Patient-Centered Digital Interventions for Self-Care Ability Among People with Pulmonary Tuberculosis: A Systematic Review

Authors

DOI:

https://doi.org/10.60099/prijnr.2025.270467

Keywords:

Medication Adherence, Patient-Centered Care, Self-Care, Systematic Review, Telemedicine, Tuberculosis, Pulmonary

Abstract

Tuberculosis remains a significant global health issue, with adherence to treatment essential for positive outcomes. This systematic review evaluated the effectiveness of patient-centered digital interventions (e.g., mobile health apps, SMS reminders, video-observed therapy) in promoting self-care behaviors among people with pulmonary tuberculosis and identified implementation challenges. A review of studies published between 2019 and 2024 was conducted across six databases, guided by the PRISMA framework. Eligible studies included adults with pulmonary tuberculosis, utilized digital interventions and reported outcomes on treatment adherence, completion rates, patient knowledge, quality of life, cost-effectiveness, and satisfaction. The study designs consisted of randomized controlled trials, quasi-experimental studies, and observational studies with control groups. Data were synthesized narratively due to heterogeneity in interventions and outcomes.

Twenty studies from 12 countries, involving over 9,000 participants, were included. Digital interventions showed significant improvements in treatment adherence in six out of ten studies, but evidence for improved completion rates was less conclusive. Patients generally found digital interventions acceptable and satisfactory. Implementation challenges included technological barriers, connectivity issues, and privacy concerns. Facilitators included user-friendly design, contextual customization, and adequate support. Patient-centered digital interventions promise to enhance treatment adherence for pulmonary tuberculosis but have fewer clear effects on completion rates. Future research should address identified challenges and explore long-term impacts on patient knowledge and quality of life.

References

Chakaya J, Khan M, Ntoumi F, Aklillu E, Fatima R, Mwaba P, et al. Global Tuberculosis Report 2020 – Reflections on the Global TB burden, treatment and prevention efforts. Int J Infect Dis [Internet]. 2021;113–12. Available from: https://www.sciencedirect.com/science/article/pii/S1201971221001934

Dadu A, Yedilbayev A, Migliori GB, Ahmedov S, Falzon D, den Boon S, et al. PASS to End TB in Europe: Accelerated efforts on prevention and systematic screening to end tuberculosis in the WHO European Region by 2030. Int J Infect Dis [Internet]. 2024;141:106980. Available from: https://www.sciencedirect.com/science/article/pii/S1201971224000511

Alipanah N, Jarlsberg L, Miller C, Linh NN, Falzon D, Jaramillo E, et al. Adherence interventions and outcomes of tuberculosis treatment: A systematic review and meta-analysis of trials and observational studies. Murray M, editor. PLOS Med [Internet]. 2018 Jul 3;15(7). Available from: https://dx.plos.org/10.1371/journal.pmed.1002595

Nezenega ZS, Perimal-Lewis L, Maeder AJ. Factors Influencing Patient Adherence to Tuberculosis Treatment in Ethiopia: A Literature Review. Int J Environ Res Public Health [Internet]. 2020 Aug 4;17(15):5626. Available from: https://www.mdpi.com/1660-4601/17/15/5626

Harries AD, Kumar AMV, Satyanarayana S, Thekkur P, Lin Y, Dlodlo RA, et al. The Growing Importance of Tuberculosis Preventive Therapy and How Research and Innovation Can Enhance Its Implementation on the Ground. Trop Med Infect Dis [Internet]. 2020 Apr 16;5(2):61. Available from: https://www.mdpi.com/2414-6366/5/2/61

Jamshidnezhad A, Kabootarizadeh L, Hoseini S. The Effects of Smartphone Applications on Patients Self-care with Hypertension: A Systematic Review Study. Acta Inform Medica [Internet]. 2019;27(4):263. Available from: https://www.ejmanager.com/fulltextpdf.php?mno=302645056

Lee S, Rajaguru V, Baek JS, Shin J, Park Y. Digital Health Interventions to Enhance Tuberculosis Treatment Adherence: Scoping Review. JMIR mHealth uHealth [Internet]. 2023 Dec 4;11–e49741. Available from: https://mhealth.jmir.org/2023/1/e49741

Conradie F, Diacon AH, Ngubane N, Howell P, Everitt D, Crook AM, et al. Treatment of Highly Drug-Resistant Pulmonary Tuberculosis. N Engl J Med. 2020;382(10).

