JMIR Publications

ABSTRACT

Background:

Self-testing using rapid diagnostic tests (RDTs), integrated with mobile phone applications, offers potential for improving health outcomes in low-resource settings, including sub-Saharan Africa. Despite its advantages, uptake remains limited due to concerns about accuracy, accessibility, and integration within existing healthcare systems.

Objective:

This study aimed to assess the acceptability of self-testing using RDTs for various health conditions, both independently and app-assisted, among community members, healthcare providers, and public health leaders in Kenya, South Africa, and Zambia.

Methods:

From May 15 to August 24, 2023, we conducted an exploratory qualitative study across rural and urban areas in the three countries. We utilized key informant interviews with public health leaders in the ministries/departments of health and community, in-depth interviews (IDIs) with healthcare providers (HCPs), and IDIs and focus group discussions (FGDs) with community members. Using framework analysis, we categorized data guided by the Theoretical Framework of Acceptability to assess affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy towards self-testing using RDTs, with and without assistance from an App, across countries and participant type.

Results:

The study involved 178 participants, including 24 key informants, 41 HCPs, and 113 community members who participated in 55 IDIs and 11 FGDs across the three countries. Self-testing, both standalone and app-assisted, was highly acceptable to community members, HCPs, and public health leaders in the three countries for its ability to empower individuals, enhance access to healthcare, and improve efficiencies in healthcare access and delivery. Self-testing was aligned with values of privacy, confidentiality, and autonomy and increased reach to under-resourced areas. Participants valued its potential to save time, reduce opportunity costs, and facilitate early diagnosis and treatment, while easing burdens on the healthcare systems. Participants perceived the benefits of self-testing to outweigh possible risks including human error, false readings, and emotional distress from unexpected results, especially if linked by an app to real-time guidance and improved healthcare coordination. Apps were praised for modernity, convenience, and ability to streamline processes for both users and healthcare systems. Foreseeable challenges included resistance from less tech-savvy individuals, ethical concerns such as misuse of self-tests, technological barriers, data security, training needs, and insufficient digital and physical infrastructure for equitable implementation. Regular education, health system support and integration, and community trust were identified as critical for success.

Conclusions:

Self-testing, alone and app-assisted, was viewed as acceptable and relevant for increasing healthcare accessibility and efficiency in these low-resource settings. However, to optimize its benefits, efforts must address challenges related to test accuracy, infrastructure development, data privacy, and integration into existing healthcare systems. Policies should further emphasize education, support, user-friendly design, and minimal costs, to ensure equitable access and effective implementation across diverse populations. Clinical Trial: N/A