Mobile Health Technology for Enhancing the COVID-19 Response in Africa: A Potential Game Changer?

Remote patient monitoring for COVID-19 patients: comparisons and framework for reporting

BACKGROUND

COVID-19 has challenged health services throughout the world in terms of hospital capacity and put staff and vulnerable populations at risk of infection. In the face of these challenges, many health providers have implemented remote patient monitoring (RPM) of COVID-19 patients in their own homes. However systematic reviews of the literature on these implementations have revealed wide variations in how RPM is implemented; along with variations in particulars of RPM reported on, making comparison and evaluation difficult. A review of reported items is warranted to develop a framework of key items to enhance reporting consistency. The aims of this review of remote monitoring for COVID-19 patients are twofold: (1) to facilitate comparison between RPM implementations by tabulating information and values under common domains. (2) to develop a reporting framework to enhance reporting consistency.

METHOD

A review of the literature for RPM for COVID-19 patients was conducted following PRISMA guidelines. The Medline database was searched for articles published between 2020 to February 2023 and studies reporting on items with sufficient detail to compare one with another were included. Relevant data was extracted and synthesized by the lead author. Quality appraisal was not conducted as the the articles considered were evaluated as informational reports of clinical implementations rather than as studies designed to answer a research question.

RESULTS

From 305 studies retrieved, 23 studies were included in the review: fourteen from the US, two from the UK and one each from Africa, Ireland, China, the Netherlands, Belgium, Australia and Italy. Sixteen generally reported items were identified, shown with the percentage of studies reporting in brackets: Reporting Period (82%), Rationale (100%), Patients (100%), Medical Team (91%) Provider / Infrastructure (91%), Communications Platform (100%), Patient Equipment (100%), Training (48%), Markers (96%), Frequency of prompt / Input (96%),Thresholds (82%), Discharge (61%), Enrolled (96%), Alerts/Escalated (78%), Patient acceptance (43%), and Patient Adherence (52%). Whilst some studies reported on patient training and acceptance, just one reported on staff training and none on staff acceptance.

CONCLUSIONS

Variations in reported items were found. Pending the establishment of a robust set of reporting guidelines, we propose a reporting framework consisting of eighteen reporting items under the following four domains: Context, Technology, Process and Metrics.

Impact of COVID-19 on Adolescent HIV Prevention and Treatment Services in the AHISA Network

We investigated perceived impacts of COVID-19 on the delivery of adolescent HIV treatment and prevention services in sub-Saharan Africa (SSA) by administering a survey to members of the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA) from February to April 2021. We organized COVID-19 impacts, as perceived by AHISA teams, under three themes: service interruptions, service adjustments, and perceived individual-level health impacts. AHISA teams commonly reported interruptions to prevention programs, diagnostic testing, and access to antiretroviral therapy (ART). Common service adjustments included decentralization of ART refills, expanded multi-month ART distribution, and digital technology use. Perceived individual-level impacts included social isolation, loss to follow-up, food insecurity, poverty, and increases in adolescent pregnancies and sexually transmitted infections. The need for collaboration among stakeholders were commonly cited as lessons learned by AHISA teams. Survey findings highlight the need for implementation science research to evaluate the effects of pandemic-related HIV service adaptations in SSA.

SMS-based digital health intervention in Rwanda's home-based care program for remote management of COVID-19 cases and contacts: A qualitative study of sustainability and scalability

Background

COVID-19 pandemic resulted in unprecedented global health challenges. Rwanda identified its first COVID-19 case on March 14, 2020 and subsequently introduced Home-Base Care (HBC) Program in August 2020 following community transmission of the virus and to alleviate logistical and financial strain on the healthcare system. Cases and contacts eligible for HBC were remotely supported by WelTel, an SMS-based mHealth intervention that was successfully implemented before for HIV epidemic in Rwanda. Enrolled cases and contacts were supported and monitored daily via their cell and/or mobile phones until they complete isolation/quarantine period. This study explored the rationale, perspectives, and experiences of key informants (KIs) during the implementation WelTel's mHealth tool for HBC in Rwanda.

