Qualitative evaluation of a text messaging intervention to support patients with active tuberculosis: implementation considerations.
Qualitative evaluation of a text messaging intervention to support patients with active tuberculosis: implementation considerations.
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DOI：
10.2196/mhealth.3971
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发表时间：
2015-02-27
影响因子：
5
通讯作者：
Chirico C
中科院分区：
文献类型：
--
作者：
Iribarren SJ;Sward KA;Beck SL;Pearce PF;Thurston D;Chirico C
结核病 (TB) 仍然是一个主要的全球公共卫生问题，移动医疗 (mHealth) 干预措施已被确定为改善结核病结果的一种方式。 TextTB 是一种基于交互式文本的干预措施，旨在促进结核病药物的依从性，已在阿根廷进行了试点测试，结果支持更大规模试验的实施。这项研究的目的是了解试点测试期间遇到的问题，以便为未来更大规模试验的实施提供信息。使用了以社会技术框架为指导的描述性、观察性定性设计。地点是阿根廷一家公立肺部专科医院内的诊所。通过 115 天的工作流程观察、短信 (n=2286)、研究日志审查和利益相关者输入收集数据。新出现的问题被归类为组织、人力、技术或社会技术考虑因素。与干预相关的问题包括工作流程问题（例如，人力、培训、安全）、技术挑战（例如，数据错误、平台缺陷）和消息传递问题（例如，无意发送多条消息、自动确认问题）。系统/环境问题包括移动网络覆盖范围变化、电力和互联网中断以及药品短缺。试点期间的干预挑战基本上是可以控制的，但在进行更大规模的试验之前需要系统地解决。概述了潜在的解决方案。研究结果可能会帮助其他考虑实施移动医疗干预措施的人来预测和缓解某些挑战。尽管某些问题可能与具体情况相关，但其他问题（例如电力/互联网中断和资源有限）并不是我们环境中特有的问题。新软件版本的发布并没有解决某些问题，因为所使用的特定功能被删除。因此，在扩展到更大规模的努力之前，需要考虑其他软件选项。改进某些功能的自动化是必要的，但是，目标是保持干预功能的交互性、用户友好性和以患者为中心。需要与利益相关者继续合作，以进行进一步的研究，并了解如何将这种移动医疗干预措施有效地融入到更大的卫生系统中。
Tuberculosis (TB) remains a major global public health problem and mobile health (mHealth) interventions have been identified as a modality to improve TB outcomes. TextTB, an interactive text-based intervention to promote adherence with TB medication, was pilot-tested in Argentina with results supporting the implementation of trials at a larger scale. The objective of this research was to understand issues encountered during pilot-testing in order to inform future implementation in a larger-scale trial. A descriptive, observational qualitative design guided by a sociotechnical framework was used. The setting was a clinic within a public pulmonary-specialized hospital in Argentina. Data were collected through workflow observation over 115 days, text messages (n=2286), review of the study log, and stakeholder input. Emerging issues were categorized as organizational, human, technical, or sociotechnical considerations. Issues related to the intervention included workflow issues (eg, human, training, security), technical challenges (eg, data errors, platform shortcomings), and message delivery issues (eg, unintentional sending of multiple messages, auto-confirmation problems). System/contextual issues included variable mobile network coverage, electrical and Internet outages, and medication shortages. Intervention challenges were largely manageable during pilot-testing, but need to be addressed systematically before proceeding with a larger-scale trial. Potential solutions are outlined. Findings may help others considering implementing an mHealth intervention to anticipate and mitigate certain challenges. Although some of the issues may be context dependent, other issues such as electrical/Internet outages and limited resources are not unique issues to our setting. Release of new software versions did not result in solutions for certain issues, as specific features used were removed. Therefore, other software options will need to be considered before expanding into a larger-scale endeavor. Improved automation of some features will be necessary, however, a goal will be to retain the intervention capability to be interactive, user friendly, and patient focused. Continued collaboration with stakeholders will be required to conduct further research and to understand how such an mHealth intervention can be effectively integrated into larger health systems.
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影响因子：
7.4
作者：
Källander K;Tibenderana JK;Akpogheneta OJ;Strachan DL;Hill Z;ten Asbroek AH;Conteh L;Kirkwood BR;Meek SR
通讯作者：
Meek SR
影响因子：
5.5
作者：
Kumar, Santosh;Nilsen, Wendy J.;Abernethy, Amy;Atienza, Audie;Patrick, Kevin;Pavel, Misha;Riley, William T.;Shar, Albert;Spring, Bonnie;Spruijt-Metz, Donna;Hedeker, Donald;Honavar, Vasant;Kravitz, Richard;Lefebvre, R. Craig;Mohr, David C.;Murphy, Susan A.;Quinn, Charlene;Shusterman, Vladimir;Swendeman, Dallas
通讯作者：
Swendeman, Dallas
影响因子：
--
作者：
Iribarren S;Beck S;Pearce PF;Chirico C;Etchevarria M;Cardinale D;Rubinstein F
通讯作者：
Rubinstein F
影响因子：
7.4
作者：
Mohr, David C.;Schueller, Stephen M.;Rashidi, Parisa
通讯作者：
Rashidi, Parisa
影响因子：
7.4
作者：
Fiordelli M;Diviani N;Schulz PJ
通讯作者：
Schulz PJ