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Wang X, Fu Q, Zhou M, Li Y. How Integrated Digital Tools Can Improve Tuberculosis Medication Adherence: A Longitudinal Study in China. Telemed J E Health 2024; 30:490-498. [PMID: 37498525 DOI: 10.1089/tmj.2023.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
Background: Poor medication adherence remains one of the major problems in the treatment of tuberculosis (TB) patients, while digital technologies have been proven effective to improve the treatment results. However, reports on the effectiveness of comprehensive practice integrating different intervention methods and technologies are limited. The aim of this study is to evaluate the effectiveness of an integrated digital adherence intervention for TB patients. Methods: We developed a digital adherence intervention platform integrating instant WeChat message, electronic medication monitors (EMMs), and manual reminders. The primary goal of the platform was to improve the accessibility of digital adherence technologies, and thus improve treatment adherence. TB patients were newly diagnosed at 10 TB-designated hospitals and came from 220 communities, from January to June 2022. The basic characteristics and treatment adherence of TB patients in WeChat, EMM, and conventional groups were compared, and the influencing factors of high medication adherence were analyzed by logistic regression. Results: A total of 2,498 TB patients were enrolled in the study, 14.5% were managed by digital technologies, 9.5% by WeChat, and 5.0% by EMM, respectively. After intervention, the median medication rate of TB patients was significantly higher in the WeChat group (95.3%) and EMM group (95.7%) compared with that of the conventional group (83.8%). On the contrary, the median number of missed medications among patients of the conventional group (nine times) was significantly higher than that in the WeChat (three times) group and EMM (three times) group. The proportion of high adherence (adherence medication rate ≥90%) among TB patients was 64.7%, 64.5%, and 43.2% in WeChat, EMM, and conventional group, respectively. Conclusions: The application of the integrated digital adherence intervention platform could significantly improve medication adherence among TB patients. The accessibility of digital adherence technologies could be improved by integrating complementary technologies in practice.
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Affiliation(s)
- Xiaojun Wang
- Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan, China
| | - Qian Fu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meilan Zhou
- Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan, China
| | - Yuehua Li
- Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan, China
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Warsito IF, Komosar M, Bernhard MA, Fiedler P, Haueisen J. Flower electrodes for comfortable dry electroencephalography. Sci Rep 2023; 13:16589. [PMID: 37789022 PMCID: PMC10547758 DOI: 10.1038/s41598-023-42732-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023] Open
Abstract
Dry electroencephalography (EEG) electrodes provide rapid, gel-free, and easy EEG preparation, but with limited wearing comfort. We propose a novel dry electrode comprising multiple tilted pins in a flower-like arrangement. The novel Flower electrode increases wearing comfort and contact area while maintaining ease of use. In a study with 20 volunteers, we compare the performance of a novel 64-channel dry Flower electrode cap to a commercial dry Multipin electrode cap in sitting and supine positions. The wearing comfort of the Flower cap was rated as significantly improved both in sitting and supine positions. The channel reliability and average impedances of both electrode systems were comparable. Averaged VEP components showed no considerable differences in global field power amplitude and latency, as well as in signal-to-noise ratio and topography. No considerable differences were found in the power spectral density of the resting state EEGs between 1 and 40 Hz. Overall, our findings provide evidence for equivalent channel reliability and signal characteristics of the compared cap systems in the sitting and supine positions. The reliability, signal quality, and significantly improved wearing comfort of the Flower electrode allow new fields of applications for dry EEG in long-term monitoring, sensitive populations, and recording in supine position.
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Affiliation(s)
- Indhika Fauzhan Warsito
- Institute of Biomedical Engineering and Informatics at the Technische Universität Ilmenau, Ilmenau, Germany
| | - Milana Komosar
- Institute of Biomedical Engineering and Informatics at the Technische Universität Ilmenau, Ilmenau, Germany
| | - Maria Anne Bernhard
- Institute of Biomedical Engineering and Informatics at the Technische Universität Ilmenau, Ilmenau, Germany
| | - Patrique Fiedler
- Institute of Biomedical Engineering and Informatics at the Technische Universität Ilmenau, Ilmenau, Germany
| | - Jens Haueisen
- Institute of Biomedical Engineering and Informatics at the Technische Universität Ilmenau, Ilmenau, Germany.
- Department of Neurology, Biomagnetic Center, University Hospital Jena, Jena, Germany.
