Feasibility and Acceptability of Mobile Ecological Momentary Assessment Among High-Risk Men Who Have Sex With Men in Vietnam (Preprint)

BACKGROUND Worldwide men who have sex with men (MSM) are at disproportionate risk for HIV infection and common mental disorders. In the context of HIV, common mental disorders are important and frequent drivers of sub-optimal prevention and treatment outcomes. Mobile ecological momentary assessments (EMA), or the repeated sampling of people’s behaviors and psychological states in daily life using mobile phones, can clarify the triggers and HIV-related sequelae of depressive-anxious symptoms and contribute towards the design of ecological momentary interventions (EMIs) that cater to the contextually varying needs of individuals to optimize prevention and treatment outcomes. OBJECTIVE Our study sought to characterize the feasibility and acceptability of mobile EMA among high-risk MSM in Hanoi, Vietnam. It evaluated the perceived relevance, usability, and concerns of this group with the content and delivery of mobile EMA; and the potential of leveraging such platforms in the future to deliver EMIs. METHODS Between January and April 2018, 46 participants were recruited. Participants completed 6-8 mobile EMA surveys daily for 7 days. Surveys occurred once upon waking, 4-6 times throughout the day, and once before sleep. All surveys queried participants’ perceived safety, social interactions, psychological state, and mental health symptoms. The morning survey further queried on sleep and medication use within the past 24 hours; while the nightly survey queried on sexual activity and substance use and allowed participants to share an audio recording of a stressful experience they had that day. At the end of the week, participants were interviewed about their experiences using the app. RESULTS Participants completed an average of 21.3 prompts over the 7-day period. Compliance averaged 62.2%. Thematic analysis of qualitative interviews suggests positive reception to the app overall, as well as five recurring themes centered on (i) relevance of psychological and behavioral items to daily experiences (e.g., mental health symptoms, audio recording); (ii) benefits to using the app (e.g., increased self-understanding); (iii) worries and concerns (e.g., privacy); (iv) usability (e.g., confusion about the interface); and (v) recommendations for future design (e.g., integrating more open-ended questions). CONCLUSIONS Mobile EMA is a feasible and acceptable among young MSM in Vietnam, but more research is needed to adapt EMA protocols to this context and enhance compliance. Most participants eagerly provided information about their mental health status and daily activities. As several participants looked towards the app for further mental health and psychosocial support, EMIs has the potential to reduce HIV and mental health comorbidity among MSM.