Perceptions and Acceptability of Digital Interventions Among Tuberculosis Patients in Cambodia: Qualitative Study of Video-Based Directly Observed Therapy

Abstract

Background Despite the development of effective drugs for treatment, tuberculosis remains one of the leading causes of death from an infectious disease worldwide. One of the greatest challenges to tuberculosis control is patient adherence to treatment. Recent research has shown that video-based directly observed therapy is a feasible and effective approach to supporting treatment adherence in high-income settings. However, few studies have explored the potential for such a solution in a low- or middle-income country setting. Globally, these countries’ rapidly rising rate of mobile penetration suggests that the potential for translation of these results may be high. Objective We sought to examine patient perceptions related to the use of mobile health, and specifically video-based directly observed therapy, in a previously unstudied patient demographic: patients with tuberculosis in a low-income country setting (Cambodia). Methods We conducted a cross-sectional qualitative study in urban and periurban areas in Cambodia, consisting of 6 focus groups with tuberculosis patients who were receiving treatment (standard directly observed therapy) through a nongovernmental organization. Results Familiarity with mobile technology and apps was widespread in this population, and overall willingness to consider a mobile app for video-based directly observed therapy was high. However, we identified potential challenges. First, patients very much valued their frequent in-person interactions with their health care provider, which may be reduced with the video-based directly observed therapy intervention. Second, there may be technical issues to address, including how to make the app suitable for illiterate participants. Conclusions While video-based directly observed therapy is a promising technology, even in country settings where mobile penetration is reportedly almost universal, it should be introduced with caution. However, the results were generally promising and yielded important insights that not only will be translated into the further adaptation of key features of video-based directly observed therapy for tuberculosis patients in Cambodia, but also can inform the future design and successful implementation of video-based directly observed therapy interventions in low- and middle-income settings more generally.

Stakeholders’ Perceptions of Benefits of and Barriers to Using Video-Observed Treatment for Monitoring Patients With Tuberculosis in Uganda: Exploratory Qualitative Study

“…The technology usability barrier is likely to affect mostly older patients and those without formal education. Similar findings have been reported in VDOT studies conducted in Vietnam, Cambodia, and South India [ 23 , 37 , 39 ]. In our experience with the VDOT pilot study, intensive training with clear instructions to patients helped them gain the required skills.…”

“…The perceived benefits of VDOT highlight aspects that can be enhanced to increase acceptability among users. The ease of monitoring, convenience, access to objective evidence of dosing, and facilitation of timely follow-up have also been reported in previous studies [ 23 , 25 , 37 , 39 ]. Health care providers and patients perceived VDOT as a cost- and time-saving approach in the long run compared with costs that are likely to be incurred with frequent travel when using in-person DOT.…”

“…The use of solar power banks for charging smartphones might be a short-term solution where electricity is unstable. The absolute costs of smartphones with internet data plans have also been documented as potential barriers in other studies [ 23 , 41 ]. The cost of smartphones on the global market is gradually decreasing, thereby boosting ownership, even in LMICs [ 44 ].…”

“…General lessons can be learned and applied across interventions and populations. For example, high acceptance in recent studies of VDOT was related to perceptions of convenience, ease of use, and perception of better privacy, whereas lower acceptance was mostly tied to technology skills, app glitches, and cellular connectivity challenges [ 23 , 24 , 36 ]. In India, a qualitative study evaluating differences in acceptability of 99DOTS, a low-cost, phone call–based strategy for reporting doses, found that high acceptance was related to improved patient-provider communication and the convenience of reduced clinic visits, among others [ 48 ].…”

Designing the Optimal Digital Health Intervention for Patients’ Use Before and After Elective Orthopedic Surgery: Qualitative Study

“…Participants valued the integration of video-based features in digital interventions, whether as a visual aid for rehabilitative exercises or to facilitate remote telemedicine consultations. Our findings support the growing popularity of video-based consultations reported in other areas of global health and social care [42][43][44], with participants reporting feelings of connectedness, empowerment, and reassurance through imageand video-based sharing [45][46][47]. The incorporation of video call features within digital health technology is gaining attention, particularly as a consequence of the global COVID-19 pandemic [43,48].…”