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Campbell JI, Aturinda I, Mwesigwa E, Habinka A, Kanyesigye M, Holden RJ, Siedner MJ, Kraemer JD. Behavioral Predictors of Intention to Use a Text Messaging Reminder System Among People Living With HIV in Rural Uganda: Survey Study. JMIR Hum Factors 2023; 10:e42952. [PMID: 37145834 DOI: 10.2196/42952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The expansion of cellular phones in sub-Saharan Africa spurred the development of SMS text message-based mobile health (mHealth) technology. Numerous SMS text message-based interventions have attempted to increase retention in care for people living with HIV in sub-Saharan Africa. Many of these interventions have failed to scale. Understanding theory-grounded factors leading to mHealth acceptability is needed to create scalable, contextually appropriate, and user-focused interventions to improve longitudinal HIV care for people living with HIV in sub-Saharan Africa. OBJECTIVE In this study, we aimed to understand the relationship between constructs from the Unified Theory of Acceptance and Use of Technology (UTAUT), constructs identified in previous qualitative research, and behavioral intention to use a novel SMS text message-based mHealth intervention designed to improve care retention among people living with HIV initiating treatment in rural Uganda. METHODS We conducted a survey of people living with HIV who were newly initiating HIV care in Mbarara, Uganda, and had agreed to use a novel SMS text message-based system that notified them of abnormal laboratory results and reminded them to return to the clinic. Survey items assessed behavioral intention to use the SMS text messaging system; constructs from UTAUT; and demographics, literacy, SMS text messaging experience, HIV status disclosure, and social support. We used factor analysis and logistic regression to estimate the relationships between UTAUT constructs and the behavioral intention to use the SMS text messaging system. RESULTS A total of 249 participants completed the surveys, of whom 115 (46.2%) expressed high behavioral intention to use the SMS text messaging intervention. In a multivariable analysis, we found that performance expectancy (adjusted odds ratio [aOR] of the scaled factor score 5.69, 95% CI 2.64-12.25; P<.001), effort expectancy (aOR of the scaled factor score 4.87, 95% CI 1.75-13.51; P=.002), and social influence (measured as a 1-unit Likert score increase in the perception that clinical staff have been helpful in the use of the SMS text messaging program; aOR 3.03, 95% CI 1.21-7.54; P=.02) were significantly associated with high behavioral intention to use the SMS text messaging program. SMS text messaging experience (aOR/1-unit increase 1.48, 95% CI 1.11-1.96; P=.008) and age (aOR/1-year increase 1.07, 95% CI 1.03-1.13; P=.003) were also significantly associated with increased odds of high intention to use the system. CONCLUSIONS Performance expectancy, effort expectancy, and social influence, as well as age and SMS experience, were drivers of high behavioral intention to use an SMS text messaging reminder system among people living with HIV initiating treatment in rural Uganda. These findings highlight salient factors associated with SMS intervention acceptability in this population and indicate attributes that are likely to be key to the successful development and scaling of novel mHealth interventions.
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Affiliation(s)
| | - Isaac Aturinda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Evans Mwesigwa
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Richard J Holden
- School of Public Health, Indiana University, Bloomington, IN, United States
| | - Mark J Siedner
- Massachusetts General Hospital, Massachusetts, MA, United States
| | - John D Kraemer
- Department of Health Management and Policy, Georgetown University School of Health, Washington, DC, United States
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de Groot LM, Straetemans M, Maraba N, Jennings L, Gler MT, Marcelo D, Mekoro M, Steenkamp P, Gavioli R, Spaulding A, Prophete E, Bury M, Banu S, Sultana S, Onjare B, Efo E, Alacapa J, Levy J, Morales MLL, Katamba A, Bogdanov A, Gamazina K, Kumarkul D, Ekaterina OL, Cattamanchi A, Khan A, Bakker MI. Time Trend Analysis of Tuberculosis Treatment While Using Digital Adherence Technologies-An Individual Patient Data Meta-Analysis of Eleven Projects across Ten High Tuberculosis-Burden Countries. Trop Med Infect Dis 2022; 7:tropicalmed7050065. [PMID: 35622692 PMCID: PMC9145978 DOI: 10.3390/tropicalmed7050065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/04/2022] [Accepted: 04/13/2022] [Indexed: 02/04/2023] Open
Abstract
Worldwide, non-adherence to tuberculosis (TB) treatment is problematic. Digital adherence technologies (DATs) offer a person-centered approach to support and monitor treatment. We explored adherence over time while using DATs. We conducted a meta-analysis on anonymized longitudinal adherence data for drug-susceptible (DS) TB (n = 4515) and drug-resistant (DR) TB (n = 473) populations from 11 DAT projects. Using Tobit regression, we assessed adherence for six months of treatment across sex, age, project enrolment phase, DAT-type, health care facility (HCF), and project. We found that DATs recorded high levels of adherence throughout treatment: 80% to 71% of DS-TB patients had ≥90% adherence in month 1 and 6, respectively, and 73% to 75% for DR-TB patients. Adherence increased between month 1 and 2 (DS-TB and DR-TB populations), then decreased (DS-TB). Males displayed lower adherence and steeper decreases than females (DS-TB). DS-TB patients aged 15−34 years compared to those >50 years displayed steeper decreases. Adherence was correlated within HCFs and differed between projects. TB treatment adherence decreased over time and differed between subgroups, suggesting that over time, some patients are at risk for non-adherence. The real-time monitoring of medication adherence using DATs provides opportunities for health care workers to identify patients who need greater levels of adherence support.