Methods

Semi-structured one-on-one virtual interviews were conducted with KIs in this qualitative study. The KIs were classified into 2 major categories: (A) Senior staff including policymakers, directors, and senior managers; (B) Technical teams including case managers, and other staff supporting the implementation of WelTel (e.g., IT staff). Interviews were audio-recorded, transcribed, and analyzed in NVivo. Thematic analysis was conducted using a hybrid approach. A topic guide was developed using the Modified Consolidated Framework for Implementation Research and feedback from local stakeholders.

Results

7 KIs were interviewed. Five themes emerged following thematic analysis including: SMS-Based mHealth for Home-Isolation; Facilitators for Intervention Adoption; Barriers for Intervention Adoption; Infection prevention and control for Home-Isolation; and SMS-Based mHealth for Future Pandemics and Epidemics. Based on interviews, strong political commitment and advanced digital infrastructure were major facilitators for adopting WelTel for HBC. A major barrier to adopting WelTel was identified as technical-based issues. This was followed by local communication culture. All participates agreed on the significance of using WelTel to improve access and adherence to infection prevention and control measures, understand transmission dynamics, and inform public health decision-making regarding HBC.

Conclusions

Rwanda successfully adopted WelTel for supporting and monitoring COVID-19 cases and contacts in home-isolation and the implementation was instrumental to the country's effort to manage the pandemic. Experiences and perspectives of cases and contacts enrolled into WelTel must be explored to understand the appropriateness and effectiveness of the intervention.

How mHealth Can Contribute to Improving the Continuum of Care: A Scoping Review Approach to the Case of Human Immunodeficiency Virus in Sub-Saharan Africa

Objectives: To determine mHealth’s contribution to improving the continuum of care in sub-Saharan Africa towards achieving treatment targets for human immunodeficiency virus (HIV) endorsed by the 2016 Political Declaration on ending acquired immunodeficiency syndrome (AIDS).

Methods: PubMed, Medline, Embase, Web of Science Core Collection and Cochrane databases; three observatories and four repositories were searched to identify and select relevant articles, projects and guidelines published from 1 January 2017, to 30 April 2021. Records focusing on the use of mHealth related to HIV treatment cascade or healthcare provider/patient relationship were considered.

Results: From 574 identified records, 381 (206 scientific manuscripts and 175 mHealth projects) were considered. After screening, 36 articles (nine randomized control trials, five cohort studies, 19 qualitative studies, and three economic studies) and 23 projects were included.

Conclusion: The cross-cutting benefits of mHealth that enhance patient empowerment have been identified. Important challenges such as gaps between research and implementation, lack of transdisciplinary collaboration, and lack of economic evidence were identified to support future mHealth research and accelerate the achievement of treatment targets for HIV.

Improving health and social systems for all children in LMICs: structural innovations to deliver high-quality services

Despite health gains over the past 30 years, children and adolescents are not reaching their health potential in many low-income and middle-income countries (LMICs). In addition to health systems, social systems, such as schools, communities, families, and digital platforms, can be used to promote health. We did a targeted literature review of how well health and social systems are meeting the needs of children in LMICs using the framework of The Lancet Global Health Commission on high-quality health systems and we reviewed evidence for structural reforms in health and social sectors. We found that quality of services for children is substandard across both health and social systems. Health systems have deficits in care competence (eg, diagnosis and management), system competence (eg, timeliness, continuity, and referral), user experience (eg, respect and usability), service provision for common and serious conditions (eg, cancer, trauma, and mental health), and service offerings for adolescents. Education and social services for child health are limited by low funding and poor coordination with other sectors. Structural reforms are more likely to improve service quality substantially and at scale than are micro-level efforts. Promising approaches include governing for quality (eg, leadership, expert management, and learning systems), redesigning service delivery to maximise outcomes, and empowering families to better care for children and to demand quality care from health and social systems. Additional research is needed on health needs across the life course, health system performance for children and families, and large-scale evaluation of promising health and social programmes.

