Identifying dissemination strategies for promoting adoption of digital health interventions in clinical settings: A convergent parallel study on text message support for HIV pre-exposure prophylaxis (PrEP) adherence.

Abstract

Many patient-focused digital health products that would be ideal for clinic-based promotion fail to gain traction in real-world practice, even when there is strong evidence that they improve health outcomes. Promoting adoption among both providers and patients in these settings remains a major challenge. For example, a recent U.S. Preventive Services Task Force review found that digital interventions such as smartphone apps and text-messaging programs increased the proportion of people taking PrEP as prescribed by about 10% compared with standard care. Despite these promising results, such interventions have seen little real-world uptake, and few studies have identified strategies to effectively promote their adoption in clinical settings or among patients. We conducted a convergent parallel, mixed methods study to identify a range of potential strategies for promoting adoption of a conceptual digital health intervention in medical outpatient clinics. Executives and leaders of PrEP clinics (N = 8) and established PrEP patients (N = 8) completed an in-depth qualitative interview followed by a survey. Interview data were analyzed using thematic analysis methods and survey data were analyzed using basic descriptive statistics. Qualitative findings identified main themes via executive interviews and patient interviews, with much overlap. Clinic executives and patients perceived direct, trusted communication from providers as the most likely driver of adoption for digital health interventions. Both groups also highlighted the potential roles non-clinic staff play in providing additional details. Additionally, both groups identified in-clinic and out-of-clinic general marketing strategies. Quantitative survey results generally confirmed these findings, with patients rating direct mentions from providers as a strategy most likely to lead to adoption, and providers rating discussions in provider meetings and direct recommendations from colleagues among the most likely to encourage them to recommend it to patients. Together, these findings identify promising dissemination strategies that should be tested in future studies.