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Affiliation(s)
- Liza M. de Groot
- KIT Royal Tropical Institute, Global Health, 1092 AD Amsterdam, The Netherlands; (L.M.d.G.); (M.S.)
| | - Masja Straetemans
- KIT Royal Tropical Institute, Global Health, 1092 AD Amsterdam, The Netherlands; (L.M.d.G.); (M.S.)
| | - Noriah Maraba
- The Aurum Institute, Parktown, Johannesburg 2193, Gauteng, South Africa;
| | - Lauren Jennings
- Desmond Tutu Health Foundation, P.O. Box 13801, Mowbray, Cape Town 7705, Western Cape, South Africa;
| | - Maria Tarcela Gler
- De La Salle Medical and Health Sciences Institute, City of Dasmariñas Cavite 4114, Philippines; (M.T.G.); (D.M.)
| | - Danaida Marcelo
- De La Salle Medical and Health Sciences Institute, City of Dasmariñas Cavite 4114, Philippines; (M.T.G.); (D.M.)
| | - Mirchaye Mekoro
- Health Poverty Action, London EC1V 2NX, UK; (M.M.); (P.S.); (R.G.)
| | - Pieter Steenkamp
- Health Poverty Action, London EC1V 2NX, UK; (M.M.); (P.S.); (R.G.)
| | - Riccardo Gavioli
- Health Poverty Action, London EC1V 2NX, UK; (M.M.); (P.S.); (R.G.)
| | - Anne Spaulding
- Health Through Walls, Port-au-Prince HT 6110, Haiti; (A.S.); (E.P.); (M.B.)
| | - Edwin Prophete
- Health Through Walls, Port-au-Prince HT 6110, Haiti; (A.S.); (E.P.); (M.B.)
| | - Margarette Bury
- Health Through Walls, Port-au-Prince HT 6110, Haiti; (A.S.); (E.P.); (M.B.)
| | - Sayera Banu
- Icddr,b, GPO Box 128, Dhaka 1000, Bangladesh; (S.B.); (S.S.)
| | - Sonia Sultana
- Icddr,b, GPO Box 128, Dhaka 1000, Bangladesh; (S.B.); (S.S.)
| | - Baraka Onjare
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands; (B.O.); (E.E.); (J.A.); (J.L.); (M.L.L.M.)
| | - Egwuma Efo
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands; (B.O.); (E.E.); (J.A.); (J.L.); (M.L.L.M.)
| | - Jason Alacapa
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands; (B.O.); (E.E.); (J.A.); (J.L.); (M.L.L.M.)
| | - Jens Levy
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands; (B.O.); (E.E.); (J.A.); (J.L.); (M.L.L.M.)
| | - Mona Lisa L. Morales
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands; (B.O.); (E.E.); (J.A.); (J.L.); (M.L.L.M.)
| | - Achilles Katamba
- Department of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7062, Uganda;
| | | | | | - Dzhumagulova Kumarkul
- The Red Crescent National Society of the Kyrgyz Republic, Bishkek 720040, Kyrgyzstan; (D.K.); (O.-L.E.)
| | - Orechova-Li Ekaterina
- The Red Crescent National Society of the Kyrgyz Republic, Bishkek 720040, Kyrgyzstan; (D.K.); (O.-L.E.)
| | - Adithya Cattamanchi
- School of Medicine, University of California San Francisco, San Francisco, CA 94110, USA;
| | - Amera Khan
- Stop TB Partnership, 1218 Geneva, Switzerland
- Correspondence: (A.K.); (M.I.B.)
| | - Mirjam I. Bakker
- KIT Royal Tropical Institute, Global Health, 1092 AD Amsterdam, The Netherlands; (L.M.d.G.); (M.S.)
