Participatory Development and Concept Testing of mHealth Messaging to Support Care Engagement and Antiretroviral Therapy Adherence for Women Living With HIV in the Southern United States: Focus Group Study

Women living with HIV in the Southern United States, or the South, face persistent and overlapping challenges to care engagement and antiretroviral therapy adherence, including HIV-related stigma, poverty, and inequitable access to health care. While mobile health (mHealth) interventions show promise for enhancing self-management and care engagement among people living with HIV, interventions tailored to women living with HIV remain limited, particularly those developed through participatory approaches that center their lived experiences. This study sought to evaluate the acceptability, comprehensibility, and personal relevance of targeted health messages developed for a proposed mHealth app tailored to women living with HIV in the South. In addition, it explored participants’ perceptions of the feasibility and desirability of the proposed intervention. This study represents phase 3 of a multistage, mixed methods project. Message content was informed by earlier phases, which included individual interviews, surveys, perceptual mapping with women living with HIV, and input from a community and clinician advisory board. In this phase, 3 focus groups (2 virtual and 1 in person) were conducted with 30 women living with HIV recruited from Southern HIV clinics and community organizations. Participants reviewed prototype wireframes and health messages, including SMS text message-style content, and provided feedback on all content. Data were analyzed using conventional content analysis.  Participants expressed strong interest in the proposed mHealth app and emphasized the importance of health messaging that is clear, supportive, and personally meaningful. Four key categories emerged: (1) acceptability of a tailored mHealth app, with participants noting the value of privacy, accessibility, and convenience; (2) acceptability of message content, including preferences for affirming, uplifting language and images; (3) personal relevance, particularly for messages addressing stigma, spirituality, family, and empowerment; and (4) comprehensibility, highlighting the need for plain language and visual clarity. These findings support the development of a tailored mHealth intervention for women living with HIV in the South. Co-designed messages that center affirmation, spirituality, and real-life challenges were perceived as acceptable, comprehensible, and highly relevant. Future work will focus on refining the content and prototype testing.