An mHealth intervention to enhance coping skills and mental health among MSM living with HIV in China: intervention development and feasibility pilot study

Abstract

Men who have sex with men (MSM) bear a disproportionate burden of HIV and mental health problems in China, hindering HIV-related care engagement and medication adherence. mHealth interventions have shown promising effects in improving mental health outcomes. Working closely with Shanghai CSW&MSM Center (SCMC) and Centers for Disease Control and Prevention, Shanghai (SCDC), we aim to address the urgent mental health need and health disparities among MSM living with HIV by developing a culturally appropriate mHealth intervention. Based on needs assessment results, we developed a multi-level, mHealth intervention with a focus on individual skills training and community staff capacity building. The partnership with SCMC has been crucial and mutually beneficial to intervention development. The strengths and priorities of the community stakeholders identified through needs assessment were critical to the selection of coping skills for MSM living with HIV, the design of SCMC staff training to facilitate delivery, and the component of weekly skill groups to enhance peer learning and intervention engagement. In the needs assessment stage (Chapter 1), we interviewed 20 stakeholders, including MSM living with HIV, staff from a community-based organization, and staff from the CDC in Shanghai. The study found that stress from multiple socio-ecological levels, lack of individual coping skills, and scarcity of psychosocial services highlighted the importance of multi-level interventions for MSM living with HIV in China. To develop an mHealth intervention (Chapter 2), the researchers used intervention mapping, the behavioral intervention technology model, and human-centered design and cultural adaptation model. The mHealth intervention, named Turning to Sunshine, consisted of individual skills learning through a mobile app, skills learning group, and on-demand phone coaching. The intervention aimed to improve mental health outcomes for MSM recently diagnosed with HIV by helping them survive emotionally intense moments, change emotional expression to regulate emotions, and reduce emotional vulnerability, as well as build community capacity for mental health support. A feasibility pilot study (Chapter 3) is ongoing and to assess intervention acceptability, feasibility, app usability, and evaluate the preliminary efficacy of the intervention. The feasibility pilot study is a 1:1 randomized control trial (n=31), with a 4-week long intervention and treatment-as-usual control group. Results showed high acceptability and feasibility of the intervention. Compared to the control group, intervention participants demonstrated greater improvements in depression, emotion regulation, HIV mastery, life satisfaction, and coping efficacy. These promising findings suggest that this mHealth approach may be beneficial for improving mental health outcomes among MSM living with HIV in China, warranting further investigation through larger randomized trials.