- Correspondence: (A.K.); (M.I.B.)
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Sekandi JN, Kasiita V, Onuoha NA, Zalwango S, Nakkonde D, Kaawa-Mafigiri D, Turinawe J, Kakaire R, Davis-Olwell P, Atuyambe L, Buregyeya E. Stakeholders' Perceptions of Benefits of and Barriers to Using Video-Observed Treatment for Monitoring Patients With Tuberculosis in Uganda: Exploratory Qualitative Study. JMIR Mhealth Uhealth 2021; 9:e27131. [PMID: 34704961 PMCID: PMC8581755 DOI: 10.2196/27131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 08/15/2021] [Accepted: 09/07/2021] [Indexed: 01/19/2023] Open
Abstract
Background Nonadherence to treatment remains a barrier to tuberculosis (TB) control. Directly observed therapy (DOT) is the standard for monitoring adherence to TB treatment worldwide, but its implementation is challenging, especially in resource-limited settings. DOT is labor-intensive and inconvenient to both patients and health care workers. Video DOT (VDOT) is a novel patient-centered alternative that uses mobile technology to observe patients taking medication remotely. However, the perceptions and acceptability of potential end users have not been evaluated in Africa. Objective This study explores stakeholders’ acceptability of, as well as perceptions of potential benefits of and barriers to, using VDOT to inform a pilot study for monitoring patients with TB in urban Uganda. Methods An exploratory, qualitative, cross-sectional study with an exit survey was conducted in Kampala, Uganda, from April to May 2018. We conducted 5 focus group discussions, each comprising 6 participants. Groups included patients with TB (n=2 groups; male and female), health care providers (n=1), caregivers (n=1), and community DOT volunteer workers (n=1). The questions that captured perceived benefits and barriers were guided by domains adopted from the Technology Acceptance Model. These included perceived usefulness, ease of use, and intent to use technology. Eligible participants were aged ≥18 years and provided written informed consent. For patients with TB, we included only those who had completed at least 2 months of treatment to minimize the likelihood of infection. A purposive sample of patients, caregivers, health care providers, and community DOT workers was recruited at 4 TB clinics in Kampala. Trained interviewers conducted unstructured interviews that were audio-recorded, transcribed, and analyzed using inductive content analysis to generate emerging themes. Results The average age of participants was 34.5 (SD 10.7) years. VDOT was acceptable to most participants on a scale of 1 to 10. Of the participants, 70% (21/30) perceived it as highly acceptable, with scores ≥8, whereas 30% (9/30) scored between 5 and 7. Emergent themes on perceived benefits of VDOT were facilitation of easy adherence monitoring, timely follow-up on missed doses, patient-provider communication, and saving time and money because of minimal travel to meet in person. Perceived barriers included limited technology usability skills, inadequate cellular connectivity, internet access, availability of electricity, cost of the smartphone, and use of the internet. Some female patients raised concerns about the disruption of their domestic work routines to record videos. The impact of VDOT on privacy and confidentiality emerged as both a perceived benefit and barrier. Conclusions VDOT was acceptable and perceived as beneficial by most study participants, despite potential technical and cost barriers. Mixed perceptions emerged about the impact of VDOT on privacy and confidentiality. Future efforts should focus on training users, ensuring adequate technical infrastructure, assuring privacy, and performing comparative cost analyses in the local context.
