JMIR Publications

ABSTRACT

Background:

Multidrug-resistant TB (MDR TB) patients face challenges adhering to medications, given that treatment is prolonged and has a high rate of adverse effects. The Medication Event Reminder Monitor (MERM) is a digital pillbox that provides daily pill-taking reminders and facilitates remote monitoring of medication adherence.

Objective:

We assessed the MERM’s acceptability to patients and healthcare providers (HCPs) during pilot implementation in India’s public sector MDR TB program.

Methods:

From October 2017 to September 2018, we conducted qualitative interviews with patients taking MDR TB therapy, who were being monitored with the MERM, and HCPs in the government program in Chennai and Mumbai. Interviews transcripts were independently coded by two researchers and analyzed to identify emergent themes. We organized findings using the unified theory of acceptance and use of technology (UTAUT), which outlines four constructs that predict technology acceptance: performance expectancy, effort expectancy, social influences, and facilitating conditions.

Results:

We interviewed 65 MDR TB patients and 10 HCPs. In patient interviews, greater acceptance of the MERM was related to perceptions that the audible and visual reminders improved medication adherence and that remote monitoring reduced the frequency of clinic visits (performance expectancy); that the device’s organization and labeling made it easier to take medications correctly (effort expectancy); that the device facilitated positive family involvement in the patient’s care (social influences); and that remote monitoring made patients feel more “cared for” by the health system (facilitating conditions). Lower patient acceptance was related to problems with the durability of the MERM’s cardboard construction and difficulties with portability and storage due to its large size (effort expectancy); concerns regarding stigma and disclosure of patients’ MDR TB diagnoses (social influences); and incorrect understanding of the MERM due to suboptimal counseling (facilitating conditions). In their interviews, HCPs reported that MERM implementation resulted in reduced in-person interactions with patients, allowing HCPs to dedicate more time to other tasks, which improved job satisfaction.

Conclusions:

Several features of the MERM support its acceptability among MDR TB patients and HCPs, and some barriers to patient use could be addressed with improved design of the device. However, some barriers to patient use—such as disease-related stigma—are more difficult to modify and may limit its use by some MDR TB patients. Further research is needed to assess the MERM’s accuracy for measuring adherence, its effectiveness for improving treatment outcomes, and patients’ sustained use of the device in larger-scale implementation.