Introduction: Premise recently travelled to Kenya as part of our PEPFAR “DREAMS Innovation Challenge” project which is supporting medical treatment adherence in HIV-positive, adolescent girls and young women. For the past six months, Premise has partnered with local Kenyan HIV clinics to collect real-time patient data covering treatment adherence, and availability and perceptions of clinical services. Premise had two primary goals for the trip: 1) monitor our strategies for increasing patient engagement through the Premise mobile app, and 2) gather feedback from both local government leaders and HIV clinic administrators regarding Premise’s data visualization and analytics tools.
Mobile App Engagement: We worked closely with our local project partner, Family Health Options Kenya (FHOK), to understand the challenges associated with deploying a technology-enabled health solution in a population with generally low levels of digital literacy. These discussions resulted in three primary strategies to increase mobile app engagement:
1) Prioritize Images Over Text: “Pictures are worth a thousand words” and text is often hard to understand and navigate for first-time tech users. Premise is prioritizing the use of images to ensure patients are able to engage and adequately comprehend content in our mobile app. Images are localized and include photos of actual clinics and prescribed medications that patients would recognize.
2) Pop-Up Messages Provide a Nudge: Premise is using “pop-up nudges” that strengthen treatment adherence and provide in-app treatment advice. This “Digital Coach” uses timed messages to remind patients to engage in the app everyday.
3) Monetary Reward for Engagement: A small monetary reward reinforces engagement with the mobile app. Patients are rewarded for engagement with the app and reporting the facts of their treatment adherence, not for adherence itself.
Data Visualizations and Analytics: A second goal of the trip was to introduce county departments of health and HIV clinic administrators to Premise’s data visualization and analytics dashboards. These tools offer policy makers and clinic staff both population-based and granular insights about their patients — allowing clinics to efficiently address clinic level and individualized challenges to treatment adherence. Further, county departments of health are able to track and confirm systemic trends across multiple clinics to guide resource and program decisions.
Similar to the raw patient data within the Premise system, each clinic’s visualization dashboard is rigorously secured. The county-level health officials have unique and secure logins that highlight top-level information from all the clinics operating within their county. Similarly, county officials and clinics administrators are able to suggest medication adherence questions that are specific to their patients, ensuring the data they gather is contextualized even within the county or clinic sub-level. Through this modularity, Premise is able to ensure personal patient information was only seen and analyzed by authorized users.
Summary: Premise’s PEPFAR “DREAMS Innovation Challenge” project is proving that a mobile app-based adherence program is a viable and powerful tool for HIV treatment. Additionally, digital adherence monitoring offers patients, clinic staff, and government administrators significant benefits such as digital coaching and real-time data visualizations and analytics dashboards that can facilitate better program and resource decisions.
Note: This blogpost was funded in part by a grant from the United States Department of State as part of the DREAMS Innovation Challenge, managed by JSI Research & Training Institute, Inc. (JSI). The opinions, findings, and conclusions state herein are those of the author and do not necessarily reflect those of the United States Department of State or JSI.