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Affiliation(s)
- Juliet Nabbuye Sekandi
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States.,Global Health Institute, College of Public Health, University of Georgia, Athens, GA, United States
| | | | - Nicole Amara Onuoha
- Global Health Institute, College of Public Health, University of Georgia, Athens, GA, United States
| | - Sarah Zalwango
- School of Public Health, Makerere University, Kampala, Uganda.,Kampala Capital City Authority, Kampala, Uganda
| | | | | | - Julius Turinawe
- School of Public Health, Makerere University, Kampala, Uganda
| | - Robert Kakaire
- Global Health Institute, College of Public Health, University of Georgia, Athens, GA, United States
| | - Paula Davis-Olwell
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States.,Global Health Institute, College of Public Health, University of Georgia, Athens, GA, United States
| | - Lynn Atuyambe
- School of Public Health, Makerere University, Kampala, Uganda
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Xing W, Zhang R, Jiang W, Zhang T, Pender M, Zhou J, Pu J, Liu S, Wang G, Chen Y, Li J, Hu D, Tang S, Li Y. Adherence to Multidrug Resistant Tuberculosis Treatment and Case Management in Chongqing, China - A Mixed Method Research Study. Infect Drug Resist 2021; 14:999-1012. [PMID: 33758516 PMCID: PMC7979342 DOI: 10.2147/idr.s293583] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/18/2021] [Indexed: 11/23/2022] Open
Abstract
Aim This paper evaluated the treatment adherence for multidrug-resistant tuberculosis (MDR-TB) and MDR-TB case management (MTCM) in Chongqing, China in order to identify factors associated with poor treatment adherence and case management. Methods Surveys with 132 MDR-TB patients and six in-depth interviews with health care workers (HCWs) from primary health centers (PHC), doctors from MDR-TB designated hospitals and MDR-TB patients were conducted. Surveys collected demographic and socio-economic characteristics, as well as factors associated with treatment and case management. In-depth interviews gathered information on treatment and case management experience and adherence behaviors. Results Patient surveys found the two main reasons for poor adherence were negative side-effects from the treatment and busy work schedules. In-depth interviews with key stakeholders found that self-perceived symptom improvement, negative side-effects from treatment and financial difficulties were the main reasons for poor adherence. MDR-TB patients from urban areas, who were unmarried, were female, had migrant status, and whose treatments were supervised by health care workers from primary health clinics, had poorer treatment adherence (P<0.05). Among the MDR-TB patients surveyed, 86.7% received any type of MTCM in general (received any kind of MTCM from HCWs in PHC, MDR-TB designated hospital and centers of disease control/TB dispensaries and 62.50% received MTCM from HCWs in PHC sectors). Patients from suburban areas were more likely to receive both MTCM in general (OR=6.70) and MTCM from HCWs in MDR-TB designated hospitals (OR=2.77), but female patients (OR=0.26) were less likely to receive MTCM from HCWs in PHC sectors, and patients who were not educated about MTCM by TB doctors in designated hospitals were less likely to receive MTCM in general (OR=0.14). Patients who had not been hospitalized were less likely to receive MTCM from HCWs in MDR-TB designated hospitals (OR=0.21). Conclusion Stronger MTCM by HCWs in PHC sectors would improve treatment adherence among MDR-TB patients. Community-based patient-centered models of MTCM in PHC sectors and the use of digital health technology could help to improve case management and thereby improve adherence.
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Affiliation(s)
- Wei Xing
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Rui Zhang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Weixi Jiang
- Duke Kunshan University, Kunshan, Jiangsu, People's Republic of China
| | - Ting Zhang
- Department of Districts and Counties, Chongqing Institute of TB Prevention and Treatment, Chongqing, People's Republic of China
| | - Michelle Pender
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jiani Zhou
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Jie Pu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Shili Liu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Geng Wang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Yong Chen
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Jin Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Daiyu Hu
- Chongqing Institute of TB Prevention and Treatment, Chongqing, People's Republic of China
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Ying Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
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7
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Milligan H, Iribarren SJ, Chirico C, Telles H, Schnall R. Insights from participant engagement with the tuberculosis treatment support tools intervention: Thematic analysis of interactive messages to guide refinement to better meet end user needs. Int J Med Inform 2021; 149:104421. [PMID: 33706032 DOI: 10.1016/j.ijmedinf.2021.104421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tuberculosis (TB) is a largely curable disease, yet it remains one of the top ten causes of death globally. In response to known challenges to completing the long course of TB treatment, our study team developed the TB treatment support tools (TB-TSTs). The mobile application (app) is comprised of the following main components: 1) tracks treatment progress, 2) provides disease tailored information, 3) interactive communication between patients and treatment supporters, and 4) is linked with a direct adherence drug metabolite test. OBJECTIVE The objective of this study was to analyze the interactive communication between the patients and the treatment supporter during the TB-TSTs pilot testing to identify issues and guide intervention refinement. METHODS We used mixed methods to analyze the interactive communication data. The study was conducted at a pulmonary disease specialized hospital in Argentina. Of the 42 study participants enrolled in the pilot study, 21 were randomly assigned to use the TB-TSTs for 6-months during their TB treatment. The treatment supporter was a registered nurse from the regional level of the National TB program. We conducted thematic and content analysis of the messages in their original language, Spanish. We assessed the themes over time and by whom initiated the messages. RESULTS There were 2561 individual messages sent between the participants and treatment supporter. We identified 19 main themes: 7 were participant and 12 were treatment supporter initiated. Participant themes included missed report rationale, arranging in-person meeting, intervention support, TB treatment progress, disease/treatment questions, side effects and additional support. Treatment supporter themes included missed report inquiry, arranging in-person meeting, introduction and instructions, check-in's, positive reinforcement, treatment progress inquiry, test-strip issues, intervention orientation, initial side-effect check in, follow-up on side effects and photo quality issues. Messages and themes decreased over time with most occurring within the first 2 months of treatment. CONCLUSIONS Although there was a decrease in the number of messages and the theme types over the 6-month study participation, treatment adherence support remained needed throughout. Potential solutions are suggested for the main issues and recommendations are being used to guide refinement.