A multi-method analytical approach to predicting young adults' intention to invest in mHealth during the COVID-19 pandemic

Mobile-based health (mHealth) systems are proving to be a popular alternative to the traditional visits to healthcare providers. They can also be useful and effective in fighting the spread of infectious diseases, such as the COVID-19 pandemic. Even though young adults are the most prevalent mHealth user group, the relevant literature has overlooked their intention to invest in and use mHealth services. This study aims to investigate the predictors that influence young adults' intention to invest in mHealth (IINmH), particularly during the COVID-19 crisis, by designing a research methodology that incorporates both the health belief model (HBM) and the expectation-confirmation model (ECM). As an expansion of the integrated HBM-ECM model, this study proposes two additional predictors: mobile Internet speed and mobile Internet cost. A multi-method analytical approach, including partial least squares structural equation modelling (PLS-SEM), fuzzy-set qualitative comparative analysis (fsQCA), and machine learning (ML), was utilised together with a sample dataset of 558 respondents. The dataset-about young adults in Bangladesh with an experience of using mHealth-was obtained through a structured questionnaire to examine the complex causal relationships of the integrated model. The findings from PLS-SEM indicate that value-for-money, mobile Internet cost, health motivation, and confirmation of services all have a substantial impact on young adults' IINmH during the COVID-19 pandemic. At the same time, the fsQCA results indicate that a combination of predictors, instead of any individual predictor, had a significant impact on predicting IINmH. Among ML methods, the XGBoost classifier outperformed other classifiers in predicting the IINmH, which was then used to perform sensitivity analysis to determine the relevance of features. We expect this multi-method analytical approach to make a significant contribution to the mHealth domain as well as the broad information systems literature.

COVID-19 and beyond: Use of digital technology for pandemic response in Africa

The use of technology has been ubiquitous in efforts to combat the ongoing COVID-19 pandemic. In this perspective, we review technologies and new approaches developed at the start of the pandemic; efforts earmarked by a flexible approach to problem solving, local tech entrepreneurship, and swift adoption of technology. We performed a systematic review of the use of technology during the initial wave of the COVID-19 pandemic in most African countries. We identified relevant articles by searching for mentions of technology, COVID-19, and specific country names. Articles were included if they specifically mentioned the use of technology or novel innovations in the response to the COVID-19 pandemic in an African country. The article search was conducted in August and included articles published between January and August 2020. We retrieved articles from journals, trusted news, government, and organization websites on Google, Google Scholar and PubMed. A total of 80 articles were retained and categorized under Disease Prevention (19 articles), Disease Surveillance xxx Antipoaching Tech Tracks COVID-19 Flare-Ups in South Africa - Scientific American. (2020, May 12), and Clinical Supplies and Management xxx Ethiopia's digital health response to COVID-19 - JSI. (2020, May 14). African nations used technology and innovative techniques to manage patients, monitor cases and disseminate information to counter the spread of COVID-19. The nature and outcomes of these efforts sometimes differed in Africa compared to other regions of the world due to its unique challenges and opportunities.

Evaluation of the implementation process of the mobile health platform 'WelTel' in six sites in East Africa and Canada using the modified consolidated framework for implementation research (mCFIR)

BACKGROUND

Health systems globally are investing in integrating secure messaging platforms for virtual care in clinical practice. Implementation science is essential for adoption, scale-up, spread and maintenance of complex evidence-based solutions in clinics with evolving priorities. In response, the mobile Health (mHealth) Research Group modified the existing consolidated framework for implementation research (CFIR) to evaluate implementation of virtual health tools in clinical settings. WelTel® is an evidence-based digital health platform widely deployed in various geographical and health contexts. The objective is to identify the facilitators and barriers for implementing WelTel and to assess the application of the mCFIR tool in facilitating focus groups in different geographical and health settings.

