‘The phone reminder is important, but will others get to know about my illness?’ Patient perceptions of an mHealth antiretroviral treatment support intervention in the HIVIND trial in South India

Abstract

ObjectivesThe recent explosion of mHealth applications in the area of HIV care has led to the development of mHealth interventions to support antiretroviral treatment adherence. Several of these interventions have been tested for effectiveness, but few studies have explored patient perspectives of such interventions. Exploring patient perspectives enhances the understanding of how an intervention works or why it does not. We therefore studied perceptions regarding an mHealth adherence intervention within the HIVIND trial in South India.MethodsThe study was conducted at three clinics in South India. The intervention comprised an automated interactive voice response (IVR) call and a pictorial short messaging service (SMS), each delivered weekly. Sixteen purposively selected participants from the intervention arm in the HIVIND trial were interviewed. All participants had completed at least 84 weeks since enrollment in the trial. Perceptions on the usefulness and perceived benefits and risks of receiving the intervention were sought. The interviews were transcribed and analysed using the framework approach to qualitative data analysis.ResultsDespite varying perceptions of the intervention, most participants found it useful. The intervention was perceived as a sign of ‘care’ from the clinic. The IVR call was preferred to the SMS reminder. Two-way communication was preferred to automated calls. Participants also perceived a risk of unintentional disclosure of their HIV status and stigma thereof via the intervention and took initiatives to mitigate this risk. Targeting reminders at those with poor adherence and those in need of social support was suggested.ConclusionsmHealth adherence interventions go beyond their intended role to provide a sense of care and support to the recipient. Although automated interventions are impersonal, they could be a solution for scale up. Interventions that engage both the recipient and the healthcare provider have greater potential for success. Personalising mHealth interventions could mitigate the risk of stigma and promote their uptake.Trial registration numberISRCTN79261738.

Mobile phone‐based interactive voice response as a tool for improving access to healthcare in remote areas in Ghana – an evaluation of user experiences

“…Evidence highlights that IVR has proven to be a reliable and inexpensive tool in mobile healthcare. For instance, IVR has been applied in low‐ and middle‐income countries for remote education of health personal, for example in the field of family planning , for diagnostic and treatment support , to enhance medical adherence , for the management and monitoring of psychiatric conditions and mental health as well as for education and behaviour change communication in the field of sexually transmitted infections and chronic diseases . The results of our study contribute essential empirical findings to the neglected area of mHealth user acceptance in sub‐Saharan Africa.…”

Review of patients perspective’s of m-health adoption factors in the developing world. Development of a framework

“…In many developing countries power was described as irregular with rural areas being most affected [53,70]. Keeping a mobile phone charged was problematic [33,36,43] and it was common to nd people paying to charge their phones at street side vendors [33,37]. Likewise, phone maintenance in the event of a fault was an equally important factor that might jeopardise adoption [50,53,76].…”

“…Information and communications technology use in low-income countries is lower among females [44,78,79] and a 'gatekeeper effect' was noted in several studies with women requiring permission from their parents, husband or partner to use a cellphone [25,30,42]. This was exacerbated by being ashamed to raise issues about women's diseases with their gatekeeper [42] or fear of punishment if they accessed a phone without permission [37]. Other cultural factors impacted cellphone use, with boys -unlike girlsbeing allowed to be inquisitive and seek out information about sexual matters [30], and restricted use being enforced through fear of "inappropriate" calling with the opposite sex [37].…”

“…This was exacerbated by being ashamed to raise issues about women's diseases with their gatekeeper [42] or fear of punishment if they accessed a phone without permission [37]. Other cultural factors impacted cellphone use, with boys -unlike girlsbeing allowed to be inquisitive and seek out information about sexual matters [30], and restricted use being enforced through fear of "inappropriate" calling with the opposite sex [37]. In Tanzania, men prevented their wives from owning mobile phones because they believed it facilitated sexual unfaithfulness [62].…”

mHealth: Vehicle for Health System Strengthening in Sri Lanka

“…Evidence from South India has shown the value of mHealth adherence interventions among HIV patients. 16 The health information management at ground level is entirely paper based with complicated registers, records and returns. Community health workers devote much of their valuable time for paper based work resulting concerns on quality, completeness and timeliness of the data.…”