Yale University School of Medicine, New Haven, Connecticut, United States of America.
PLoS One. 2013 May 28;8(5):e64662. doi: 10.1371/journal.pone.0064662. Print 2013.
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.
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.
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.
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.
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.
随着南非夸祖鲁-纳塔尔省通过将护理和治疗从训练有素的专业中心转移到社区医院来应对日益严重的耐多药结核病（MDR-TB）疫情，提供和监测 MDR-TB 治疗带来了新的挑战。特别是，对于每天前往患者家中给药和监测治疗的流动医疗工作者（HCW），即经过培训的卫生专业人员来说，跟踪和报告不良临床事件变得困难。我们设计并试点了一个移动电话应用程序（Mobilize），用于流动 HCW，该应用程序可通过低成本的功能手机对 MDR-TB 患者进行电子标准化记录和跟踪。
我们评估了使用 Mobilize 在 MDR-TB 治疗强化阶段每周记录和提交不良事件表的可接受性和可行性，并在试点期间评估了流动 HCW 的认知情况。
在一个地点对所有五名流动 HCW 进行了培训并提供了手机。利用混合方法评估，对移动 HCW 的使用模式进行了七个月的电子跟踪和分析。设计了定性焦点小组和问卷，以了解移动电话技术对工作环境的影响。
流动 HCW 提交了 33 份预期不良事件表中的 9 份（27%），这与定性结果相矛盾，定性结果表明 Mobilize 改善了不良事件的沟通，有助于他们的日常工作流程，并且可以成功扩展到其他卫生干预措施。当他们表达的观点与实际做法相矛盾时，流动 HCW 提到了健忘，并认为患者应该对自己的护理承担更多责任。
尽管移动医疗技术得到了积极响应，但由于本研究中流动 HCW 和 MDR-TB 患者数量较少，因此本试点经验表明 HCW 的接受程度较差。尽管由于本研究中流动 HCW 和 MDR-TB 患者数量较少，我们的结果应谨慎解释，但我们建议在资源匮乏的环境中扩大新的移动医疗倡议之前，仔细探索 HCW 的动机和技术增强措施。
