背景:用移动货币激励措施补充数字依从性技术(DAT)可能会提高其在支持结核病药物依从性方面的效用,然而,这种综合方法的可行性和可接受性仍不清楚。
目的:本研究旨在描述一种名为MyMobileWallet的新型DAT干预措施的可行性和可接受性,该措施由实时依从性监测组成,短信提醒,以及低收入环境中结核病药物依从性的移动货币激励措施。
方法:我们有目的地从姆巴拉拉的姆巴拉拉地区转诊医院招募结核病患者,乌干达,谁(1)开始结核病治疗时或在过去4周内,(2)拥有一部手机,(3)能够使用短信测试消息,(4)年龄≥18岁,和(5)住在姆巴拉拉区。在研究结束时(第6个月),我们使用接受和使用技术统一理论(UTAUT)的访谈和问卷调查来收集可行性和可接受性数据,反映患者使用我的移动钱包每个组件的经验。可行性还包括跟踪依从性监测器的功能(即,电子药盒)以及SMS短信和移动货币交付。我们使用内容分析方法对定性数据进行归纳分析,使用Stata(第13版;StataCorpLLC)对定量数据进行分析。
结果:所有39名参与者报告说干预措施是可行的,因为他们易于使用(例如,访问和阅读短信),并按预期工作。几乎所有的短信(6880/7064,97.4%)都按计划发送。监测员传递的依从性数据效果良好,98.37%(5682/5776)的数据按计划传输。所有参与者还报告说,干预措施是可以接受的,因为它帮助他们按照规定服用结核病药物;移动货币激励措施减轻了他们与结核病相关的经济负担;短信提醒和基于电子药丸盒的警报提醒他们按时服药;参与者认为实时依从性监测在服药时“被监视”。这鼓励他们按时服药以表明他们的承诺。干预被认为是一种护理的标志,最终创造了情感支持和与医疗保健的联系感。参与者更喜欢每日短信提醒(32/39,82%),而不是与错过剂量相关的提醒(7/39,18%),引用结核病药物每天服用的事实。
结论:在基于贫困的结构性障碍严重限制结核病治疗和护理的低资源环境中,使用与SMS短信提醒和移动货币激励措施相关的实时依从性监测结核病药物依从性是可行和可接受的。
BACKGROUND: Complementing digital adherence technologies (DATs) with mobile money incentives may improve their utility in supporting tuberculosis medication adherence, yet the feasibility and acceptability of this integrated approach remain unclear.
OBJECTIVE: This study aims to describe the feasibility and acceptability of a novel DAT intervention called My Mobile Wallet composed of real-time adherence monitoring, SMS text message reminders, and mobile money incentives for tuberculosis medication adherence in a low-income setting.
METHODS: We purposively recruited people living with tuberculosis from the Mbarara Regional Referral Hospital in Mbarara, Uganda, who (1) were starting tuberculosis treatment at enrollment or within the past 4 weeks, (2) owned a mobile phone, (3) were able to use SMS test messaging, (4) were aged ≥18 years, and (5) were living in Mbarara district. At study exit (month 6), we used interviews and questionnaires informed by the unified theory of acceptance and use of technology (UTAUT) to collect feasibility and acceptability data, reflecting patients\' experiences of using each component of My Mobile Wallet. Feasibility also included tracking the functionality of the adherence monitor (ie, an electronic pillbox) as well as SMS text message and mobile money delivery. We used a content analytical approach to inductively analyze qualitative data and Stata (version 13; StataCorp LLC) to analyze quantitative data.
RESULTS: All 39 participants reported that the intervention was feasible because it was easy for them to use (eg, access and read SMS text messages) and worked as expected. Almost all SMS text messages (6880/7064, 97.4%) were sent as planned. The transmission of adherence data from the monitor worked well, with 98.37% (5682/5776) of the data transmitted as planned. All participants additionally reported that the intervention was acceptable because it helped them take their tuberculosis medication as prescribed; the mobile money incentives relieved them of tuberculosis-related financial burdens; SMS text message reminders and electronic pillbox-based alarms reminded them to take their medication on time; and participants perceived real-time adherence monitoring as \"being watched\" while taking their medication, which encouraged them to take their medication on time to demonstrate their commitment. The intervention was perceived as a sign of care, which eventually created emotional support and a sense of connectedness to health care. Participants preferred daily SMS text message reminders (32/39, 82%) to reminders linked to missed doses (7/39, 18%), citing the fact that tuberculosis medication is taken daily.
CONCLUSIONS: The use of real-time adherence monitoring linked to SMS text message reminders and mobile money incentives for tuberculosis medication adherence was feasible and acceptable in a low-resource setting where poverty-based structural barriers heavily constrain tuberculosis treatment and care.