Introduction: Tuberculosis (TB) is a potentially life threatening disease with the majority of the cases occurring in developing countries including India. Treatment is widely available through the WHO recommended Directly Observed Short Course treatment Strategy (DOTS). In countries like India, TB treatment monitoring is an uphill task because of the large number of cases and due to the shortage of healthcare workforce in the country.
With the meteoric rise in the usage of mobile phones in India, even amongst the rural population, outreach to patients and access to information has never been easier. Mobile phones can be of great value for remote monitoring of patients, especially in areas with shortage of healthcare workers. We performed a mobile health study to monitor TB drug treatment via short text messages (SMS) and we report the reasons for refusal to participate in a m-Health service in our setting.
Methods: Consecutive TB patients seeking care and support from DOTS centres were approached to participate in the mobile health (m-Health) study to improve drug adherence. After an informed consent a semi structured questionnaire was administered. Details on demographics, information on mobile phone usage, ability to read and write text messages, the reasons for refusal were collected. Proportions (including percentage) were calculated.
Results: We screened 157 individuals and 34% (n=53) refused to participate in the study. Among those who refused, 81% (n=43) were males, 61% (n=32) were in the age group of 18-45 years, 45% (n=25) had no formal education, 96% (n=51) of individuals had a monthly income of 5000 rupees and 77% (n=41) patients resided in an urban area. The main reason for refusal to participate in the m-Health study included not owning a mobile phone (62%, n=33) with a significant proportion among illiterates (84%, n=21, p=0.002). Out of 38% (n=20) subjects who owned a mobile phone, 80% (n=16) were unable to use the SMS facility in their mobile phones.
Conclusion: Mobile phones have not reached the neediest in the society, especially among those who cannot read and write. Evaluation (field testing) of m-Health system is a pre requisite before large scale deployment of such services.