KNCV Tuberculosis Foundation, Den Haag, Netherlands.
KNCV Tuberculosis Foundation Philippines, Metro Manila, Philippines.
JMIR Hum Factors. 2024 Jul 23;11:e54117. doi: 10.2196/54117.
Digital adherence technologies (DATs) are being studied to determine their potential to support tuberculosis (TB) treatment and address the shortcomings of directly observed therapy. Previous research has shown inconclusive results on whether DATs can enhance medication adherence among persons with TB.
This study aims to understand the acceptability of DATs, namely, medication labels and smart pillboxes, among persons with TB, health care workers (HCWs), and key informants (KIs) in the Philippines. The objective is to gain valuable insights that can inform the design and implementation of DATs in the Southeast Asian region, which meet the needs and preferences of end users.
Persons with TB, HCWs, and KIs were recruited from intervention facilities to participate in in-depth interviews conducted between March 2022 and January 2023. These interviews were transcribed and translated into English. A thematic analysis was carried out using NVivo software (Lumivero) to identify and analyze themes. Themes were then structured within a modified social-ecological model.
A total of 25 persons with drug-sensitive TB and 20 HCWs or KIs were interviewed. Both groups emphasized that users' technology literacy level, financial conditions, and motivation to be cured determined how they interacted with the DAT. They also acknowledged that DATs helped foster their relationship with HCWs and enabled efficient treatment support. Concerning technology, persons with TB found DATs easy to use and able to reduce clinic visits. HCWs mentioned that DATs added to their workload but also allowed them to support users who missed doses. However, both groups experienced technical challenges with DATs. Regarding program implementation, users appreciated the clear explanations and demonstrations provided by HCWs. Yet, some users reported inconsistencies between DAT settings and the information provided. HCWs stressed the importance of comprehensive training and sufficient resources for effective program implementation in the future. At the community level, both groups noted that DATs and program design protected users' privacy and reduced the risk of stigma. Finally, users and HCWs shared various contextual factors that influenced their experience with DAT, including infrastructure challenges and the impact of the COVID-19 pandemic.
In the Philippines, persons with TB and HCWs showed a high level of acceptance and satisfaction with the impact of DAT and program design. They expressed a desire for the continuation of DATs. The challenges encountered underscore the need for ongoing technological development to minimize malfunctions, enhance the capacity of health facilities, and improve infrastructure. DATs have demonstrated their ability to strengthen user-HCW relationships and protect users from stigmatization. Additional efforts are required to scale up the DAT program in the Philippines.
数字依从性技术（DATs）正在被研究，以确定其在支持结核病（TB）治疗和解决直接观察治疗的缺点方面的潜力。之前的研究表明，DATs 是否能提高结核病患者的药物依从性，结果尚无定论。
本研究旨在了解菲律宾结核病患者、卫生保健工作者（HCWs）和关键信息者（KIs）对 DATs（即药物标签和智能药盒）的可接受性。目的是获得有价值的见解，以告知在东南亚地区设计和实施 DATs，满足最终用户的需求和偏好。
从干预设施中招募结核病患者、HCWs 和 KIs 参与 2022 年 3 月至 2023 年 1 月期间进行的深入访谈。这些访谈被转录并翻译成英文。使用 NVivo 软件（Lumivero）进行主题分析，以识别和分析主题。然后，主题在一个修改后的社会生态模型内进行构建。
共访谈了 25 名药物敏感型结核病患者和 20 名 HCWs 或 KIs。两组均强调，用户的技术素养水平、财务状况和治愈的动机决定了他们与 DAT 的互动方式。他们还承认，DATs 有助于培养他们与 HCWs 的关系，并为高效的治疗支持提供便利。在技术方面，结核病患者认为 DATs 易于使用，并能减少就诊次数。HCWs 提到，DATs 增加了他们的工作量，但也使他们能够支持错过剂量的患者。然而，两组都在 DATs 方面遇到了技术挑战。关于项目实施，用户对 HCWs 提供的清晰解释和演示表示赞赏。然而，一些用户报告说，DAT 设置与提供的信息之间存在不一致。HCWs 强调了全面培训和充足资源对于未来有效实施项目的重要性。在社区层面，两组都注意到，DATs 和项目设计保护了用户的隐私，并降低了污名化的风险。最后，用户和 HCWs 分享了各种影响他们对 DAT 体验的情境因素，包括基础设施挑战和 COVID-19 大流行的影响。
在菲律宾，结核病患者和 HCWs 对 DAT 的影响和项目设计表现出高度的接受度和满意度。他们表示希望继续使用 DATs。所遇到的挑战突出表明需要不断进行技术开发，以最小化故障，增强卫生设施的能力，并改善基础设施。DATs 已经证明了它们能够加强用户与 HCWs 之间的关系，并保护用户免受污名化。需要进一步努力来扩大菲律宾的 DAT 项目规模。
