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Researcher Spotlight: Nick Tarantino, PhD - Dimagi

Text-Messages & Gamification for HIV-Treatment Adherence in Ghana

We were thrilled to talk to Nick Tarantino, PhD, a psychologist and Assistant Professor of Psychology at Providence College and Research Scientist at Rhode Island Hospital (Nick was an Assistant Professor at Brown University at the time of our interview), to get an update on his research on HIV treatment-adherence in Ghana. We asked him about his use of gamification through mobile phones, and the challenge of making mHealth interventions locally appropriate. 

Q: Hi Nick, can you please introduce yourself please? 

Nick: I’m Dr. Nick Tarantino. I’m an Assistant Professor at Warren Alpert Medical School at Brown University*. I also have a position at Rhode Island Hospital as a Senior Research Scientist. 

Q: What is your primary area of focus?

Nick: I develop interventions for HIV prevention or treatment adherence with young people who are at risk for infection or living with HIV.

Q: How did you arrive at this interest?

Nick: I’ve been in this area for about 15 years. I initially focused on prevention with adolescents, which was fun and interesting –– as teens have their own particular challenges at that age.  I then shifted to doing more work on treatment adherence for young people living with HIV, which is actually an HIV prevention strategy: if you’re able to take your HIV medicine as prescribed, you can reduce your viral load so that you do not transmit the virus to a sexual partner.

Q: What about medication adherence in particular interests you? 

Nick: Medication adherence seems like a very simple thing, right? but it’s actually quite challenging, especially for HIV medicine. There are a lot of different reasons why somebody might not take their medication, ranging from the stigma and discrimination that still occurs for people living with HIV, to just getting tired of taking it. I find it interesting to develop interventions that help on the individual level and create better social contexts that facilitate medication adherence.

Q: You use mobile technology as an intervention, including in Ghana where your study approach is quite unique. Can you tell us about how you’re using mobile technology?

Nick: Sure. So the main study right now is called the “Text-Based Adherence Game Project”, in which we’re developing an intervention that’s delivered through text messages (SMS). It’s not new to send text message reminders to take medicine or to offer linkages to clinic support. What is new is that we’ve incorporated gamification strategies that you normally find in a mobile app or on a smartphone.

Our intervention is designed to be delivered on low-cost mobile phones, so it’s accessible by anyone with a mobile phone, and does not require internet access.

Q: How did you arrive at gamification as an intervention strategy? 

Nick: It was a while back: I was reading about interventions in the USA and other high income countries. A lot of them were moving in the direction of apps and including novel features like gamification. I thought it was an interesting way of motivating and engaging people to make a healthier behavior into a game.

These apps had stories or themes, and included patients picking character names, getting rewarded for behavior like taking their medicine, and competing against other young people living with HIV.

This can be a particularly engaging strategy for young people.  Taking medicine every day can be boring. It can also be very isolating. To know that there are other people playing or engaging with a game and motivating each other is pretty cool.

So I thought, why not deconstruct these features and try to deliver them through just SMS for people in LMICs who might not have access to consistent data or smartphones. We built the same features: peer competition and comparison, a point system, progress monitoring to tell people how they’re doing, a story, a character name, personalization. We do all of that in SMS format, which has never been done before.

Q: What is one of your research findings that you’re most excited about? 

Nick: We did a small pilot open-trial with 12 young people living with HIV in Ghana, where we tested our text-based adherence game intervention. We did pre- and post-assessments on some of our main outcomes, including self-reported antiretroviral adherence, and a couple other potential mediating variables, such as coping with living with a chronic illness.

What we saw pre- to post-intervention were some promising findings of shifts in the right direction:I believe past-four-week adherence went up from ~78% prior to receiving the intervention up to 92 or 93%. That’s really cool to see that.

Q: What are some of the challenges you encountered conducting frontline research? 

Nick: One of the challenges has been getting the content of our interventions and the ways we use mobile technology to really fit to the local, cultural context.

We did a lot of formative work to develop our intervention, including in-depth interviews with young people living with HIV, interviews with clinic staff and family members, we had youth advisory board meetings to share examples and content from the interventions. Despite those efforts, I still felt like a lot of what we created came from the lens of our context in the USA, or from the researchers’ creating the content. 

We need to do more to involve local young people  who are living with HIV, and have them create the text messages themselves.

Q: Last question: are you optimistic about the future of mHealth? 

Nick: Yes, of course. You have to be, that’s the future, right? I’ve said this from the beginning though: I’m not an mHealth person, I just thought this would be the best tool to reach people. 

I’m also not a tech guy, but I like the direction mHealth is going in: the fact that it’s being used to connect people –– it’s more than putting an app with reminders in your pocket. Connecting people remotely, is now, of course very important, but I think technology also has to be able to connect people in person at some point –– and that’s the direction I like to see it going in. I’m interested in how we can use technology to get people to come back together. 

How can we form almost naturally-occurring support systems – whether it’s peer support groups at the clinic or meetups –– so that there’s no need for us to come in and use our technology to create an intervention. That potential is really interesting.

Nick Tarantino, PhD, is an Assistant Professor of Psychology at Providence College, and a Sr. Research Scientist at the Rhode Island Hospital the Division of Child and Adolescent Psychiatry. He is also a practicing licensed psychologist. Nick’s research interests include adolescent risk behavior and family-based prevention interventions. He is currently leading two studies in Ghana on HIV treatment adherence that leverage SMS messaging to 1) share gamified messages with young adults(including a point system and leaderboard), and 2) include parents in their teen’s HIV care.



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