Children's National Hospital, 111 Michigan Ave NW, Washington, D.C, 20010, USA.
University of California San Francisco, San Francisco, CA, USA.
BMC Public Health. 2022 May 19;22(1):1010. doi: 10.1186/s12889-022-13393-5.
Distribution of long-lasting insecticide treated nets (LLINs) is the most widely used intervention for the prevention of malaria but recall and social desirability biases may lead to challenges in accurately measuring use of bednets. SmartNet is a remote electronic monitor that provides objective measurements of bednet use over weeks at a time. Assessing local acceptability is important when implementing innovative global health technologies such as SmartNet. This study draws on established models such as the Technology Acceptance Model (TAM) and Theoretical Framework of Acceptability (TFA) to assess acceptability of SmartNet in Ugandan households.
Semi-structured qualitative interviews were conducted at weeks one and six following installation of SmartNet in ten households in Western Uganda. Heads-of-households answered open-ended questions addressing the main acceptability domains of the TFA and TAM models (i.e. perceived ease of use, ethicality, etc.). Responses were digitally recorded, transcribed, coded and analyzed using a thematic analysis approach.
Seven out of ten households interviewed reported no difference in use between SmartNet and a standard LLIN. Households stated the large size, soft fabric, and the efficacy of SmartNet relative to a standard LLIN contributed to perceived usefulness and perceived ease of use. Opportunity costs of the novel monitoring system expressed by households included difficulty washing nets and dislike of blinking lights on the device. Barriers to SmartNet use focused on questions of the ethics of bednet use monitoring, discomfort with technical aspects of the device and a poor understanding of its function amongst others in the community. However, explaining SmartNet to other community members resolved these concerns and often resulted in interest and acceptance among peers.
Objective monitoring of bednet use with SmartNet appears acceptable to these households in Uganda. Use of SmartNet seems to be similar to behaviors around use of standard LLINs. Viewpoints on many aspects of SmartNet were generally favorable. Concerns around ethicality of bednet monitoring are present and indicate the need for continuing community education. The device will continue to be optimized to make it more acceptable to users and to accurately reflect standard LLIN use to improve our understanding of prevention behaviors in malaria endemic settings.
长效驱虫蚊帐（LLINs）的分发是预防疟疾最广泛使用的干预措施，但召回和社会期望偏差可能导致准确测量蚊帐使用情况的挑战。SmartNet 是一种远程电子监测器，可以一次在数周内提供对蚊帐使用情况的客观测量。在实施 SmartNet 等创新性全球卫生技术时，评估当地的可接受性非常重要。本研究借鉴了已建立的模型，如技术接受模型（TAM）和可接受性理论框架（TFA），以评估 SmartNet 在乌干达家庭中的可接受性。
在 SmartNet 安装在乌干达西部的十个家庭中一周和六周后，进行了半结构化定性访谈。户主回答了开放式问题，涉及 TFA 和 TAM 模型的主要可接受性领域（即感知易用性、伦理等）。使用主题分析方法对响应进行数字化记录、转录、编码和分析。
接受采访的十个家庭中有七个表示 SmartNet 和标准 LLIN 的使用没有区别。家庭表示，SmartNet 的尺寸大、织物柔软以及相对于标准 LLIN 的效果有助于感知有用性和感知易用性。家庭对新型监测系统的机会成本包括网难洗和对设备上闪烁灯光的不喜欢。SmartNet 使用的障碍主要集中在蚊帐使用监测的伦理问题、对设备技术方面的不适以及社区其他成员对其功能的理解不足等问题上。然而，向其他社区成员解释 SmartNet 解决了这些问题，并常常在同行中引起兴趣和接受。
乌干达这些家庭对 SmartNet 进行蚊帐使用的客观监测表示可接受。SmartNet 的使用似乎与标准 LLIN 相似。对 SmartNet 许多方面的观点普遍是有利的。对蚊帐监测伦理的关注是存在的，这表明需要继续对社区进行教育。该设备将继续进行优化，以提高用户的接受程度，并准确反映标准 LLIN 的使用情况，从而更好地了解疟疾流行地区的预防行为。