Suwankeeree W, Picheansathian W. Strategies to promote adherence to treatment by pulmonary tuberculosis patients: A systematic review. Int J Evid Based Healthc. 2014;12.

Pradipta IS, Houtsma D, van Boven JFM, Alffenaar JWC, Hak E. Interventions to improve medication adherence in tuberculosis patients: a systematic review of randomized controlled studies. npj Prim Care Respir Med. 2020;30.

Nglazi MD, Bekker LG, Wood R, Hussey GD, Wiysonge CS. Mobile phone text messaging for promoting adherence to anti-tuberculosis treatment: A systematic review. BMC Infect Dis. 2013;13(1).

Thomas BE, Kumar JV, Periyasamy M, Khandewale AS, Mercy JH, Raj EM, et al. Acceptability of the medication event reminder monitor for promoting adherence to multidrug-resistant tuberculosis therapy in two Indian cities: Qualitative study of patients and health care providers. J Med Internet Res [Internet]. 2021;23(6). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85107884281&doi=10.2196%2F23294

Andom AT, Gilbert HN, Ndayizigiye M, Mukherjee JS, Lively CT, Nthunya J, et al. Understanding barriers to tuberculosis diagnosis and treatment completion in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho. Fauk NK, editor. PLoS One [Internet]. 2023 May 11;18(5). Available from: https://dx.plos.org/10.1371/journal.pone.0285774

Ssemasaazi JA, Bongomin F, Akunzirwe R, Bayowa JR, Ssendikwanawa E, Adolphus C, et al. Private practitioners’ practices for tuberculosis management in a city largely served by the private health sector in Uganda. PLoS One. 2024;19(1 January).

Khachadourian V, Truzyan N, Harutyunyan A, Petrosyan V, Davtyan H, Davtyan K, et al. People-centred care versus clinic-based DOT for continuation phase TB treatment in Armenia: a cluster randomized trial. BMC Pulm Med [Internet]. 2020 Dec 25;20(1):105. Available from: https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-020-1141-y

Subbaraman R, de Mondesert L, Musiimenta A, Pai M, Mayer KH, Thomas BE, et al. Digital adherence technologies for the management of tuberculosis therapy: mapping the landscape and research priorities. BMJ Glob Heal [Internet]. 2018 Oct 11;3(5). Available from: https://gh.bmj.com/lookup/doi/10.1136/bmjgh-2018-001018

Yoeli E, Rathauser J, Bhanot SP, Kimenye MK, Mailu E, Masini E, et al. Digital health support in treatment for tuberculosis. N Engl J Med [Internet]. 2019 Sep 5;381(10):986–7. Available from: http://www.nejm.org/doi/10.1056/NEJMc1806550

Story A, Aldridge RW, Smith CM, Garber E, Hall J, Ferenando G, et al. Smartphone-enabled video-observed versus directly observed treatment for tuberculosis: a multicentre, analyst-blinded, randomised, controlled superiority trial. Lancet [Internet]. 2019;393(10177):1216–24. Available from: https://www.sciencedirect.com/science/article/pii/S0140673618329933

Ngwatu BK, Nsengiyumva NP, Oxlade O, Mappin-Kasirer B, Nguyen NL, Jaramillo E, et al. The impact of digital health technologies on tuberculosis treatment: A systematic review. Vol. 51, European Respiratory Journal. 2018.

Iribarren S, Milligan H, Goodwin K, Vidrio OAA, Chirico C, Telles H, et al. Mobile tuberculosis treatment support tools to increase treatment success in patients with tuberculosis in Argentina: protocol for a randomized controlled trial. JMIR Res Protoc [Internet]. 2021;10(6). Available from: https://www.scopus.com/inward/record.uri?eid=2-2.085108832118&doi=10.2196%2F28094&partnerID=40&md5=3cd7ecae1f9476c5eabbd6f3a5b9e176

Grudniewicz A, Gray CS, Boeckxstaens P, De Maeseneer J, Mold J. Operationalizing the chronic care model with goal-oriented care. Patient - Patient-Centered Outcomes Res [Internet]. 2023 Nov 29;16(6):569–78. Available from: https://link.springer.com/10.1007/s40271-023-00645-8