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Affiliation(s)
- Hannah Milligan
- Department of Bio-behavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States.
| | - Sarah J Iribarren
- Department of Bio-behavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States.
| | - Cristina Chirico
- National Tuberculosis Control Program Region Five (Programa Control de la Tuberculosis Región Sanitaria V.), Hospital Zonal Del Torax Dr Antonio Cetrangolo, Buenos Aires, Argentina
| | - Hugo Telles
- National Tuberculosis Control Program Region Five (Programa Control de la Tuberculosis Región Sanitaria V.), Hospital Zonal Del Torax Dr Antonio Cetrangolo, Buenos Aires, Argentina
| | - Rebecca Schnall
- Columbia University School of Nursing, New York, NY, United States
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Guo X, Yang Y, Takiff HE, Zhu M, Ma J, Zhong T, Fan Y, Wang J, Liu S. A Comprehensive App That Improves Tuberculosis Treatment Management Through Video-Observed Therapy: Usability Study. JMIR Mhealth Uhealth 2020; 8:e17658. [PMID: 32735222 PMCID: PMC7428914 DOI: 10.2196/17658] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/23/2020] [Accepted: 06/03/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Treatment of pulmonary tuberculosis (TB) requires at least six months and is compromised by poor adherence. In the directly observed therapy (DOT) scheme recommended by the World Health Organization, the patient is directly observed taking their medications at a health post. An alternative to DOT is video-observed therapy (VOT), in which the patients take videos of themselves taking the medication and the video is uploaded into the app and reviewed by a health care worker. We developed a comprehensive TB management system by using VOT that is installed as an app on the smartphones of both patients and health care workers. It was implemented into the routine TB control program of the Nanshan District of Shenzhen, China. OBJECTIVE The aim of this study was to compare the effectiveness of VOT with that of DOT in managing the treatment of patients with pulmonary TB and to evaluate the acceptance of VOT for TB management by patients and health care workers. METHODS Patients beginning treatment between September 2017 and August 2018 were enrolled into the VOT group and their data were compared with the retrospective data of patients who began TB treatment and were managed with routine DOT between January 2016 and August 2017. Sociodemographic characteristics, clinical features, treatment adherence, positive findings of sputum smears, reporting of side effects, time and costs of transportation, and satisfaction were compared between the 2 treatment groups. The attitudes of the health care workers toward the VOT-based system were also analyzed. RESULTS This study included 158 patients in the retrospective DOT group and 235 patients in the VOT group. The VOT group showed a significantly higher fraction of doses observed (P<.001), less missed observed doses (P<.001), and fewer treatment discontinuations (P<.05) than the DOT group. Over 79.1% (186/235) of the VOT patients had >85% of their doses observed, while only 16.4% (26/158) of the DOT patients had >85% of their doses observed. All patients were cured without recurrences. The VOT management required significantly (P<.001) less median patient time (300 minutes vs 1240 minutes, respectively) and transportation costs (¥53 [US $7.57] vs ¥276 [US $39.43], respectively; P<.001) than DOT. Significantly more patients (191/235, 81.3%) in the VOT group preferred their treatment method compared to those on DOT (37/131, 28.2%) (P<.001), and 92% (61/66) of the health care workers thought that the VOT method was more convenient than DOT for managing patients with TB. CONCLUSIONS Implementation of the VOT-based system into the routine program of TB management was simple and it significantly increased patient adherence to their drug regimens. Our study shows that a comprehensive VOT-based TB management represents a viable and improved evolution of DOT.
