Perceived mHealth barriers and benefits for home-based HIV testing and counseling and other care: Qualitative findings from health officials, community health workers, and persons living with HIV in South Africa

Abstract

mHealth has been proposed to address inefficiencies in the current South African healthcare system, including home-based HIV testing and counseling (HTC) programs. Yet wide-scale adoption of mHealth has not occurred. Even as infrastructure barriers decrease, a need to better understand perceived adoption barriers by stakeholders remains. We conducted focus group discussions (FGD) in South Africa in 2016 with 10 home-based HTC field staff, 12 community health workers (CHWs) and 10 persons living with HIV (PLH). Key informant (KI) interviews were conducted with five health officials. Perceptions about current home-based HTC practices, future mHealth systems and the use of biometrics for patient identification were discussed, recorded and transcribed for qualitative analysis. Themes were based on a conceptual model for perceived mHealth service quality. Stakeholders brought up a lack of communication in sharing patient health information between clinics, between clinics and CHWs, and between clinics and patients as major barriers to care that mHealth can address. CHWs need better patient information from clinics in terms of physical location and health status to plan visitation routes and address patient needs. CHWs perceive that communication barriers create distrust towards them by clinic staff. PLH want automated appointment and medication reminders. KI see mHealth as a way to improve health information transfer to government officials to better allocate healthcare resources. Stakeholders are also optimistic about the ability for biometrics to improve patient identification but disagreed as to which biometrics would be acceptable, especially in older patients. All stakeholders provided useful information towards the development of mHealth systems. Hospitals are adopting patient-centered approaches that solicit feedback from patients and incorporate them into decision-making processes. A similar approach is needed in the development of mHealth systems. Further, such systems are critical to the successful extension of the health system from health facilities into people’s homes.

Using mHealth to Deliver a Home-Based Testing and Counseling Program to Improve Linkage to Care and ART Adherence in Rural South Africa

“…Biometric fingerprint identification was acceptable to all study participants despite focus group caveats about the wide-scale acceptability of biometric identification systems in our population (van Heerden et al 2017). A limitation in drawing conclusions about acceptability is that our sample was relatively small.…”

“…As noted above, HTC biometric systems have been used for the simpler task of participant verification. Fingerprint identification issues that we encountered underscore the importance of building flexibility into the identification system as recommended by our focus groups (van Heerden et al 2017), especially for fieldwork in resource-poor settings. Luckily, we followed the advice of our focus groups as our study allowed identification through fingerprints, South African IDs, and cell phone numbers.…”

“…First , this study addresses challenges associated with identifying and keeping track of clients who live in informal housing, which often lacks physical addresses. As part of the study’s formative phase, focus groups were conducted with research field staff, hereafter referred to as field staff , which identified a need for mobile mapping tools that could be used to better coordinate and navigate visitation routes (van Heerden et al 2017). In response, our research team developed a mobile mapping application that can be used by field staff to plan and record home visits, which may improve efficiency and prevent duplication.…”

“…Focus group discussions with field staff introduced above raised concerns around acceptability. For example, discussants felt that older PLH may be less trusting of biometric systems and would be more hesitant to have their fingers scanned relative to younger PLH (van Heerden et al 2017). …”

Categorization of Factors Influencing Community Health Workers from a Socio-Technical Systems Perspective

“…Several authors [1,2,4] have suggested that CHWs as a workforce could be beneficial in the South African context. In addition, it is noted that CHWs are considered a dependable vehicle to provide quality contextual health services both in urban and rural settings within the South African context [5]. The South African government has introduced various initiatives to address the historic disparate healthcare system [1].…”