背景:在结核病(TB)控制中,不坚持治疗是一个障碍。确保遵守的传统方法,也就是说,直接观察治疗,面临着阻碍其广泛采用的重大挑战。视频直接观察治疗(VDOT)等数字粘附技术正在成为有前途的解决方案。然而,随着这些新技术的发展,一个关键的差距是缺乏评估其疗效和非洲患者独特体验的综合研究.
目的:本研究的目的是评估影响可接受性的患者体验,有用性,在结核病治疗监测期间,使用增强的VDOT系统易于使用。
方法:我们在坎帕拉的横断面出口定性研究中进行了个人开放式访谈,乌干达。30名18-65岁完成VDOT随机试验的参与者被有目的地选择代表性别差异。坚持水平,和艾滋病毒状况。我们使用演绎和归纳编码的混合过程来识别与VDOT参与研究经验相关的内容。守则被组织成主题和次主题,用于开发总体类别,这些类别由修改后的资源有限设置的技术接受模型改编而成。我们探索了参与者关于VDOT易用性和实用性的经验,从而确定其可接受性的促进者和障碍。感知有用性是指用户期望从技术中获得的好处,而感知的易用性是指用户如何轻松地浏览其各种功能。我们通过从评估感知结构转变为经验结构来适应。
结果:参与者的平均年龄为35.3(SD12)岁。在30名参与者中,15人(50%)是女性,13人(43%)受教育程度低,和22(73%)拥有手机,其中10人(45%)拥有智能手机。9人(28%)感染了结核病/艾滋病毒,接受抗逆转录病毒治疗。具有经验的有用性和VDOT使用便利性的推动者的新兴子主题是SMS文本消息提醒,医疗保健提供者对患者的技术培训支持,及时的患者-提供者沟通,家庭社会支持,和财政激励。TB/HIV合并感染的患者报告了他们抗逆转录病毒药物依从性支持的额外益处。VDOT的有用性和易用性的外部障碍是不稳定的电力,应用程序中的技术故障,以及农村地区缺乏蜂窝网络覆盖。对耻辱的担忧,疾病披露,和担心侵犯隐私和保密影响了VDOT的易用性。
结论:总体而言,参与者对增强的VDOT有积极的体验。他们发现增强的VDOT系统用户友好,有益的,并且可以接受,特别是由于支持功能,如短信提醒,激励机制,卫生保健提供者的技术培训,家庭支持。然而,解决与技术基础设施和隐私相关的障碍至关重要,保密性,以及与VDOT相关的污名化问题。
BACKGROUND: In tuberculosis (TB) control, nonadherence to treatment persists as a barrier. The traditional method of ensuring adherence, that is, directly observed therapy, faces significant challenges that hinder its widespread adoption. Digital adherence technologies such as video directly observed therapy (VDOT) are emerging as promising solutions. However, as these novel technologies gain momentum, a critical gap is the lack of comprehensive studies evaluating their efficacy and the unique experiences of patients in Africa.
OBJECTIVE: The aim of this
study was to assess patients\' experiences that affected acceptability, usefulness, and ease of use with an enhanced VDOT system during monitoring of TB treatment.
METHODS: We conducted individual open-ended interviews in a cross-sectional exit qualitative
study in Kampala, Uganda. Thirty participants aged 18-65 years who had completed the VDOT randomized
trial were purposively selected to represent variability in sex, adherence level, and HIV status. We used a hybrid process of deductive and inductive coding to identify content related to the experience of
study participation with VDOT. Codes were organized into themes and subthemes, which were used to develop overarching categories guided by constructs adapted from the modified Technology Acceptance Model for Resource-Limited Settings. We explored participants\' experiences regarding the ease of use and usefulness of VDOT, thereby identifying the facilitators and barriers to its acceptability. Perceived usefulness refers to the benefits users expect from the technology, while perceived ease of use refers to how easily users navigate its various features. We adapted by shifting from assessing perceived to experienced constructs.
RESULTS: The participants\' mean age was 35.3 (SD 12) years. Of the 30 participants, 15 (50%) were females, 13 (43%) had low education levels, and 22 (73%) owned cellphones, of which 10 (45%) had smartphones. Nine (28%) were TB/HIV-coinfected, receiving antiretroviral therapy. Emergent subthemes for facilitators of experienced usefulness and ease of VDOT use were SMS text message reminders, technology training support to patients by health care providers, timely patient-provider communication, family social support, and financial incentives. TB/HIV-coinfected patients reported the added benefit of adherence support for their antiretroviral medication. The external barriers to VDOT\'s usefulness and ease of use were unstable electricity, technological malfunctions in the app, and lack of cellular network coverage in rural areas. Concerns about stigma, disease disclosure, and fear of breach in privacy and confidentiality affected the ease of VDOT use.
CONCLUSIONS: Overall, participants had positive experiences with the enhanced VDOT. They found the enhanced VDOT system user-friendly, beneficial, and acceptable, particularly due to the supportive features such as SMS text message reminders, incentives, technology training by health care providers, and family support. However, it is crucial to address the barriers related to technological infrastructure as well as the privacy, confidentiality, and stigma concerns related to VDOT.