METHODS

Both qualitative and descriptive quantitative approaches were employed. Six mCFIR sessions were held in three countries with 51 key stakeholders. The mCFIR tool consists of 5 Domains and 25 constructs and was distributed through Qualtrics Experience Management (XM). "Performance" and "Importance" scores were valued on a scale of 0 to 10 (Mean ± SD). Descriptive analysis was conducted using R computing software. NVivo 12 Pro software was used to analyze mCFIR responses and to generate themes from the participants' input.

RESULTS

We observed a parallel trend in the scores of Importance and Performance. Of the five Domains, Domain 4 (End-user Characteristics) and Domain 3 (Inner Settings) scored highest in Importance (8.9 ± 0.5 and 8.6 ± 0.6, respectively) and Performance (7.6 ± 0.7 and 7.2 ± 1.3, respectively) for all sites. Domain 2 (Outer Setting) scored the lowest in both Importance and Performance for all sites (7.6 ± 0.4 and 5.6 ± 1.8). The thematic analysis produced the following themes: for areas of strengths, the themes brought up were timely diagnosis and response, cost-effectiveness, and user-friendliness. As for areas for improvement, the themes discussed were training, phone accessibility, stakeholder engagement, and literacy.

CONCLUSION

The mCFIR tool allowed for a comprehensive understanding of the barriers and facilitators to the implementation, reach, and scale-up of digital health tools. Amongst several important findings, we observed the value of bringing the perspectives of both end users (HCPs and patients) to the table across Domains.

TRIAL REGISTRATION

NCT02603536 - November 11, 2015: WelTelOAKTREE: Text Messaging to Support Patients With HIV/AIDS in British Columbia (WelTelOAKTREE). NCT01549457 - March 9, 2012: TB mHealth Study-Use of Cell Phones to Improve Compliance in Patients on LTBI Treatment.

African National Public Health Institutes Responses to COVID-19: Innovations, Systems Changes, and Challenges

National public health institutes (NPHIs)-science-based governmental agencies typically part of, or closely aligned with, ministries of health-have played a critical part in many countries' responses to the COVID-19 pandemic. Through listening sessions with NPHI leadership, we captured the experiences of NPHIs in Africa. Our research was further supplemented by a review of the literature. To address issues related to COVID-19, NPHIs in Africa developed a variety of innovative approaches, such as working with the private sector to procure and manage vital supplies and address key information needs. Creative uses of technology, including virtual training and messaging from drones, contributed to sharing information and battling misinformation. Positive impacts of the pandemic response include increased laboratory capacity in many countries, modernized surveillance systems, and strengthened public-private partnerships; much of this enhanced capacity is expected to persist beyond the pandemic. However, several challenges remain, including the lack of staff trained in areas like bioinformatics (essential for genomic analysis) and the need for sustained relationships and data sharing between NPHIs and agencies not traditionally considered public health (eg, those related to border crossings), as well as the impact of the pandemic on prevention and control of non-COVID-19 conditions-both infectious and noncommunicable. Participants in the listening sessions also highlighted concerns about inequities in access to, and quality of, the public health services and clinical care with resultant disproportionate impact of the pandemic on certain populations. COVID-19 responses and challenges highlight the need for continued investment to strengthen NPHIs and public health infrastructure to address longstanding deficiencies and ensure preparedness for the next public health crisis.

Navigating the ethics of remote research data collection

COVID-19 has accelerated broad trends already in place toward remote research data collection and monitoring. This move implicates novel ethical and regulatory challenges which have not yet received due attention. Existing work is preliminary and does not seek to identify or grapple with the issues in a rigorous and sophisticated way. Here, we provide a framework for identifying and addressing challenges that we believe can help the research community realize the benefits of remote technologies while preserving ethical ideals and public trust. We organize issues into several distinct categories and provide points to consider in a table that can help facilitate ethical design and review of research studies using remote health instruments.

