Bikorimana Laban, Estrada Eve Hiyori, Niyigena Anne, Riviello Robert, Kateera Fredrick, Hedt-Gauthier Bethany, Cubaka Vincent K
Partners In Health - Rwanda, Kigali, Rwanda.
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
Matern Health Neonatol Perinatol. 2025 Feb 5;11(1):3. doi: 10.1186/s40748-024-00200-9.
Telemedicine interventions, while promising for enhancing healthcare access, require an evaluation of feasibility and acceptability to inform field implementation. This qualitative study explored the acceptability of a telemedicine intervention in which surgical incision photos taken by community health workers (CHWs) were sent to hospital-based general practitioners to diagnose surgical site infections (SSIs) following cesarean section in rural Rwanda. As the study timeline coincided with the beginning of the COVID-19 pandemic we additionally asked about their perceptions of telemedicine in this context .
We conducted qualitative, semi-structured in-depth interviews in Kinyarwanda among 26 individuals (14 women and 12 CHWs) who participated in the telemedicine intervention. The interviews were transcribed verbatim and translated into English. Thematic analysis was applied and parallel inductive coding was used to develop English and Kinyarwanda codebooks. These were consolidated into a master codebook for final coding.
All women and CHWs found the photo-based telemedicine program acceptable, though some concerns were raised. One woman voiced concerns about the reliability of photos in detecting SSIs compared to in-person visits. Women and CHWs reported perceived faster healing associated with the intervention, enhanced access to postoperative care from home, and cost savings as notable benefits of the telemedicine program. Trust in CHWs emerged as a critical factor for community acceptance. While one CHW expressed reservations about implementing the intervention during COVID-19, the majority of CHWs and patients indicated strong acceptance, with some even preferring it.
These findings highlight the acceptance - from both caregivers and patients - of the photo-based telemedicine intervention in a resource-limited context, even amid crises like the COVID-19 pandemic. This acceptance was reinforced with recognized benefits, with trust in CHWs serving as a crucial factor. These insights can inform the development of telemedicine interventions in similar settings.
远程医疗干预虽有望改善医疗服务可及性，但需评估其可行性和可接受性，以为实地实施提供参考。本定性研究探讨了一项远程医疗干预的可接受性，该干预中社区卫生工作者（CHW）拍摄的手术切口照片被发送给驻院全科医生，用于诊断卢旺达农村地区剖宫产术后的手术部位感染（SSI）。由于研究时间线与新冠疫情开始时间重合，我们还询问了他们在此背景下对远程医疗的看法。
我们用基尼亚卢旺达语对26名参与远程医疗干预的个人（14名女性和12名CHW）进行了定性、半结构化深度访谈。访谈逐字记录并翻译成英语。采用主题分析，并使用平行归纳编码来编制英语和基尼亚卢旺达语编码手册。这些编码手册被整合为一个主编码手册用于最终编码。
所有女性和CHW都认为基于照片的远程医疗项目是可接受的，不过也提出了一些担忧。一名女性表示，与亲自就诊相比，照片在检测SSI方面的可靠性令人担忧。女性和CHW报告称，该干预带来了愈合更快、在家中获得术后护理更便捷以及节省费用等显著好处，这些都是远程医疗项目的优势。对CHW的信任成为社区接受该项目的关键因素。虽然一名CHW对在新冠疫情期间实施该干预有所保留，但大多数CHW和患者表示强烈接受，有些人甚至更喜欢这种方式。
这些发现凸显了在资源有限的情况下，甚至在新冠疫情等危机期间，照护者和患者对基于照片的远程医疗干预的接受度。这种接受度因公认的益处而得到加强，对CHW的信任是一个关键因素。这些见解可为类似环境下远程医疗干预的发展提供参考。
