title: A pilot study of an mHealth application for healthcare workers: poor uptake despite high reported acceptability at a rural South African community-based MDR-TB treatment program.
abstract: BACKGROUND
  As the South African province of KwaZulu-Natal addresses a growing multidrug-resistant tuberculosis (MDR-TB) epidemic by shifting care and treatment from trained specialty centers to community hospitals, delivering and monitoring MDR-TB therapy has presented new challenges. In particular, tracking and reporting adverse clinical events have been difficult for mobile healthcare workers (HCWs), trained health professionals who travel daily to patient homes to administer and monitor therapy. We designed and piloted a mobile phone application (Mobilize) for mobile HCWs that electronically standardized the recording and tracking of MDR-TB patients on low-cost, functional phones.
  
  
  OBJECTIVE
  We assess the acceptability and feasibility of using Mobilize to record and submit adverse events forms weekly during the intensive phase of MDR-TB therapy and evaluate mobile HCW perceptions throughout the pilot period.
  
  
  METHODS
  All five mobile HCWs at one site were trained and provided with phones. Utilizing a mixed-methods evaluation, mobile HCWs' usage patterns were tracked electronically for seven months and analyzed. Qualitative focus groups and questionnaires were designed to understand the impact of mobile phone technology on the work environment.
  
  
  RESULTS
  Mobile HCWs submitted nine of 33 (27%) expected adverse events forms, conflicting with qualitative results in which mobile HCWs stated that Mobilize improved adverse events communication, helped their daily workflow, and could be successfully expanded to other health interventions. When presented with the conflict between their expressed views and actual practice, mobile HCWs cited forgetfulness and believed patients should take more responsibility for their own care.
  
  
  CONCLUSIONS
  This pilot experience demonstrated poor uptake by HCWs despite positive responses to using mHealth. Though our results should be interpreted cautiously because of the small number of mobile HCWs and MDR-TB patients in this study, we recommend carefully exploring the motivations of HCWs and technologic enhancements prior to scaling new mHealth initiatives in resource poor settings.
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut, United States of America. Krisda.Chaiyachati@yale.edu
authors.forename: Krisda H
authors.initials: KH
authors.lastname: Chaiyachati
authors.forename: Marian
authors.initials: M
authors.lastname: Loveday
authors.forename: Stephen
authors.initials: S
authors.lastname: Lorenz
authors.forename: Neal
authors.initials: N
authors.lastname: Lesh
authors.forename: Lee-Megan
authors.initials: LM
authors.lastname: Larkan
authors.forename: Sandro
authors.initials: S
authors.lastname: Cinti
authors.forename: Gerald H
authors.initials: GH
authors.lastname: Friedland
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Haberer
mesh_terms: D000328:Adult; D040421:Cell Phone; D005260:Female; D058015:Health Communication; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D012424:Rural Population; D013019:South Africa; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*