Developing and testing of an Early Warning mobileHealth screening and risk scoring application for preventing heath worker in-hospital transmission of Covid-19: A feasibility study

BACKGROUND

Hospitals have been identified as very high-risk places for Covid-19 transmission between health workers and non-covid-19 patients. Health care workers are the most at risk population to contract and transmit the infection especially to the already vulnerable non-Covid-19 patients. In Low-income countries, routine testing is not feasible due to the high cost of testing therefore presenting the risk of un-controlled transmission within the non Covid-19 treatment wards. This challenge necessitated the development of an affordable intermediary screening tool that would enable early identification of potentially infected health care workers and for early real time DNA-PCR testing prioritization. This would limit the contact time of potentially infected health care workers with the patients but also efficiently utilize the limited testing kits.

OBJECTIVE

To describe an early warning in-hospital risk analysis mobile application for screening Covid-19 and determine the feasibility and user friendliness among health care workers.

METHODS

Materials and methods: Using the WHO, Ministry of Health of Uganda guidelines on the case definition of Covid-19, we developed a screening questionnaire tool for risk assessment of Covid-19. Specific signs and symptoms were weighted based on how prevalent they were among Covid-19 patients and subsequently an algorithm developed for the various case scenarios of Covid-19. Risk sores were computed based on the symptoms and contact history and a daily risk category assigned based on the risk score. The questionnaire, flow charts and algorithms were then integrated into an android mobile application. Following the launch, 100 health care workers in the directorate of surgical services used the application for one month and the feasibility and consistence of use as well as user friendliness was evaluated. Health care workers would submit their daily risk scores and high-risk staff would be selected for testing and further intervention including treatment.

RESULTS

Results: The primary result of this research project was the development of a mobile based daily early warning system for in-hospital transmission of Covid-19. Overall, the EWAS mobile application was found to be feasible with over 69% of the health care workers having logged more than 67% of the required times. Over 93% of the participants reported the tool as easy to use.

CONCLUSIONS

Conclusion: The EWAS mobile application is a feasible and user-friendly daily risk scoring tool for preventing in-hospital transmission of Covid-19. Despite it, not being designed to be a diagnostic but a screening tool, there is a need to evaluate its sensitivity in predicting persons likely to have contracted Covid-19.

CLINICALTRIAL

A scope of mobile health solutions in COVID-19 pandemics

Background and aim

COVID-19 has become an international emergency. The use of digital solutions can be effective in managing, preventing, and overcoming the further spread of infectious disease outbreaks. Accordingly, the use of mobile-health (m-health) technologies has the potential to promote public health. This review aimed to study the application of m-health solutions for the management of the COVID-19 outbreak.

Methods

The search strategy was done in Medline (PubMed), Embase, IEEE, and Google Scholar by using related keywords to m-health and COVID-19 on July 6, 2020. English papers that used m-health technologies for the COVID-19 outbreak were included.

Results

Of the 2046 papers identified, 16 were included in this study. M-health had been used for various aims such as early detection, fast screening, patient monitoring, information sharing, education, and treatment in response to the COVID-19 outbreak. M-health solutions were classified into four use case categories: prevention, diagnosis, treatment, and protection. The mobile phone-based app and short text massaging were the most frequently used modalities, followed by wearables, portable screening devices, mobile-telehealth, and continuous telemetry monitor during the pandemics.

Conclusion

It appears that m-health technologies played a positive role during the COVID-19 outbreak. Given the extensive capabilities of m-health solutions, investigation and use of all potential applications of m-health should be considered for combating the current Epidemics and mitigating its negative impacts.

Things must not fall apart: the ripple effects of the COVID-19 pandemic on children in sub-Saharan Africa

