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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
A Pilot Study of an mHealth Application for Healthcare Workers: Poor Uptake Despite High Reported Acceptability at a Rural South African Community-Based MDR-TB Treatment Program
PLoS ONE, Volume 8, No. 5, Article e64662, Year 2013
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Description
Introduction:As the South African province of KwaZulu-Natal addresses a growing multidrug-resistant tuberculosis (MDR-TB) epidemic by shifting care and treatment from trained specialty centers to community hospitals, delivering and monitoring MDR-TB therapy has presented new challenges. In particular, tracking and reporting adverse clinical events have been difficult for mobile healthcare workers (HCWs), trained health professionals who travel daily to patient homes to administer and monitor therapy. We designed and piloted a mobile phone application (Mobilize) for mobile HCWs that electronically standardized the recording and tracking of MDR-TB patients on low-cost, functional phones.Objective:We assess the acceptability and feasibility of using Mobilize to record and submit adverse events forms weekly during the intensive phase of MDR-TB therapy and evaluate mobile HCW perceptions throughout the pilot period.Methods:All five mobile HCWs at one site were trained and provided with phones. Utilizing a mixed-methods evaluation, mobile HCWs' usage patterns were tracked electronically for seven months and analyzed. Qualitative focus groups and questionnaires were designed to understand the impact of mobile phone technology on the work environment.Results:Mobile HCWs submitted nine of 33 (27%) expected adverse events forms, conflicting with qualitative results in which mobile HCWs stated that Mobilize improved adverse events communication, helped their daily workflow, and could be successfully expanded to other health interventions. When presented with the conflict between their expressed views and actual practice, mobile HCWs cited forgetfulness and believed patients should take more responsibility for their own care.Discussion:This pilot experience demonstrated poor uptake by HCWs despite positive responses to using mHealth. Though our results should be interpreted cautiously because of the small number of mobile HCWs and MDR-TB patients in this study, we recommend carefully exploring the motivations of HCWs and technologic enhancements prior to scaling new mHealth initiatives in resource poor settings. © 2013 Chaiyachati et al.
Authors & Co-Authors
Chaiyachati, Krisda
United States, New Haven
Yale School of Medicine
South Africa
Tugela Ferry Care and Research Collaboration tf Cares
Loveday, Marian
South Africa, Tygerberg
South African Medical Research Council
South Africa, Durban
University of Kwazulu-natal
Lorenz, Stephen
United States, Boston
Massachusetts General Hospital
Lesh, Neal B.
United States, Cambridge
Dimagi, Inc.
Larkan, Lee Megan
South Africa, Pietermaritzburg
Kwazulu-natal Department of Health
Cinti, Sandro
United States, Ann Arbor
Va Ann Arbor Healthcare System
Friedland, Gerald H.
United States, New Haven
Yale School of Medicine
South Africa
Tugela Ferry Care and Research Collaboration tf Cares
Haberer, Jessica Elizabeth
United States, Boston
Massachusetts General Hospital
Statistics
Citations: 95
Authors: 8
Affiliations: 8
Identifiers
Doi:
10.1371/journal.pone.0064662
e-ISSN:
19326203
Research Areas
Health System And Policy
Infectious Diseases
Study Approach
Qualitative