The Technology Acceptance Model for Resource-Limited Settings (TAM-RLS): A Novel Framework for Mobile Health Interventions Targeted to Low-Literacy End-Users in Resource-Limited Settings

Abstract

Background Although mobile health (mHealth) technologies have shown promise in improving clinical care in resource-limited settings (RLS), they are infrequently brought to scale. One limitation to the success of many mHealth interventions is inattention to end-user acceptability, which is an important predictor of technology adoption. Methods We conducted in-depth interviews with 43 people living with HIV in rural Uganda who had participated in a clinical trial of a short messaging system (SMS)-based intervention designed to prompt return to clinic after an abnormal laboratory test. Interviews focused on established features of technology acceptance models, including perceived ease of use and perceived usefulness, and included open-ended questions to gain insight into unexplored issues related to the intervention’s acceptability. We used conventional (inductive) and direct content analysis to derive categories describing use behaviors and acceptability. Results Interviews guided development of a proposed conceptual framework, the technology acceptance model for resource-limited settings (TAM-RLS). This framework incorporates both classic technology acceptance model categories as well as novel factors affecting use in this setting. Participants described how SMS message language, phone characteristics, and experience with similar technologies contributed to the system’s ease of use. Perceived usefulness was shaped by the perception that the system led to augmented HIV care services and improved access to social support from family and colleagues. Emergent themes specifically related to mHealth acceptance among PLWH in Uganda included 1) the importance of confidentiality, disclosure, and stigma, and 2) the barriers and facilitators downstream from the intervention that impacted achievement of the system’s target outcome. Conclusion The TAM-RLS is a proposed model of mHealth technology acceptance based upon end-user experiences in rural Uganda. Although the proposed model requires validation, the TAM-RLS may serve as a useful tool to guide design and implementation of mHealth interventions.

Improving Sustainable Mobile Health Care Promotion: A Novel Hybrid MCDM Method

“…Perceived usefulness measures the performance of specific technology in prompting people to act, whereas perceived ease of use indicates the degree of difficulty in using specific technology. Scholars have subsequently verified the effectiveness of this model [59], and the influence of perceived usefulness and perceived ease of use on the adoption of mobile health care have been demonstrated in numerous studies [60][61][62]. Therefore, the technological dimension of this study involves usefulness and ease of use.…”

Developments in Privacy and Data Ownership in Mobile Health Technologies, 2016-2019

“…Still other authors noted this dichotomy within their reported results with some participants expressing significant privacy concerns and others stating it to not be an issue [146,147]. While some users expressed such concerns related to collection of highly sensitive-data, such as that related to behavioral health, reproductive health, or HIV status [135,[148][149][150][151], other users who provided such data still reported little unease related to their privacy [139,142,[152][153][154]].…”

CareConekta: study protocol for a randomized controlled trial of a mobile health intervention to improve engagement in postpartum HIV care in South Africa

“…Those in the intervention arm will receive additional questions related to the enhanced app features. The outcomes selected for analysis correspond with the Technology Acceptance Model for Resource-Limited Settings (TAM-RLS) framework, which was designed to draw attention to end-user acceptability as a predictor of mHealth technology adoption in lowresource settings [48].…”