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Affiliation(s)
- Xujun Guo
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Centre for Chronic Disease Control, Shenzhen, China
| | - Yarui Yang
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Centre for Chronic Disease Control, Shenzhen, China
| | - Howard E Takiff
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Centre for Chronic Disease Control, Shenzhen, China.,Pathogenomique Mycobacterienne Integree, Institut Pasteur, Paris, France.,Laboratorio de Genética Molecular, Instituto Venezolano de Investigaciones Cientificas, Caracas, Venezuela
| | - Minmin Zhu
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Centre for Chronic Disease Control, Shenzhen, China
| | - Jianping Ma
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Centre for Chronic Disease Control, Shenzhen, China
| | - Tao Zhong
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Centre for Chronic Disease Control, Shenzhen, China
| | - Yuzheng Fan
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Centre for Chronic Disease Control, Shenzhen, China
| | - Jian Wang
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Centre for Chronic Disease Control, Shenzhen, China
| | - Shengyuan Liu
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Centre for Chronic Disease Control, Shenzhen, China
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9
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Koepp J, Baron MV, Hernandes Martins PR, Brandenburg C, Kira ATF, Trindade VD, Ley Dominguez LM, Carneiro M, Frozza R, Possuelo LG, De Mello Pinto MV, Mahlmann Kipper L, Pinheiro da Costa BE. The Quality of Mobile Apps Used for the Identification of Pressure Ulcers in Adults: Systematic Survey and Review of Apps in App Stores. JMIR Mhealth Uhealth 2020; 8:e14266. [PMID: 32470916 PMCID: PMC7327590 DOI: 10.2196/14266] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 12/14/2022] Open
Abstract
Background The increasing global use of smartphones has contributed to the growing use of apps for various health conditions, showing promising results. Through mobile apps, it is possible to perform chronological and iconographic follow-up of wounds, such as pressure ulcers, using a simple and practical tool. However, numerous surveys have pointed out issues related to the functionality, design, safety, and veracity of app information. Objective The objective of this study was to perform a systematic review of published studies regarding mobile apps and a systematic survey in app stores looking for apps developed to identify, evaluate, treat, and/or prevent pressure ulcers in adults, and to evaluate those apps based on software quality characteristics. Methods This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The main bibliographic databases were searched between January 1, 2007 and October 15, 2018, and an app survey was performed in app stores. The selected studies were evaluated according to software quality characteristics by the International Organization for Standardization/International Electrotechnical Commission (ie, ISO/IEC 25010:2011) that involve functionality, efficiency, compatibility, usability, reliability, safety, maintenance, and portability. Results The search in databases and web-based app stores returned a total of 2075 studies. After removal of duplicates and screening of titles and abstracts, 48 complete articles were evaluated for eligibility, and among these, six were included for qualitative synthesis. Conclusions In this review, it was observed that all studies involved the initial phase of app development or improvement, and therefore, the apps still need to be evaluated using different software quality characteristics, so that in the future, a gold standard can be approached. Therefore, the prescription of an app for the identification, evaluation, treatment, and/or prevention of pressure ulcers in adults is currently limited. However, the evaluated studies provided important insights for future research. It is of utmost importance that future surveys develop apps jointly with users, using collaborative and cocreative processes and assess patients in real-world situations across different service settings, and they should consider different ethnicities, so that apps are useful to end users, such as patients, family members, health professionals, and students, in the health area. In addition, it is necessary for studies to describe the methodological course of app development in a clear and objective way in order to ensure reproducibility of the study and to offer inputs to allow future research to approach the development of ideal apps that are geared to positively impact the health of end users. Trial Registration PROSPERO CRD42018114137; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=114137
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Affiliation(s)
- Janine Koepp
- University of Santa Cruz do Sul, Santa Cruz do Sul, Brazil.,Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Miriam Viviane Baron
- Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Coordination of Improvement of Higher Education Personnel - Brazil, Brasília, Brazil
| | | | - Cristine Brandenburg
- Federal University of Ceará, Fortaleza, Brazil.,National Council for Scientific and Technological Development - Brazil, Brasilia, Brazil
| | | | - Vanessa Devens Trindade
- Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,National Council for Scientific and Technological Development - Brazil, Brasilia, Brazil
| | | | | | - Rejane Frozza
- University of Santa Cruz do Sul, Santa Cruz do Sul, Brazil
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10
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Lee Y, Raviglione MC, Flahault A. Use of Digital Technology to Enhance Tuberculosis Control: Scoping Review. J Med Internet Res 2020; 22:e15727. [PMID: 32053111 PMCID: PMC7055857 DOI: 10.2196/15727] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 02/06/2023] Open
