PDF(Pubmed)
Abstract：
BACKGROUND: Substance use disorders are prevalent and undertreated among people with HIV. Computer-delivered interventions (CDIs) show promise in expanding reach, delivering evidence-based care, and offering anonymity. Use in HIV clinic settings may overcome access barriers. Incorporating digital counselors may increase CDI engagement, and thereby improve health outcomes.
OBJECTIVE: We aim to develop and pilot a digital counselor-delivered brief intervention for people with HIV who use drugs, called \"C-Raven,\" which is theory grounded and uses evidence-based practices for behavior change.
METHODS: Intervention mapping was used to develop the CDI including a review of the behavior change research in substance use, HIV, and digital counselors. We conducted in-depth interviews applying the situated-information, motivation, and behavior skills model and culturally adapting the content for local use with people with HIV. With a user interaction designer, we created various digital counselors and CDI interfaces. Finally, a mixed methods approach using in-depth interviews and quantitative assessments was used to assess the usability, acceptability, and cultural relevance of the intervention content and the digital counselor.
RESULTS: Participants found CDI easy to use, useful, relevant, and motivating. A consistent suggestion was to provide more information about the negative impacts of drug use and the interaction of drug use with HIV. Participants also reported that they learned new information about drug use and its health effects. The CDI was delivered by a \"Raven,\" digital counselor, programmed to interact in a motivational interviewing style. The Raven was perceived to be nonjudgmental, understanding, and emotionally responsive. The appearance and images in the intervention were perceived as relevant and acceptable. Participants noted that they could be more truthful with a digital counselor, however, it was not unanimously endorsed as a replacement for a human counselor. The C-Raven Satisfaction Scale showed that all participants rated their satisfaction at either a 4 (n=2) or a 5 (n=8) on a 5-point Likert scale and all endorsed using the C-Raven program again.
CONCLUSIONS: CDIs show promise in extending access to care and improving health outcomes but their development necessarily requires integration from multiple disciplines including behavioral medicine and computer science. We developed a cross-platform compatible CDI led by a digital counselor that interacts in a motivational interviewing style and (1) uses evidence-based behavioral change methods, (2) is culturally adapted to people with HIV who use drugs, (3) has an engaging and interactive user interface, and (4) presents personalized content based on participants\' ongoing responses to a series of menu-driven conversations. To advance the continued development of this and other CDIs, we recommend expanded testing, standardized measures to evaluate user experience, integration with clinician-delivered substance use treatment, and if effective, implementation into HIV clinical care.
OBJECTIVE: We aim to develop and pilot a digital counselor-delivered brief intervention for people with HIV who use drugs, called \"C-Raven,\" which is theory grounded and uses evidence-based practices for behavior change.
METHODS: Intervention mapping was used to develop the CDI including a review of the behavior change research in substance use, HIV, and digital counselors. We conducted in-depth interviews applying the situated-information, motivation, and behavior skills model and culturally adapting the content for local use with people with HIV. With a user interaction designer, we created various digital counselors and CDI interfaces. Finally, a mixed methods approach using in-depth interviews and quantitative assessments was used to assess the usability, acceptability, and cultural relevance of the intervention content and the digital counselor.
RESULTS: Participants found CDI easy to use, useful, relevant, and motivating. A consistent suggestion was to provide more information about the negative impacts of drug use and the interaction of drug use with HIV. Participants also reported that they learned new information about drug use and its health effects. The CDI was delivered by a \"Raven,\" digital counselor, programmed to interact in a motivational interviewing style. The Raven was perceived to be nonjudgmental, understanding, and emotionally responsive. The appearance and images in the intervention were perceived as relevant and acceptable. Participants noted that they could be more truthful with a digital counselor, however, it was not unanimously endorsed as a replacement for a human counselor. The C-Raven Satisfaction Scale showed that all participants rated their satisfaction at either a 4 (n=2) or a 5 (n=8) on a 5-point Likert scale and all endorsed using the C-Raven program again.
CONCLUSIONS: CDIs show promise in extending access to care and improving health outcomes but their development necessarily requires integration from multiple disciplines including behavioral medicine and computer science. We developed a cross-platform compatible CDI led by a digital counselor that interacts in a motivational interviewing style and (1) uses evidence-based behavioral change methods, (2) is culturally adapted to people with HIV who use drugs, (3) has an engaging and interactive user interface, and (4) presents personalized content based on participants\' ongoing responses to a series of menu-driven conversations. To advance the continued development of this and other CDIs, we recommend expanded testing, standardized measures to evaluate user experience, integration with clinician-delivered substance use treatment, and if effective, implementation into HIV clinical care.
