Examining the challenges of capitalising on mHealth’s potential to deliver locally aligned person-centred MDR-TB care in Vietnam: A qualitative study

Abstract

Background: Vietnam's booming digital telecommunications sector offers opportunities to deliver mHealth interventions to support the control and reduction of the country's high MDR-TB burden. This qualitative study is an iterative evaluation to support the stepwise/incremental design and implementation process of mHealth technologies, a smartphone app.   Design/Methods: Using qualitative enquiry, we examine the design and implementation gaps of the initial iteration of a smartphone app, introduced within MDR routine care in Vietnam, to improve early adverse event (AE) identification and management. Semi-structured in-depth interviews were conducted with 37 participants, including MDR-TB patients and healthcare workers (HCWs) enrolled in a clinical trial of a mHealth intervention.   Results: We found that the app acquired social meaning that built patients' confidence to actively engage with providers, and drove initial uptake. This ignited more equitable patient-HCW communication. However, this tended to migrate outside of the app to other forms, including pre-existing modes, of communication. We demonstrate how the social value of the novel mHealth app, as interpreted by patient-users, may moderate its uptake and acceptability, yet its sustained usage will be disrupted by perceived limited functional value. We developed a framework to explain why and how users engage with m-health interventions over time, inform adjustments in its design and support the digital and systemic infrastructure necessary to meet the needs of the diverse groups of stakeholders within a local health system.   Conclusions: Iterative approaches in developing and evaluating mHealth technologies should be adopted to attend to the social influences on mHealth technologies, which illuminates why some seemingly 'acceptable' technologies may struggle to sustain engagement and become integrated into local context.