Zero to 19 year-old children in sub-Saharan Africa bear a disproportionate proportion of the global burden of communicable and non-communicable diseases. Significant public health gains have been made in the fight against these diseases, however, factors such as underequipped health systems, disease outbreaks, conflict, and political instability continue to challenge prevention and control. The novel coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) introduces new challenges to public health programs in sub-Saharan Africa. Of particular concern are programs targeting major conditions among children, such as undernutrition, vaccine-preventable pneumonia and diarrhea, malaria, tuberculosis, HIV, and sickle cell disease. This article focuses on the impact of the COVID-19 pandemic on child health in sub-Saharan Africa. We review the epidemiology of major pediatric diseases and, referencing modeling projections, discuss the short- and long-term impact of the pandemic on major disease control. We deliberate on potential complications of SARS-CoV-2 co-infections/co-morbidities and identify critical social and ethical issues. Furthermore, we highlight the paucity of COVID-19 data and clinical trials in this region and the lack of child participants in ongoing studies. Lastly, approaches and interventions to mitigate the pandemic's impact on child health outcomes are discussed. IMPACT: Children in sub-Saharan Africa bear a disproportionate burden of communicable and non-communicable diseases globally; this remains true even as the COVID-19 pandemic persists. Amidst the fast-expanding COVID-19 literature, there is little comprehensive coverage of the pandemic's indirect impact on child health in sub-Saharan Africa. This article comprehensively outlines the threat that the pandemic poses to major disease prevention and control for children in sub-Saharan Africa. It discusses the potential impact of SARS-CoV-2 co-infections/co-morbidities, highlights research gaps, and advocates for data and action to mitigate the ripple effects of the pandemic on this population.

Clinical characteristics and mortality associated with COVID-19 in Jakarta, Indonesia: A hospital-based retrospective cohort study

Background

Data on COVID-19-related mortality and associated factors from low-resource settings are scarce. This study examined clinical characteristics and factors associated with in-hospital mortality of COVID-19 patients in Jakarta, Indonesia, from March 2 to July 31, 2020.

Methods

This retrospective cohort included all hospitalised patients with PCR-confirmed COVID-19 in 55 hospitals. We extracted demographic and clinical data, including hospital outcomes (discharge or death). We used logistic regression to examine factors associated with mortality.

Findings

Of 4265 patients with a definitive outcome by July 31, 3768 (88%) were discharged and 497 (12%) died. The median age was 46 years (IQR 32-57), 5% were children, and 31% had >1 comorbidity. Age-specific mortalities were 11% (7/61) for <5 years; 4% (1/23) for 5-9; 2% (3/133) for 10-19; 2% (8/638) for 20-29; 3% (26/755) for 30-39; 7% (61/819) for 40-49; 17% (155/941) for 50-59; 22% (132/611) for 60-69; and 34% (96/284) for ≥70. Risk of death was associated with higher age, male sex; pre-existing hypertension, diabetes, or chronic kidney disease; clinical diagnosis of pneumonia; multiple (>3) symptoms; immediate ICU admission, or intubation. Across all ages, risk of death was higher for patients with >1 comorbidity compared to those without; notably the risk was six-fold increased among patients <50 years (adjusted odds ratio 5.87, 95%CI 3.28-10.52; 27% vs 3% mortality).

Interpretation

Overall in-hospital mortality was lower than reported in high-income countries, probably due to younger age distribution and fewer comorbidities. Deaths occurred across all ages, with >10% mortality among children <5 years and adults >50 years.

Contact Tracing and the COVID-19 Response in Africa: Best Practices, Key Challenges, and Lessons Learned from Nigeria, Rwanda, South Africa, and Uganda

Most African countries have recorded relatively lower COVID-19 burdens than Western countries. This has been attributed to early and strong political commitment and robust implementation of public health measures, such as nationwide lockdowns, travel restrictions, face mask wearing, testing, contact tracing, and isolation, along with community education and engagement. Other factors include the younger population age strata and hypothesized but yet-to-be confirmed partially protective cross-immunity from parasitic diseases and/or other circulating coronaviruses. However, the true burden may also be underestimated due to operational and resource issues for COVID-19 case identification and reporting. In this perspective article, we discuss selected best practices and challenges with COVID-19 contact tracing in Nigeria, Rwanda, South Africa, and Uganda. Best practices from these country case studies include sustained, multi-platform public communications; leveraging of technology innovations; applied public health expertise; deployment of community health workers; and robust community engagement. Challenges include an overwhelming workload of contact tracing and case detection for healthcare workers, misinformation and stigma, and poorly sustained adherence to isolation and quarantine. Important lessons learned include the need for decentralization of contact tracing to the lowest geographic levels of surveillance, rigorous use of data and technology to improve decision-making, and sustainment of both community sensitization and political commitment. Further research is needed to understand the role and importance of contact tracing in controlling community transmission dynamics in African countries, including among children. Also, implementation science will be critically needed to evaluate innovative, accessible, and cost-effective digital solutions to accommodate the contact tracing workload.

