Thi Thanh Xuan Nguyen

Background: In Vietnam, an upper-middle-income country, the majority of people living with HIV smoke. Vietnam has established quitline services to support this population, but they remain underused. Text messaging is widely used in Vietnam, and studies in other countries have shown that text messaging interventions can promote smoking cessation. Our goal was to conduct a formative study to inform the development of a text messaging intervention to increase access to quitline services and promote smoking cessation among people living with HIV who smoke in Vietnam. Objective: This study aimed to identify factors influencing smoking behaviors among people living with HIV in Vietnam through qualitative interviews to inform a tailored text messaging intervention. Methods: In October 2022, study staff conducted 30- to 45-minute qualitative interviews with 20 people living with HIV from clinics in Hai Phong and Quang Ninh provinces, Vietnam. Interviews explored factors that influenced smoking, such as substance use, mental health, HIV stigma, social context, and health. A rapid qualitative analysis approach was used to synthesize themes from the data, including identifying key domains based on prior literature, developing a semistructured interview guide, and organizing data within domains to support iterative theme development. These interviews were used to develop prompts to guide people living with HIV who smoke in writing peer messages for a text messaging intervention. Results: Across 6 themes, participants described smoking as part of their everyday lives, shaped by social situations, stress, alcohol use, and their experiences living with HIV. Social smoking and early initiation were important influences on smoking behaviors, whereas financial concerns and protecting family members and others from secondhand smoke promoted cessation. Some participants used smoking to cope, whereas others wished to quit for better health. HIV stigma was a major contributor to smoking, with many participants describing increased smoking after diagnosis. Participants suggested that cessation support should be better tailored to their needs. Conclusions: Smoking behaviors among people living with HIV are shaped by overlapping influences, including societal norms, mental health, HIV-related stigma, and other structural stressors. An understanding of these overlapping factors can inform the development of text-based interventions that offer effective cessation support tailored to this population.

Introduction: Waterpipe tobacco smoking (WTP) is highly prevalent in Vietnam. WTP use is associated with higher nicotine exposure and increased risk of pulmonary and cardiovascular diseases. The aim of this study is to understand WTP use and how it may influence smoking behaviors and cessation...

Background: Worldwide, the COVID-19 pandemic contributed to further gaps in mental health care, particularly in low- and middle-income countries such as Vietnam, where care is inaccessible for 90% of those who need it. There has subsequently been a considerable increase in the use of digital mental health interventions such as smartphone apps. Presently, the evidence for such interventions is limited, especially in cases in which the interventions have been adapted from evidence-based in-person formats. Implementation science aims to promote the incorporation of scientific findings into practice. A key determinant of implementation success is an intervention’s usability. Hurdles to usability include an intervention being too confusing or time-intensive to use. Facilitators include incorporating a greater number of engagement features and integrating human support. Objective: The aim of this implementation science feasibility study was to describe the challenges and mitigation strategies used in the development, usability testing, and implementation of a digital depression intervention (VMood smartphone app) developed in Vietnam. VMood was adapted from an evidence-based in-person intervention originally developed in Canada that is grounded in principles of cognitive behavioral therapy with supportive coaching by a lay health or social services worker. The research team is currently testing the effectiveness and cost-effectiveness of VMood in a randomized controlled trial across 8 provinces in Vietnam informed by the results of this feasibility assessment. Methods: This mixed methods feasibility study was organized using an implementation outcome framework focused on acceptability, adoption, appropriateness, and feasibility. This study involved three data collection components: (1) usability testing (interviews and focus groups with app user and provider participants who tested VMood in 1 Vietnamese province), (2) app metrics (from the early phase of the randomized controlled trial in the same province but from different municipalities), and (3) discourse data (notes from various team meetings, communications, and reports on VMood’s development and implementation). Qualitative data were analyzed using thematic content analysis. App use data were analyzed using basic descriptive statistics. Results: The findings of the 3 data components showed that there were seven main challenges: (1) challenges with recruitment and uptake of the app, (2) challenges with use and engagement, (3) screening challenges, (4) digital divide, (5) limitations to digital applications for mental health, (6) technological challenges, and (7) funding and policy constraints. Various solutions to help mitigate the challenges were used by the team. Conclusions: The findings contribute important evidence on the challenges to the development and feasibility assessment of a digital depression app adapted from an in-person intervention in Vietnam. The findings have applicability for others looking to develop and implement digital interventions in similar contexts, serving as a unique opportunity to share the lessons learned regarding the development and testing process.

BACKGROUND Worldwide, the COVID-19 pandemic contributed to further gaps in mental health care, particularly in low- and middle-income countries such as Vietnam, where care is inaccessible for 90% of those who need it. There has subsequently been a considerable increase in the use of digital mental health interventions such as smartphone apps. Presently, the evidence for such interventions is limited, especially in cases in which the interventions have been adapted from evidence-based in-person formats. Implementation science aims to promote the incorporation of scientific findings into practice. A key determinant of implementation success is an intervention’s usability. Hurdles to usability include an intervention being too confusing or time-intensive to use. Facilitators include incorporating a greater number of engagement features and integrating human support. OBJECTIVE The aim of this implementation science feasibility study was to describe the challenges and mitigation strategies used in the development, usability testing, and implementation of a digital depression intervention (VMood smartphone app) developed in Vietnam. VMood was adapted from an evidence-based in-person intervention originally developed in Canada that is grounded in principles of cognitive behavioral therapy with supportive coaching by a lay health or social services worker. The research team is currently testing the effectiveness and cost-effectiveness of VMood in a randomized controlled trial across 8 provinces in Vietnam informed by the results of this feasibility assessment. METHODS This mixed methods feasibility study was organized using an implementation outcome framework focused on acceptability, adoption, appropriateness, and feasibility. This study involved three data collection components: (1) usability testing (interviews and focus groups with app user and provider participants who tested VMood in 1 Vietnamese province), (2) app metrics (from the early phase of the randomized controlled trial in the same province but from different municipalities), and (3) discourse data (notes from various team meetings, communications, and reports on VMood’s development and implementation). Qualitative data were analyzed using thematic content analysis. App use data were analyzed using basic descriptive statistics. RESULTS The findings of the 3 data components showed that there were seven main challenges: (1) challenges with recruitment and uptake of the app, (2) challenges with use and engagement, (3) screening challenges, (4) digital divide, (5) limitations to digital applications for mental health, (6) technological challenges, and (7) funding and policy constraints. Various solutions to help mitigate the challenges were used by the team. CONCLUSIONS The findings contribute important evidence on the challenges to the development and feasibility assessment of a digital depression app adapted from an in-person intervention in Vietnam. The findings have applicability for others looking to develop and implement digital interventions in similar contexts, serving as a unique opportunity to share the lessons learned regarding the development and testing process.