BACKGROUND
Harm reduction services reduce negative consequences associated with drug injection and are often embedded within syringe service programs (SSPs). People who inject drugs (PWID), however, suboptimally engage with such services due to stigma, fear, transportation restrictions, and limited hours of operation. mHealth applications (apps) may provide an opportunity to overcome these barriers, extending the reach of SSPs beyond the traditional brick-and-mortar models.
OBJECTIVE
We sought to assess the prevalence of smartphone ownership, level of comfort providing personal information required to use mHealth apps, and interest in the use of a mHealth app to access harm reduction services among PWID in order to guide development of an app.
METHODS
We administered a survey to 115 PWID enrolled via respondent-driven sampling from July 2018 to July 2019. We examined the extent to which PWID had access to smartphones; were comfortable providing personal information such as name, email, and address; and expressed interest in a variety of app-based services. Participant demographics, health status and behaviors were also measured to evaluate correlations between participant characteristics and mHealth-related variables. Binary logistic regression and Poisson regression were used to identify independent correlates of mHealth-related variables. Primary regression outcomes included summary scores for access, comfort, and interest. Secondary outcomes included binary survey responses for individual comfort or interest components.
RESULTS
The majority of this PWID sample were white, male, and middle-aged; and 67.9% owned a smartphone. Participants reported high comfortability with providing personal information in order to use a mHealth app, including name (88.1%), phone number (84.4%), email (78.0%), physical address (78.0%), and linkage to medical records (66.1%). Participants also reported strong interests in app-based services including medications and/or sterile syringes delivery (90.9%), labs or appointments scheduling (81.8%), medication reminders (70.0%), educational material about safe injection practices (59.1%), and group communication forums (58.2%). Most participants were comfortable with the idea of home delivery of syringes (85.0%). Overall, aside from homeless participants having lower access to smartphones (AOR=0.15; P=.001), none of the participant characteristics were associated with primary outcomes. Among secondary outcomes, recent SSP use was positively associated with comfortability with home delivery of syringes (AOR=3.29, P=0.042), and age >50 years was associated with increased interest in educational materials (AOR=4.64, P=.018) and group communication forums (AOR=3.69, P=.035).
CONCLUSIONS
Findings here suggest that aside from homelessness, PWID broadly have access to smartphones and they are comfortable sharing a wide array of personal information, including linkage to electronic medical records, and express interest in a wide array of services within an app. Given suboptimal access to and utilization of SSP services among PWID, a mHealth app has high potential to address the harm reduction needs of this vulnerable population.
Acceptability of an mHealth App to Provide Harm Reduction Services for People Who Inject Drugs: A Survey Study Focusing on Access to Smartphones, Comfort with Shared Personal Information, and Interest in Comprehensive Services (Preprint)