Barriers and facilitators of implementing electronic monitors to improve adherence and health outcomes in tuberculosis patients: protocol for a systematic review based on the Consolidated Framework for Implementation Research

Abstract

Background Tuberculosis (TB) has been regarded as ‘a relentless scourge’, increasing morbidity and mortality and burdening vulnerable populations. Poor adherence to TB treatment and ineffective traditional interventions hinders TB control. A novel TB approach called ‘electronic monitors’, equipping medication boxes with daily audio or visual reminders for electronically monitoring medication intake, seems promising in improving adherence and health outcomes and overcoming the weaknesses of traditional interventions. However, no review has systematically examined and synthesized the influencing factors of implementing electronic monitors. Implementation research offers the means to analyse the influencing factors of the implementation and its process, fitting well with the aim of this review. Therefore, the widely recognized Consolidated Framework for Implementation Research (CFIR), which offers a common taxonomy for evaluating intervention implementation, will be adopted to systematically identify barriers and facilitators of the electronic monitors for improving adherence and health outcomes in patients with TB. Methods and analysis The systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature research will be conducted in five electronic databases (Ovid MEDLINE, CINAHL, EMBASE, Cochrane Library and Web of Science) to identify the barriers and facilitators of implementing electronic monitors in patients with TB. The CFIR will be used as a guide for categorizing and synthesizing the barriers and facilitators. Study screening, data extraction, quality appraisal and data analysis will be conducted by two independent reviewers. The use of additional reviewers will solve any disagreements between the two reviewers. Discussion Given the increased prominence of TB epidemiology and the adherence problem of electronic monitors, there is a solid rationale for synthesizing the existing studies via the CFIR. The findings and conclusion of this review will lay bare the achievements and effectiveness of implementing electronic monitors, as well as the attendant gaps and limitations. Further strategies for facilitating the implementation of electronic monitors will also be explored. This review will be of essential significance for research and practice, supporting future academic research initiatives centred on patients with TB and aiding electronic monitor design in lowering the morbidity and mortality associated with TB disease. Trial registration number: PROSPERO: CRD42023395747.

Implementation outcomes of tuberculosis digital adherence technologies: a scoping review using the RE-AIM framework

“…This study and the companion review on contextual factors are the first, to our knowledge, to systematically report on the implementation of DATs for the treatment of TB and M. tuberculosis infection. We found one protocol paper aiming to conduct a systematic review of barriers and facilitators of implementing pillboxes for TB treatment; results have not yet been reported [84]. Systematic reviews of the implementation of mHealth technologies using the RE-AIM framework, however, have been conducted in other disease areas.…”

Barriers and Facilitators to High-Volume Evidence-Based Innovation and Implementation in a Large, Community-Based Learning Health System

“…18 CFIR is a widely accepted framework for assessing barriers and facilitators of implementation. 7,10,[19][20][21][22][23][24][25][26] Its creation involved reviews of several hundred publications across multiple scienti c disciplines followed by the combination of different constructs into a single framework. 26 The current project utilized the full core CFIR framework, without a recently proposed six-element addendum regarding anticipated vs. actual outcomes.…”

“…34 However, most current implementation literature evaluates a single topic, a certain medical specialty setting, or, when characterizing multiple projects, may summarize disparate already-published single-topic data collected using different methods. 35,36,37,38,20,25,39 While useful for speci c efforts, this approach may not identify the common and generalizable domains attainable from using a consistent, prospective approach to data collection and mapping across multiple projects. In contrast, identifying common potentially modi able implementation facilitators and barriers across many project topics can enumerate the likely highest-yield systems-level topic areas relevant for strategic development of learning health systems.…”