摘要：
背景：药物使用障碍在HIV感染者中普遍存在且治疗不足。计算机提供的干预措施(CDI)显示出扩大覆盖范围的前景，提供循证护理，提供匿名。在HIV诊所中使用可以克服进入障碍。合并数字顾问可能会增加CDI参与度，从而改善健康结果。
目标：我们的目标是为使用药物的HIV感染者开发和试点数字顾问提供的简短干预措施，叫做“C-Raven，“这是理论基础，并使用基于证据的实践来改变行为。
方法：使用干预作图来开发CDI，包括对物质使用中的行为变化研究的回顾，艾滋病毒,和数字顾问。我们进行了深入访谈，应用位置信息，动机，和行为技能模型，并在文化上适应艾滋病毒感染者的当地使用内容。有了用户交互设计师，我们创建了各种数字顾问和CDI界面。最后,使用深度访谈和定量评估的混合方法方法来评估可用性，可接受性,干预内容和数字辅导员的文化相关性。
结果：参与者发现CDI易于使用，有用的,相关,和激励。一个一致的建议是提供更多关于吸毒的负面影响以及吸毒与艾滋病毒相互作用的信息。参与者还报告说，他们了解到有关药物使用及其健康影响的新信息。CDI是由一只“乌鸦”送来的，“数字顾问，编程为以激励式面试风格进行交互。乌鸦被认为是非判断性的，理解,和情感上的反应。干预中的外观和图像被认为是相关且可接受的。与会者指出，他们可以更真实地与数字顾问，然而,它没有被一致认可作为人类辅导员的替代品。C-Raven满意度量表显示，所有参与者在5点Likert量表上对他们的满意度评分为4（n=2）或5（n=8），并且都再次使用C-Raven程序进行了认可。
结论：CDI在扩大获得护理和改善健康结果方面显示出希望，但其发展必然需要包括行为医学和计算机科学在内的多个学科的整合。我们开发了一个由数字顾问领导的跨平台兼容的CDI，该CDI以动机性访谈风格进行交互，并且（1）使用基于证据的行为改变方法，（2）在文化上适应吸毒的艾滋病毒感染者，（3）具有引人入胜的交互式用户界面，（4）根据参与者对一系列菜单驱动的对话的持续响应，呈现个性化内容。为了推进该CDI和其他CDI的持续发展，我们建议进行扩展测试，评估用户体验的标准化措施，与临床医生提供的物质使用治疗整合，如果有效，实施艾滋病毒临床护理。
目标：我们的目标是为使用药物的HIV感染者开发和试点数字顾问提供的简短干预措施，叫做“C-Raven，“这是理论基础，并使用基于证据的实践来改变行为。
方法：使用干预作图来开发CDI，包括对物质使用中的行为变化研究的回顾，艾滋病毒,和数字顾问。我们进行了深入访谈，应用位置信息，动机，和行为技能模型，并在文化上适应艾滋病毒感染者的当地使用内容。有了用户交互设计师，我们创建了各种数字顾问和CDI界面。最后,使用深度访谈和定量评估的混合方法方法来评估可用性，可接受性,干预内容和数字辅导员的文化相关性。
结果：参与者发现CDI易于使用，有用的,相关,和激励。一个一致的建议是提供更多关于吸毒的负面影响以及吸毒与艾滋病毒相互作用的信息。参与者还报告说，他们了解到有关药物使用及其健康影响的新信息。CDI是由一只“乌鸦”送来的，“数字顾问，编程为以激励式面试风格进行交互。乌鸦被认为是非判断性的，理解,和情感上的反应。干预中的外观和图像被认为是相关且可接受的。与会者指出，他们可以更真实地与数字顾问，然而,它没有被一致认可作为人类辅导员的替代品。C-Raven满意度量表显示，所有参与者在5点Likert量表上对他们的满意度评分为4（n=2）或5（n=8），并且都再次使用C-Raven程序进行了认可。
结论：CDI在扩大获得护理和改善健康结果方面显示出希望，但其发展必然需要包括行为医学和计算机科学在内的多个学科的整合。我们开发了一个由数字顾问领导的跨平台兼容的CDI，该CDI以动机性访谈风格进行交互，并且（1）使用基于证据的行为改变方法，（2）在文化上适应吸毒的艾滋病毒感染者，（3）具有引人入胜的交互式用户界面，（4）根据参与者对一系列菜单驱动的对话的持续响应，呈现个性化内容。为了推进该CDI和其他CDI的持续发展，我们建议进行扩展测试，评估用户体验的标准化措施，与临床医生提供的物质使用治疗整合，如果有效，实施艾滋病毒临床护理。