Abstract
Background Tuberculosis (TB) is the leading cause of death from a single infectious agent, with around 1.5 million deaths reported in 2018, and is a major contributor to suffering worldwide, with an estimated 10 million new cases every year. In the context of the World Health Organization’s End TB strategy and the quest for digital innovations, there is a need to understand what is happening around the world regarding research into the use of digital technology for better TB care and control. Objective The purpose of this scoping review was to summarize the state of research on the use of digital technology to enhance TB care and control. This study provides an overview of publications covering this subject and answers 3 main questions: (1) to what extent has the issue been addressed in the scientific literature between January 2016 and March 2019, (2) which countries have been investing in research in this field, and (3) what digital technologies were used? Methods A Web-based search was conducted on PubMed and Web of Science. Studies that describe the use of digital technology with specific reference to keywords such as TB, digital health, eHealth, and mHealth were included. Data from selected studies were synthesized into 4 functions using narrative and graphical methods. Such digital health interventions were categorized based on 2 classifications, one by function and the other by targeted user. Results A total of 145 relevant studies were identified out of the 1005 published between January 2016 and March 2019. Overall, 72.4% (105/145) of the research focused on patient care and 20.7% (30/145) on surveillance and monitoring. Other programmatic functions 4.8% (7/145) and electronic learning 2.1% (3/145) were less frequently studied. Most digital health technologies used for patient care included primarily diagnostic 59.4% (63/106) and treatment adherence tools 40.6% (43/106). On the basis of the second type of classification, 107 studies targeted health care providers (107/145, 73.8%), 20 studies targeted clients (20/145, 13.8%), 17 dealt with data services (17/145, 11.7%), and 1 study was on the health system or resource management. The first authors’ affiliations were mainly from 3 countries: the United States (30/145 studies, 20.7%), China (20/145 studies, 13.8%), and India (17/145 studies, 11.7%). The researchers from the United States conducted their research both domestically and abroad, whereas researchers from China and India conducted all studies domestically. Conclusions The majority of research conducted between January 2016 and March 2019 on digital interventions for TB focused on diagnostic tools and treatment adherence technologies, such as video-observed therapy and SMS. Only a few studies addressed interventions for data services and health system or resource management.
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Affiliation(s)
- Yejin Lee
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Global Studies Institute, University of Geneva, Geneva, Switzerland
| | - Mario C Raviglione
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Global Studies Institute, University of Geneva, Geneva, Switzerland.,Centre for Multidisciplinary Research in Health Science (MACH), Università di Milano, Milan, Italy
| | - Antoine Flahault
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Global Studies Institute, University of Geneva, Geneva, Switzerland
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11
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Liu Z, Ng M, Gunasekeran DV, Li H, Ponampalam K, Ponampalam R. Mobile technology: Usage and perspective of patients and caregivers presenting to a tertiary care emergency department. World J Emerg Med 2020; 11:5-11. [PMID: 31892997 DOI: 10.5847/wjem.j.1920-8642.2020.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Developments in information technology (IT) have driven a push in healthcare innovation in the emergency department (ED). Many of these applications rely on mobile technology (MT) such as smartphones but not everyone is comfortable with MT usage. Our study aims to characterize the technology usage behavior of users in the ED so as to guide the implementation of IT interventions in the ED. METHODS A cross-sectional survey was conducted in the emergency department of a tertiary hospital. Patients and their caregivers aged 21 and above were recruited. The survey collected demographic information, technology usage patterns, and participant reported comfort level in the usage of MT. We performed descriptive statistics and multivariate logistic regression to identify factors differentially associated with comfort in usage of MT. RESULTS A total of 498 participants were recruited, and 299 (60%) were patients. English was the most commonly written and read language (66.9%) and 64.2% reported a comfort level of 3/5 or more in using MT. Factors that were associated with being comfortable in using MT include having a tertiary education, being able to read and write English, as well as being a frequent user of IT. Caregivers were more likely to display these characteristics. CONCLUSION A large proportion of ED patients are not comfortable in the usage of MT. Factors that predicted comfort level in the usage of MT were common amongst caregivers. Future interventions should take this into consideration in the design of MT interventions.
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Affiliation(s)
- Zhenghong Liu
- SingHealth Emergency Medicine Residency Programme, Singapore Health Services, Singapore
| | - Mingwei Ng
- SingHealth Emergency Medicine Residency Programme, Singapore Health Services, Singapore
| | | | - Huihua Li
- Health Services Research Unit, Singapore General Hospital, Singapore
| | | | - R Ponampalam
- Department of Emergency Medicine, Singapore General Hospital, Singapore
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