Description of the Research
mHealth is an emerging field that harnesses the increasingly sophisticated capabilities of mobile communications technology for measurement and intervention in health research and care. As a new field of inquiry, researchers have yet to articulate best-practice guidelines for mHealth projects enrolling vulnerable populations, especially those who engage in stigmatizing and illegal behavior (e.g., persons who inject drugs (PWIDs)). The goal of this study is to explore potential harms and benefits of mHealth to assess daily polydrug use among PWIDs.
Methods
PWIDs ≥ 18 years old from Philadelphia and San Diego who reported weekly polydrug use. They (n=40) completed brief behavioral surveys on a cell phone and a semi-structured interview assessing their experience and principles of research ethics including beneficence and respect for persons. Interviews were transcribed verbatim and coded using thematic analysis.
Results
PWIDs identified few, if any, harms related to participation in a mHealth study and all reported potential benefits associated with participation. Many felt answering questions about their daily drug use and sexual activity would positively influence their abilities to reflect on and assess their risk behaviors. Some showed a propensity for altruism through contribution to research and most indicated that the questions were not harmful to their mental and behavioral states. In contrast, potential harms of participation, which included legal, social, behavioral, and psychological risks, were identified less than half as often as benefits. Participants also provided insights into making processes for participant selection more fair while maximizing data collection for the study protocol, and on how to maximize the risk-benefit ratio (e.g., incorporate information about potential harms into the informed consent process and provide a report at the end of the study which quantifies their drug use and related spending during their participation in the study).
Conclusion
Data suggest that few harms and many potential benefits may exist for PWIDs engaging in high-intensity behavioral studies using mHealth platforms. To confirm findings, larger, longitudinal studies are needed. However, researchers and ethics review boards should consider this kind of formative assessment as they develop and review protocols for mHealth studies with drug users. Potential implications for best-practice and protocol development will be discussed.
Limitations
The study is limited by sample size and recruitment strategies (PWIDs from a longitudinal cohort study (California) or syringe access program (Pennsylvania)). Other populations of drug users (e.g., less frequent users) may have a higher sense of risk or benefit.