Acceptability, feasibility, and user experiences of 💎 NOLA Gem: a geospatially customizable culturally tailored JITAI for violence-affected people living with HIV

Simone J. Skeen; Stephanie Tokarz; Rayna E. Gasik; Ethan A. Smith; Katherine P. Theall; Gretchen A. Clum

The NOLA Gem+GEMA user interface: panel a. (left) displays the “My Skills” and “Sessions” menus; panel b. (right) displays a sample daily diary and resultant skills recommendation prompt.

Abstract

People with HIV (PWH) often endure comorbid mental health challenges, disproportionately rooted in violent trauma, with maladaptive coping (e.g. hazardous alcohol use) undermining treatment adherence. Momentary stressors can be both intra-individual and environmental: typically place-based. Evidence-based interventions such as Living in the Face of Trauma (LIFT) impart adaptive coping skills, but lack scalability, context awareness, and real-time accessibility. We piloted NOLA Gem, adapting LIFT into a just-in-time adaptive intervention (JITAI) featuring daily diary inputs, personalizable geofencing of stressful or traumatogenic spaces, and stress endorsement– or geofence-triggered “push” adaptive coping skills tools. User-guided “pull” psychoeducation sessions were available on demand. PWH with trauma histories (M age = 54.2; 73.3% Black, 56.7% male; 63.3% <$20K household income) were quasi-randomized into treatment (NOLA Gem, n = 22), or control (daily diaries exclusively, n = 8) for a 21-day timespan; mixed methods acceptability and usability data were captured at offboarding. Paradata determined feasibility. All procedures and methods were IRB approved and preregistered. Stata SE/18.0 and Python 3.13 commits are on GitHub. Acceptability was high: 100% of NOLA Gem users considered the app “very” or “somewhat” successful at addressing daily stressors, 91% endorsed increased calm and emotional wellbeing, 50% were “extremely likely” (Net Promoter Score = 10/10) to recommend the app to friends. Overall, an average 28 (of 42 possible) daily diaries was completed; 23.7% elicited an adaptive coping recommendation (80.9% considered “very” or “somewhat” relevant to users’ daily stressors). Most frequent were Calming Breathwork: 46 (19.7%), and Mindfulness Meditation: 31 (21.5%). These skills were most frequently completed: n = 46, 12.68% of all completed skills and n = 41, 20.0%, respectively. In interviews, participants described enhanced stress management and self-insight, often intuiting the JITAI model. The daily diaries’ length and timing, and occasional glitches, were consistently voiced frustrations. These results offer a promising acceptability and feasibility profile for NOLA Gem, with well-honed “push” decision rules deterring habituation, and skills completion rates in excess of recommendation rates indicating valuable user-initiated “pull” engagement. Pruning daily diary items and determining efficacy are clear future directions.