Table 2.

| Emergent themes related to barriers and facilitators of digital health intervention (DHI) adoption

	Patient perspective	Provider perspective	Representative quote
Barriers to DHI adoption
Patients attending to content	X	X	“People with short attention spans…they’re gonna be clicking through.” (Patient, FG 3); “The biggest challenge would be to keep them focused because most of them, it’s hard to sit in one place for an extended amount of time.” (Provider, FG 6)
Age & the “Digital Divide”	X	X	“For some people, yes, it’s [DHIs] going to work, but it’s more of an age group situation than who it will and won’t work for them, in my opinion.” (Patient, FG 1) “The internet has become so complicated. I don’t wanna mess with all the passwords and all that kind of stuff.” (Patient, FG 4) “It’s trying to make sure that you got the right fit for the right generation, or the right learning style, or the right communication style…because what works for me, won’t work for my mother, which isn’t gonna work for my son.” (Patient, FG 3)
Impersonal	X	X	“A computer’s not gonna talk to you.” (Patient, FG 2) “I wouldn’t necessarily like it. I like the interaction of a human being.” (Patient, FG 4)
Too much information is overwhelming	X		“Like when after first finding out I think, um, it felt a little overwhelming, seeing like this stack of papers, with all this information on it. I feel like maybe seeing it maybe all in an iPad or something it would seem not like where I can go through it slowly or whatever but having a stack of papers where- with all this- telling me all this stuff about it- uh- it was a little overwhelming sometimes.” (Patient, FG 3)
Privacy and confidentiality	X	X	“A lot of people got that privacy issue. I would too…anybody can get hacked.” (Patient, FG 1)
Length and frequency of program	X	X	“As long as it’s not like long. It’ll be like, oh, five minutes, oh, three minutes. Something short that they’ll learn something from it, but it’ll be like they sat through it all.” (Provider, FG 7)
Patient Literacy		X	“I think if you have the adherence nurse or whoever this designated person is with that patient and you’re working along with a tablet that would be fine, but there are a lot of literacy issues with this population.” (Provider, FG 8)
Patient & Provider Self-Motivation	X	X	“It would be a matter of the provider saying this app is available and then the person would have to be self-motivated to use the app.” (Provider, FG 8) “Unless that physician knows about this program, what good does it do me?” (Patient, FG 4)
Access to smartphones and data plans		X	“They’re not gonna have that kind of phone…I mean the app is a great idea. Maybe when the government-issued phones get onboard and they start issuing the smartphones to the clients.” (Provider, FG 6)
Facilitators to DHI adoption
Entertaining and appealing (i.e., interactive, games)	X	X	“Honestly, if y’all came out with this [sample intervention content] I wouldn’t take it…’cause it’s nothing really appealing to me, and I know everything that’s on here. I’m not saying that I know everything, but my point is I’ll do it if it’s appealing.” (Patient, FG 4) “Make it a game cuz I’ve got a lot of clients that’ll sit there on their phone and just be playing a game.” (Provider, FG 2)
Include testimonials	X	X	“People that’s been [living with HIV] that’s still alive. Let them make tapes. You know, put ‘em on DVD. Include it with the packet, that way if they want they got it for backup. In case they don’t wanna read all that paperwork. They could look at testimonials.” (Patient, FG 2) “Having advice. Maybe telling them what to do. Even have like a person to call if you need advice or stuff like that. Even having comments from other people that are going through the same situation.” (Provider, FG 7)
Include peer mentors or in-person sessions as an adjunct	X	X	“If it would be like, maybe a class, and teaching people how to use it.” (Patient, FG 5) “I would say, like she said, a number so they can call so they don’t feel like they’re talking to a machine which is what they feel majority of the time due to the fact that it can get so busy that you won’t speak to a client that you spoke to yesterday until next week or the week after and you’re like, oh snap, I have to call this client back, he left me a message two weeks ago.” (Provider, FG 7) “I think patients like in-person sessions. They like having that relationship. They like having that point person that they really connect with…I think to have that as your foundation because then they establish a relationship, and then maybe they have a couple of phone calls or a few, some text messages or something, and then this follow-up with the person again. In between they’re getting some of those things? I think that would be a program that would be very attractive to patients.” (Provider, FG 8)
