"People Who Access It Will Read about People Who Went through Challenging Situations and How They Overcame and Lived Happy Lives": Feedback on a Digital Health Intervention from Healthcare Providers and Adolescents Living with HIV and Depression in Uganda

Background and Purpose Depression among adolescents living with HIV (ALHIV) has been associated with poor treatment adherence and lower quality of life. Mobile health (mHealth) interventions have been implemented to provide access to HIV health-related information in Uganda. However, no intervention has targeted adolescents with comorbid HIV and depression. Engaging stakeholders is crucial to develop culturally relevant, evidence-based interventions for ALHIV. This study’s purpose was to collect feedback from adolescents and healthcare providers on a proposed mHealth application aimed to reduce depression among ALHIV in Uganda.

Methods We conducted eight adolescent focus groups (n=61) and four provider focus groups (n=28) at four HIV clinics in Southern Uganda. Participants were asked on their ideas for an mHealth intervention targeting depression, including content, methods, design, and format. The focus groups were conducted in Luganda, the local language, and were audio recorded. Recordings were transcribed and translated into English for coding. Two independent coders conducted qualitative coding to develop themes representing the participants’ responses and compared themes mentioned by each group.

Results Adolescents and their providers shared similar feedback regarding a proposed mHealth intervention, citing private/group messaging as important app features, information on depression and personal stories as necessary educational content, and lack of access to phones and fear of mistreatment from peers as barriers to use. Both groups noted fears of app users spreading sensitive information outside the app. Additionally, adolescents noted the impact of depression symptoms on app use and their desire to learn more about HIV medication and how to maintain hope. Providers suggested content to help adolescents leverage social support.

Conclusions and Implications Although the two groups had similar suggestions, each group shared unique themes that are critical to incorporate in mHealth application development. Our results emphasize the importance of gathering input from adolescents and their healthcare providers who may be implementing the intervention to develop a tailored and effective resource that is sustainable within existing systems of care.