informed Choices for HIV (EPIC-HIV1), a DHI designed for men living in rural KwaZulu-Natal, South Africa, intended to support them in making an informed choice about whether to take an HIV test and, if necessary, engage in care.

Methods: We conducted a retrospective analysis of the documentation generated during the development of EPIC-HIV1 including findings about requirements, design representations, and the results of iterative rounds of testing. We developed an account of the process, the outcomes, and the strengths and limitations of the design and evaluation techniques applied. We also present the design of EPIC-HIV1 and summarize considerations when designing for hard-to-reach people in such settings.

Results: The PBA was applied to deliver a first prototype. This helped identify key messages to convey and how to manage issues such as user privacy, but the resulting prototype was judged by the team not to be engaging for potential users, and it was unclear whether the design was inclusive of people with low digital or health literacy. We therefore introduced methods from HCI to iteratively test and refine the app. Working with local community representatives, we conducted four refinement cycles with 29 participants, adapting and retesting the app until no further changes were needed. Key changes included making it clearer what the consequences of selecting options in the app were and changing wording to minimize misconceptions (eg, that the app would test for HIV) while addressing common concerns about testing and emphasizing long-term benefits of engaging with care, if needed.

Conclusions: Techniques for developing DHIs need to be situationally appropriate. The PBA enabled us to establish both empirical data and theory to design the content of EPIC-HIV1, but it did not directly inform interaction design to make the app usable and effective for the intended users; HCI techniques tailored to the setting enabled us to refine the app to be easy for men with little familiarity with digital technologies to use within the constraints of the setting. Iterative testing ensured the app was easy to use and that the intended clinical messages were communicated effectively.

Keywords: HIV; behavior change techniques; digital health; digital intervention; person-based approach; resource-constrained settings; user-centered design.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
An integrated development lifecycle illustrating how a person-based approach to digital health intervention design can be augmented by human computer interaction methods.
Figure 2
Figure 2
Methods used in the first 3 phases of the person-based approach, phase 4 (implementation) is out of scope for this paper. AHRI: Africa Health Research Institute; BCT: behavior change taxonomy; EPIC-HIV1: Empowering People through Informed Choices for HIV; SDT: self-determination theory.
Figure 3
Figure 3
Illustration of 7 characters from the PowerPoint prototype of Empowering People through Informed Choices for HIV.
Figure 4
Figure 4
First iteration of the Empowering People through Informed Choices for HIV app cycle (3 example screen shots).
Figure 5
Figure 5
Illustrative photos of pop-up evaluation testing in remote locations using an Africa Health Research Institute vehicle.
Figure 6
Figure 6
Example of design changes made, illustrated with screenshots from the first and third versions of Empowering People through Informed Choices for HIV.
See this image and copyright information in PMC

References

    1. UNAIDS Addressing a blind spot in the response to HIV — Reaching out to men and boys. UNAIDS. 2017. [2025-03-04]. https://www.unaids.org/en/resources/documents/2017/blind_spot .
    1. Iwuji CC, Orne-Gliemann J, Larmarange J, Okesola N, Tanser F, Thiebaut R, Rekacewicz C, Newell M, Dabis F, ANRS 12249 TasP trial group Uptake of home-based HIV testing, linkage to care, and community attitudes about ART in rural KwaZulu-natal, south africa: descriptive results from the first phase of the ANRS 12249 TasP cluster-randomised trial. PLoS Med. 2016;13(8):e1002107. doi: 10.1371/journal.pmed.1002107. https://dx.plos.org/10.1371/journal.pmed.1002107 PMEDICINE-D-15-03328 - DOI - DOI - PMC - PubMed
    1. Randera-Rees S, Safari WC, Gareta D, Herbst K, Baisley K, Grant AD. Can we find the missing men in clinics? Clinic attendance by sex and HIV status in rural South Africa. Wellcome Open Res. 2021;6:169. doi: 10.12688/wellcomeopenres.16702.1. - DOI - PMC - PubMed
    1. Tanser FC, Kim HY, Mathenjwa T, Shahmanesh M, Seeley J, Matthews P, Wyke S, McGrath N, Adeagbo O, Sartorius B, Yapa HM, Zuma T, Zeitlin A, Blandford A, Dobra A, Bärnighausen T. Home-based intervention to test and start (HITS): a community-randomized controlled trial to increase HIV testing uptake among men in rural south Africa. J Int AIDS Soc. 2021;24(2):e25665. doi: 10.1002/jia2.25665. https://europepmc.org/abstract/MED/33586911 - DOI - PMC - PubMed
    1. Blandford A, Wesson J, Amalberti R, AlHazme R, Allwihan R. Opportunities and challenges for telehealth within, and beyond, a pandemic. The Lancet Global Health. 2020;8(11):e1364–e1365. doi: 10.1016/s2214-109x(20)30362-4. - DOI - PMC - PubMed