Understanding the usability of an mHealth tool to support medication adherence schedules in newly diagnosed tuberculosis patients : a mixed-methods research study

Abstract

Tuberculosis is an infectious disease, one which is curable and preventable. Alongside HIV, TB ranks as a leading cause of death worldwide. Although TB monitoring using direct observation of therapy has seen remarkable success in specific contexts, it still has limitations related to improving adherence. The use of technology-driven supportive tools aimed at increasing ongoing adherence has the potential to improve medication adherence. However, evidence remains minimal. The main purpose of this study was to determine the influence of mobile health (mHealth), for example through wisepill technology feedback reminders, on newly diagnosed TB patients’ adherence to medication. The study intended to demonstrate medication adherence by using TB patients’ perceptions of self-efficacy and stigma to predict successful treatment outcomes, and to understand, through TB patient experiences, the barriers to adoption and sustainable use of mHealth technologies. A mixed-methods research design using purposive and convenience sampling was utilised to acquire understanding of the usability of an mHealth tool to support medication adherence schedules in tuberculosis patients. The sample comprised 90 patients with drug-susceptible tuberculosis. Quantitative results revealed that supportive feedback reminders from wisepill technology did not increase adherence over time. Adherence scores from wisepill differed significantly from patients’ subjective reports on adherence. Wisepill technology, stigma and self-efficacy predicted successful treatment outcomes, once reminders from wisepill technology were added. A sample of 10 participants were interviewed. Thematic analysis of the qualitative data established four themes, namely: 1) end-user experiences; 2) the influence of using the mHealth tool during TB treatment; 3) stigma and self-efficacy; and 4) sustainability of using the mHealth tool. Key lessons acquired from the qualitative findings highlighted that feedback reminders encouraged medication intake, it is valuable and provides companionship in supporting the participants’ treatment journey. The qualitative results enhanced the quantitative results and created a sense of convergence. The study generated evidence-based knowledge of mHealth use and adherence over time in a South African context. Usability of adherence technologies, coupled with improved adherence and treatment outcomes, can inform policymakers in defining the national standard for TB adherence to reduce transmission of the disease. In addition, this understanding is of key importance for developing intervention programmes to improve medication adherence among TB patients.