Acceptability of Telemedicine for Early Surgical Site Infection Diagnosis after Cesarean Section

Abstract

Introduction: While telemedicine is a plausible tool for scaling up access to healthcare, such innovations must be feasible and acceptable for real-world application. This qualitative study describes the acceptability of a telemedicine intervention which used photos of surgical incisions taken by community health workers (CHWs) to detect surgical site infections (SSIs) among women after cesarean section in rural Rwanda. Methods: Twenty-five semi-structured interviews (13 patients, 12 CHWs) were conducted in the local dialect (Kinyarwanda) among women who participated in the telemedicine intervention. The interviews were transcribed verbatim and translated into English, and parallel inductive coding processes were done to create English and Kinyarwanda codebooks. Results from the 2 methodologies were merged to create a master codebook for the final coding process. Results: The overwhelming majority of participants reported that this photo-based telemedicine was acceptable, with only 1 patient concerned about the reliability of photos to detect SSIs. Faster healing, improved access to home-based postoperative care, and saving out-of-pocket expenditures were reported perceived advantages of the intervention. Trust in CHWs was reported by all as essential to the acceptance of this intervention. All but 1 of the CHWs believed that it was acceptable to implement this intervention during the COVID-19 period. Conclusion: Photo-based telemedicine procedures were feasible and acceptable by the majority of patients and CHWs, even during the COVID-19 pandemic. Trust in CHWs was described as a key factor in patients' acceptance of this program. Given this, local CHWs should be involved early in the development and implementation of such interventions.