Abstract
BackgroundDigital adherence technologies have been widely promoted as a means to improve tuberculosis medication adherence. However, uptake of these technologies has been suboptimal by both patients and health workers. Not surprisingly, studies have not demonstrated significant improvement in treatment outcomes.ObjectiveThis study aimed to optimize a well-known digital adherence technology, 99DOTS, for end user needs in Uganda. We describe the findings of the ideation phase of the human-centered design methodology to adapt 99DOTS according to a set of design principles identified in the previous inspiration phase.Methods99DOTS is a low-cost digital adherence technology wherein tuberculosis medication blister packs are encased within an envelope that reveals toll-free numbers that patients can call to report dosing. We identified 2 key areas for design and testing: (1) the envelope, including the form factor, content, and depiction of the order of pill taking; and (2) the patient call-in experience. We conducted 5 brainstorming sessions with all relevant stakeholders to generate a suite of potential prototype concepts. Senior investigators identified concepts to further develop based on feasibility and consistency with the predetermined design principles. Prototypes were revised with feedback from the entire team. The envelope and call-in experience prototypes were tested and iteratively revised through focus groups with health workers (n=52) and interviews with patients (n=7). We collected and analyzed qualitative feedback to inform each subsequent iteration.ResultsThe 5 brainstorming sessions produced 127 unique ideas that we clustered into 6 themes: rewards, customization, education, logistics, wording and imagery, and treatment countdown. We developed 16 envelope prototypes, 12 icons, and 28 audio messages for prototype testing. In the final design, we altered the pill packaging envelope by adding a front flap to conceal the pills and reduce potential stigma associated with tuberculosis. The flap was adorned with either a blank calendar or map of Uganda. The inside cover contained a personalized message from a local health worker including contact information, pictorial pill-taking instructions, and a choice of stickers to tailor education to the patient and phase of treatment. Pill-taking order was indicated with colors, chevron arrows, and small mobile phone icons. Last, the call-in experience when patients report dosing was changed to a rotating series of audio messages centered on the themes of prevention, encouragement, and reassurance that tuberculosis is curable.ConclusionsWe demonstrated the use of human-centered design as a promising tool to drive the adaptation of digital adherence technologies to better address the needs and motivations of end users. The next phase of research, known as the implementation phase in the human-centered design methodology, will investigate whether the adapted 99DOTS platform results in higher levels of engagement from patients and health workers, and ultimately improves tuberculosis treatment outcomes.
Highlights
BackgroundTuberculosis (TB) is the leading infectious killer globally, with an estimated 10 million people falling sick annually and nearly 1.5 million dying of the disease [1]
JMIR Form Res 2020 | vol 4 | iss. 12 | e19270 | p. 1 the pills and reduce potential stigma associated with tuberculosis
The inside cover contained a personalized message from a local health worker including contact information, pictorial pill-taking instructions, and a choice of stickers to tailor education to the patient and phase of treatment
Summary
BackgroundTuberculosis (TB) is the leading infectious killer globally, with an estimated 10 million people falling sick annually and nearly 1.5 million dying of the disease [1]. The range and breadth of DATs have expanded rapidly as companies continue to develop unique technological platforms and devices, including (1) short message service (SMS) text message reminders; (2) “dose-in-hand” event monitors, including electronic pill boxes [12,13] and sleeves that fit over medication blister packs [14]; (3) video-observed treatment to remotely record pill ingestion using smartphones; and (4) wireless-observed treatment, in which silicon sensors embedded in TB pills document ingestion [11,15] Each of these products connects with virtual platforms that allow providers to view real-time adherence data for their patients. Studies have not demonstrated significant improvement in treatment outcomes
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