Garfein RS, Liu L, Cuevas-Mota J, Collins K, Muñoz F, Catanzaro DG, et al. Tuberculosis treatment monitoring by video directly observed therapy in 5 health districts, California, USA. Emerg Infect Dis [Internet]. 2018 Oct;24(10):1806–15. Available from: http://wwwnc.cdc.gov/eid/article/24/10/18-0459_article.htm

Wannheden C, Åberg-Wennerholm M, Dahlberg M, Revenäs Å, Tolf S, Eftimovska E, et al. Digital health technologies enabling partnerships in chronic care management: scoping review. J Med Internet Res [Internet]. 2022 Aug 1;24(8). Available from: https://www.jmir.org/2022/8/e38980

Baruch Baluku J, Katusabe S, Mutesi C, Bongomin F. Roles and challenges of nurses in tuberculosis care in Africa: A narrative review. Vol. 31, Journal of Clinical Tuberculosis and Other Mycobacterial Diseases. 2023.

Wynn M, Garwood-Cross L, Vasilica C, Griffiths M, Heaslip V, Phillips N. Digitizing nursing: A theoretical and holistic exploration to understand the adoption and use of digital technologies by nurses. J Adv Nurs [Internet]. 2023 Oct 2;79(10):3737–47. Available from: https://onlinelibrary.wiley.com/doi/10.1111/jan.15810

Keutzer L, Wicha SG, Simonsson US. Mobile health apps for improvement of tuberculosis treatment: descriptive review. JMIR mHealth uHealth [Internet]. 2020 Apr 21;8(4). Available from: http://mhealth.jmir.org/2020/4/e17246

Musiimenta A, Tumuhimbise W, Atukunda E, Mugaba A, Linnemayr S, Haberer J. Digital adherence technologies linked to mobile money incentives for medication adherence among people living with tuberculosis: mixed methods feasibility and acceptability study. JMIR Hum Factors [Internet]. 2024 May 31;11. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85196172120&doi=10.2196%2F47996&partnerID=40&md5=199cc216314af2078cfdec1649dc3fd7

Musiimenta A, Tumuhimbise W, Mugaba AT, Muzoora C, Armstrong-Hough M, Bangsberg D, et al. Digital monitoring technologies could enhance tuberculosis medication adherence in Uganda: mixed methods study. J Clin Tuberc Other Mycobact Dis [Internet]. 2019;17. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85072216600&doi=10.1016%2Fj.jctube.2019.100119&partnerID=40&md5=ee80c28912ed8e7b643fa8468042d

Thompson RR, Kityamuwesi A, Kuan A, Oyuku D, Tucker A, Ferguson O, et al. Cost and cost-effectiveness of a digital adherence technology for tuberculosis treatment support in Uganda. Value Heal [Internet]. 2022;25(6):924–30. Available from: https://www.sciencedirect.com/science/article/pii/S1098301521032307

Patel D, Berger CA, Kityamuwesi A, Ggita J, Tinka LK, Turimumahoro P, et al. Iterative adaptation of a tuberculosis digital medication adherence technology to meet user needs: Qualitative study of patients and health care providers using human-centered design methods. JMIR Form Res [Internet]. 2020;4(12). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85098545891&doi=10.2196%2F19270&partnerID=40&md5=c0521eb061fb5e63e0fbe2ebaae23cdc

Louwagie G, Kanaan M, Morojele NK, Zyl A Van, Moriarty AS, Li J, et al. Effect of a brief motivational interview and text message intervention targeting tobacco smoking, alcohol use and medication adherence to improve tuberculosis treatment outcomes in adult patients with tuberculosis: A multicentre, randomised controlled trial. BMJ Open [Internet]. 2022;12(2). Available from: https://www.proquest.com/scholarly-journals/effect-brief-motivational-interview-text-message/docview/2628421639/se-2?accountid=31533

Manyazewal T, Woldeamanuel Y, Holland DP, Fekadu A, Marconi VC. Effectiveness of a digital medication event reminder and monitor device for patients with tuberculosis (SELFTB): A multicenter randomized controlled trial. BMC Med. 2022 Sep;20(1):310.