Addressing Africa's pandemic puzzle: Perspectives on COVID-19 transmission and mortality in sub-Saharan Africa

To date, SARS-CoV-2 (the virus that causes COVID-19) has spread to almost every region of the world, infecting millions and resulting in the deaths of hundreds of thousands of people. Although it was predicted that Africa would suffer a massive loss of life due to this pandemic, the number of COVID-19 cases has been relatively low across the continent. Researchers have speculated that several factors may be responsible for this outcome in Africa, including the extensive experience that countries have with infectious diseases and the young median age of their populations. However, it is still important for African countries to adopt aggressive and bold approaches against COVID-19, in case the nature of the pandemic changes. This short review will summarize the status of the outbreak in Africa and propose possible reasons for current trends, as well as discuss interventions aimed at preventing a rapid increase in the number of COVID-19 cases in the future.

Telemedicine Across the Globe-Position Paper From the COVID-19 Pandemic Health System Resilience PROGRAM (REPROGRAM) International Consortium (Part 1)

Coronavirus disease 2019 (COVID-19) has accelerated the adoption of telemedicine globally. The current consortium critically examines the telemedicine frameworks, identifies gaps in its implementation and investigates the changes in telemedicine framework/s during COVID-19 across the globe. Streamlining of global public health preparedness framework that is interoperable and allow for collaboration and sharing of resources, in which telemedicine is an integral part of the public health response during outbreaks such as COVID-19, should be pursued. With adequate reinforcement, telemedicine has the potential to act as the "safety-net" of our public health response to an outbreak. Our focus on telemedicine must shift to the developing and under-developing nations, which carry a disproportionate burden of vulnerable communities who are at risk due to COVID-19.

Lived Experiences and Technological Literacy of Heart Failure Patients and Clinicians at a Cardiac Care Centre in Uganda

Background

Digital health could serve as a low-cost means of enabling better self-care in patients living with heart failure (HF) in resource-limited settings such as Uganda. However, digital health interventions previously deployed in such settings have been unsuccessful due to a lack of local patient and clinician engagement in the design process.

Objective

To engage Ugandan HF patients and clinicians regarding their experiences with HF management and technology, so as to inform the future design of a digital health intervention for HF patients in Uganda.

Methods

The study employed a convergent parallel mixed-methods design. Data collection was completed at the Uganda Heart Institute in Kampala, Uganda. Data were ascertained through a patient survey and semi-structured interviews completed with HF patients, caregivers, physicians, and nurses. A conventional content analysis approach was used to qualitatively examine interview transcripts.

Findings

Survey data were collected from 101 HF patients (62 female/39 male, aged 54.2 ± 17.5 years). Nearly half (48%) disagreed that they knew what to do in response to changes in their HF symptoms. Almost all patients (98%) had access to a mobile device. Many patients (63%) identified as comfortable in using mobile money - a local set of services that use Unstructured Supplementary Service Data (USSD). Interviews were completed with 19 HF patients, three caregivers, seven physicians, and three nurses. Qualitative analysis revealed four clusters of themes: overdependence of patients on the clinic, inconvenience associated with attending the clinic, inconsistent patient self-care behaviours at home, and technological abilities that favoured USSD-based services.

Conclusions

Ugandan HF patients possess unmet information needs that leave them ill-equipped to care for themselves. Future digital health interventions for this population should empower patients with HF-specific information and reassurance in their self-care abilities. Based on patient preferences, such systems should harness USSD technology with which most patients are already comfortable.