Video-Observed Therapy With a Notification System for Improving the Monitoring of Tuberculosis Treatment in Thailand: Usability Study

Abstract

Background In Thailand, the health care system has struggled to cope with COVID-19, resulting in directly observed therapy for tuberculosis being de-emphasized. A video-observed therapy (VOT) system, or more specifically, the Thai VOT (TH VOT) system, was developed to replace directly observed therapy. According to the pilot study, the system needed notifications to improve usability and user compliance. The updated version of the TH VOT system thus enabled LINE (Line Corporation) notifications. Objective This study aimed to reassess users’ compliance with and the usability of the updated TH VOT system. Methods This study was conducted in the Hat Yai and Mueang Songkhla districts in Songkhla Province, Southern Thailand, from September 18 to December 1, 2021. The system was used by not only patients with tuberculosis but also tuberculosis staff, who acted as observers in primary health care settings. Some of the observers used the simulated VOT system instead of the actual system due to the lack of participating patients in their jurisdiction. After 30 days of using the system, VOT session records were analyzed to determine the compliance of the patients and observers. The User Experience Questionnaire was administered to reassess the usability of the system and compare the ratings of the participants with the general benchmark scores of the User Experience Questionnaire. The results were summarized to reveal the degree of user compliance and usability in the following three groups: the patients, actual VOT observers, and simulated VOT observers. Results Of the 19 observers, 10 used the actual VOT system, and the remaining 9 used the simulated VOT system; there were also 10 patients with tuberculosis. The patients, actual VOT observers, and simulated VOT observers exhibited about 70%, 65%, and 50% compliance, respectively, in terms of following the standard operating procedures every day. The scores of all groups on all dimensions were well above the average scores. There was no significant difference in any of the dimensional scores among the three groups. Conclusions The updated version of the TH VOT system was deemed usable by both the patients and the health care staff. Compliance with the use of the system was high among the patients but moderate among the observers.

Tuberculosis Treatment Compliance Under Smartphone-Based Video-Observed Therapy Versus Community-Based Directly Observed Therapy: Protocol for a Cluster Randomized Controlled Trial

“…The server then notifies the observer to review the video. Data regarding patient and observer compliance will be assessed according to our previous study protocol [ 9 ]. The usability of the system was tested during November 2021.…”

“…The usability of the system was tested during November 2021. It was found to function well with no technical problems and was usable among both TB patients and observers [ 9 ].…”

“…We aim to observe each patient for 60 days during the intensive phase of their TB treatment. Daily compliance will be audited by one auditor who will supervise all observers in the study area according to a standard assessment protocol [ 9 ]. The study flow is summarized in Figure 1 .…”

“…To avoid a learning curve on the VOT side, the observers will be trained to demonstrate to the patient on how to correctly record and approve the recorded video according to the SOP [ 7 ]. They will be required to undergo real or simulated activities for 1 month before the trial [ 9 ].…”

“…Globally, A-VOT is more commonly used than S-VOT because it allows patients to record drug-administration sessions at their convenience; moreover, the video can be watched multiple times [ 8 ]. Thus, Thailand uses an A-VOT system to collect video records that can be audited [ 9 ]. Instead of a home visit in a community, an observer can flexibly use the A-VOT system to lower their travel costs and risk of SARS-CoV-2 infection.…”