Include educational content (i.e., nutrition, treatment options, medication, substance use)	X		“The encouragement, the problem solving, social support, self-worth, coping with stress, depression, alcoholism and drugs. I think that would be something really good to have for a person coming in to this particular situation.” (Patient, FG 1) “So if I get intoxicated enough that I throw up, you know, do I take my pill again?” You know, different things like that. I wish they were more educated on different circumstances from, like travel, like if you’re going into different time zones.” (Patient, FG 3)
Include medication reminders	X	X	“Maybe some new app or something that has a better program in it for like – ‘Beep, beep. Take your medicine.’” (Patient, FG 3)
Use as a platform to initiate difficult topics of conversation	X	X	“Providers should come up with some way of giving the information if you want it. Instead of, per se, you gotta come to the clinic and ask a doctor or a counselor, it just pop up on your cell phone.” (Patient, FG 4) “Even my male doctor, I’ve had to say some things, and I gotta whisper to him. Then I am thinking, ‘Why am I so embarrassed to talk to him about this stuff?’ But I know that I have to, and I do, but a lot of people don’t. A lot of people can’t mention stuff, so the computer program might be something you might want to set up.” (Patient FG 1)
Promote standardized conversations with patients		X	“Two-fold…you can go and get additional information about that, if you so desire…it can also – the doctor can also [use it as] a promotional tool.” (Patient, FG 4) “I mean I think I don’t think about it in this step wise approach, and I have more of a like a global just thought of what are the issues. Maybe a little motivational interviewing in an interview, but I wouldn’t go through these things in such a methodical way. Like I wouldn’t prioritize transportation, which I think is so smart. [Laughter]I mean, instead of exploring why don’t you take your medicine, just asking, ‘Can you make it to pick up your medicine? Can you make it to your appointments?’”(Provider, FG 8)
Patient tracking and coordinated care		X	“Apps on the collaborative care side might be helpful for us, like managing our team-based approach. Some type of—and I’m so technologically not savvy, but some type of hub where we can upload information from each area that we’re covering.” (Provider, FG 8)
Include scare tactics and personalized feedback for risk behaviors		X	“We all know that the egg in the pan, that had some effect, though, that when they—“This is your brain on drugs.” You know what I mean? Actual “This is gonna happen,” you know what I mean? The stuff that’s going to happen—you know what I mean? If you continue to—you know what I mean?—actually seeing or I don’t know, but cuz I remember that egg in the pan.” (Provider, FG 6)
Dissemination methods to increase uptake
Completion in the clinic	X	X	“Do the IPad in the examination room. There’s sometimes you sit back there quite a bit before you see the doctor.” (Patient, FG 2)
Language	X	X	“I would always tell my doctor, ‘Would you please Ghettofy [simplify] that for me because I’m not understanding what you’re sayin’.” (Patient, FG 2) “Are you looking to broaden that and not just be English? Because there’s other cultures that might have HIV, like Latino, Cambodian, African… Because not everybody speaks English. This is America.” (Provider, FG 6)
Multiple delivery modalities	X	X	“[Also}, give them a CD that way they can use it on down the road if they want.” (Patient, FG 2) “I’m not savvy on the computers so, the DVD I think, everybody’s got a DVD.” (Patient, FG 2)
Target younger PLWH or newly diagnosed	X	X	“I think, would be great for someone that’s just starting on their meds and dealing with it. But, you know- but, as far as someone in my position, these things have all been figured out long ago.” (Patient, FG 1)
Waiting room televisions as educational tools instead of TV programming	X	X	“I know some places have programming on the TV that it’s about their clinic, but they make it a show and they’ll entertain [the patient] while they’re waiting, and you don’t even realize it’s there and you’re watching it. I think that’ll help them.” (Provider, FG 7) “They’ve got two TV screens in the waiting room here at the lobby. Instead of having a computer program that’s interactive, just have something that’s running. That’s your program base that’s informational that you can read.” (Patient, FG2)