Use of and Attitudes Toward Technology Among Young People Living With HIV in San Francisco: Cross-Sectional Study

Introduction

The COVID-19 pandemic catalyzed a digital shift in our work and social engagements. Our online world has expanded immensely, with smartphone use increasing from 15% before the pandemic to 36% and tablet/PC use from 2% to 22% [1]. Concerns about this increased screentime and adverse mental health outcomes, especially among young adults, persist despite research in the 1990s and early 2000s [2]. The scientific literature around technology and mental health offers mixed support [2]. Research on the effectiveness of digital and mobile health interventions continues to increase, and the results are promising for many health conditions, especially among young adults with chronic conditions [3]. In this research letter, we present findings on digital technology use among a sample of young people living with HIV and describe their attitudes toward technology and anxiety about being without technology.

Methods

Study Design and Participants

We conducted a secondary data analysis of baseline data from a digital HIV navigation intervention study that used text messaging to improve HIV care linkage, retention, and viral suppression among 120 out-of-care young people living with HIV in San Francisco, California. Participants were eligible if they identified as a man who has sex with men or a trans woman, were aged between 18 and 34 years, resided in San Francisco, and were not engaged in HIV care. A digital navigator delivered motivational interviewing, social support, health education, and referrals to participants through text messaging over a period of 6 months. Study procedures were described in a prior manuscript [4].

Measures and Analysis

We analyzed the following sociodemographic information: age, gender identity, race/ethnicity, education, employment status, and current living situation. To assess use of the internet, mobile phones, and social networking sites [5], participants were asked how often (once a week or less, several times a week, once a day, or several times a day or more) they used email, text messaging, or apps; searched for information; checked social media; or sought out sexual partners or relationships on social networking sites. Positive and negative attitudes toward technology and dependence on technology [5] were assessed using 6, 4, and 4 dichotomous (yes/no) items, respectively. For each of these 3 constructs, items were summed (1/0) and high and low categories created using the median score as a cutoff. To measure psychological distress [6], a composite score was created by summing responses to items ranging from “none of the time” (0) to “all of the time” (5), detailing the frequencies of the following in the last month: feeling calm and peaceful, having a lot of energy, feeling downhearted and blue, and physical health or emotional problems interfering with social activities. Descriptive statistics were used to characterize variables. No missing data were recorded.

Ethical Considerations

The study protocol was approved by the Institutional Review Board of the University of California, San Francisco (16-19675). Participants provided signed informed consent and were remunerated US $50 for completing the baseline assessment. Data for this secondary analysis were deidentified to protect participants’ privacy and confidentiality.

Results

The sample was racially and ethnically diverse, with a majority of participants reporting some college or more, unstable housing, and unemployment (56.7%, 67.5%, and 64.2%, respectively). A majority of participants (87.5%) reported using text messaging several times a day or more, followed by mobile phone apps, searching for information on a mobile phone, checking social media, and seeking sexual partners and or relationships on social networking sites (80.8%, 80.0%, 61.7%, and 25.8%, respectively). While most participants (93.3%) reported high levels of positive attitudes toward technology, more than a third (39.2%) reported high levels of negative attitudes toward technology. Many (63.3%) reported high levels of anxiety being without technology. A majority of participants reported being anxious without their cell phone and without internet access (74.2% and 66.7%, respectively). Slightly more than half (53.3%) reported feeling anxious about their personal health information being available online, and nearly two-thirds (65.0%) reported being dependent on technology.

Discussion

We found that many young people living with HIV used mobile phones, social media, apps, and social networking sites on a regular basis. This high use may be a factor in participants’ experience of anxiety being without these digital technologies. Other research has found that technology dependence is an important consideration to shape the care of young people [7]. Furthermore, technology can exacerbate isolation, negative social comparison, loneliness, and other poor mental health outcomes [8]. This study has limited generalizability due to its study design and its focus on HIV care engagement among young people living with HIV. Despite this, it is critical to consider not only how digital technology can improve health, but also its influence on technology dependence and anxiety as unintended consequences [9].