title: Smartphone self-monitoring to support self-management among people living with HIV: perceived benefits and theory of change from a mixed-methods randomized pilot study.
abstract: BACKGROUND
  Self-monitoring by mobile phone applications offers new opportunities to engage patients in self-management. Self-monitoring has not been examined thoroughly as a self-directed intervention strategy for self-management of multiple behaviors and states by people living with HIV (PLH).
  
  
  METHODS
  PLH (n = 50), primarily African American and Latino, were recruited from 2 AIDS services organizations and randomly assigned to daily smartphone (n = 34) or biweekly Web-survey only (n = 16) self-monitoring for 6 weeks. Smartphone self-monitoring included responding to brief surveys on medication adherence, mental health, substance use, and sexual risk behaviors, and brief text diaries on stressful events. Qualitative analyses examine biweekly open-ended user-experience interviews regarding perceived benefits and barriers of self-monitoring, and to elaborate a theoretical model for potential efficacy of self-monitoring to support self-management for multiple domains.
  
  
  RESULTS
  Self-monitoring functions include reflection for self-awareness, cues to action (reminders), reinforcements from self-tracking, and their potential effects on risk perceptions, motivations, skills, and behavioral activation states. Participants also reported therapeutic benefits related to self-expression for catharsis, nonjudgmental disclosure, and in-the-moment support. About one-third of participants reported that surveys were too long, frequent, or tedious. Some smartphone group participants suggested that daily self-monitoring was more beneficial than biweekly due to frequency and in-the-moment availability. About twice as many daily self-monitoring group participants reported increased awareness and behavior change support from self-monitoring compared with biweekly Web-survey only participants.
  
  
  CONCLUSIONS
  Self-monitoring is a potentially efficacious disruptive innovation for supporting self-management by PLH and for complementing other interventions, but more research is needed to confirm efficacy, adoption, and sustainability.
authors: Departments of *Psychiatry and Biobehavioral Sciences; †Computer Science, University of California, Los Angeles, Los Angeles, CA; and ‡Computer Science, Cornell Tech, New York, NY.
authors: Dallas
authors: D
authors: Swendeman
authors: Nithya
authors: N
authors: Ramanathan
authors: Laura
authors: L
authors: Baetscher
authors: Melissa
authors: M
authors: Medich
authors: Aaron
authors: A
authors: Scheffler
authors: W Scott
authors: WS
authors: Comulada
authors: Deborah
authors: D
authors: Estrin
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D040421:Cell Phone; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012648:Self Care / Q000295:instrumentation* / Q000379:methods; D063106:Transgender Persons; D064878:Web Browser