Liu X, Thompson J, Dong H, Sweeney S, Li X, Yuan Y, et al. Digital adherence technologies to improve tuberculosis treatment outcomes in China: a cluster-randomised superiority trial. Lancet Glob Heal [Internet]. 2023;11(5)–703. Available from: https://www.sciencedirect.com/science/article/pii/S2214109X23000682

Guo XJ, Yang YR, Takiff HE, Zhu MM, Ma JP, Zhong T, et al. A comprehensive app that improves tuberculosis treatment management through video-observed therapy: Usability study. JMIR Mhealth Uhealth. 2020;8(7).

Kumwichar P, Prappre T, Chongsuvivatwong V. Tuberculosis treatment compliance under smartphone-based video-observed therapy versus community-based directly observed therapy: Cluster randomized controlled trial. JMIR Mhealth Uhealth [Internet]. 2024 Jun 3;12(6). Available from: https://mhealth.jmir.org/2024/1/e53411

Iribarren SJ, Milligan H, Chirico C, Goodwin K, Schnall R, Telles H, et al. Patient-centered mobile tuberculosis treatment support tools (TB-TSTs) to improve treatment adherence: A pilot randomized controlled trial exploring feasibility, acceptability and refinement needs. Lancet Reg Heal - Am [Internet]. 2022;13. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85131713482&doi=10.1016%2Fj.lana.2022.100291&partnerID=40&md5=09109ac5c6c03dda440c521a8b134abb

Thomas BE, Kumar J V, Chiranjeevi M, Shah D, Khandewale A, Thiruvengadam K, et al. Evaluation of the accuracy of 99DOTS, a novel cellphone-based strategy for monitoring adherence to tuberculosis medications: Comparison of digital adherence data with urine isoniazid testing. Clin Infect Dis [Internet]. 2020;71(9)–6. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85093496672&doi=10.1093%2Fcid%2Fciaa333&partnerID=40&md5=a40c71ebe999a2f4338f4b5578c4c795

Chen AZ, Kumar R, Baria RK, Shridhar PK, Subbaraman R, Thies W. Impact of the 99DOTS digital adherence technology on tuberculosis treatment outcomes in North India: A pre-post study. BMC Infect Dis [Internet]. 2023;23(1). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85166047199&doi=10.1186%2Fs12879-023-08418-2&partnerID=40&md5=753382df2441eafdce8accfa4eb67369

Santra S, Garg S, Basu S, Sharma N, Singh MM, Khanna A. The effect of a mhealth intervention on anti-tuberculosis medication adherence in Delhi, India: A quasi-experimental study. Indian J Public Health [Internet]. 2021;65(1):34–8. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85103433780&doi=10.4103%2Fijph.IJPH_879_20&partnerID=40&md5=13cbc37f3499c567ae1ac912486d6e71

Holzman SB, Atre S, Sahasrabudhe T, Ambike S, Jagtap D, Sayyad Y, et al. Use of smartphone-based video directly observed therapy (vDOT) in tuberculosis care: Single-arm, prospective feasibility study. JMIR Form Res [Internet]. 2019;3(3). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85084186572&doi=10.2196%2F13411&partnerID=40&md5=4b3a0e81a299ff0bfc57bb2d8873be30

Wei X, Hicks JP, Pasang P, Zhang Z, Haldane V, Liu X, et al. Protocol for a randomised controlled trial to evaluate the effectiveness of improving tuberculosis patients’ treatment adherence via electronic monitors and an app versus usual care in Tibet. Trials [Internet]. 2019 Dec 16;20(1):273. Available from: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-019-3364-x

Park S, Moon N, Oh B, Park M, Kang K, Sentissi I, et al. Improving Treatment Adherence with Integrated Patient Management for TB Patients in Morocco. Int J Environ Res Public Health [Internet]. 2021;18(19):9991. Available from: https://www.proquest.com/scholarly-journals/improving-treatment-adherence-with-integrated/docview/2580972135/se-2?accountid=31533

Burzynski J, Mangan JM, Lam CK, Macaraig M, Salerno MM, deCastro BR, et al. In-Person vs Electronic Directly Observed Therapy for Tuberculosis Treatment Adherence. JAMA Netw Open [Internet]. 2022 Jan 20;5(1). Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2788246

Do D, Garfein RS, Jazmine CM, Collins K, Liu L. Change in patient comfort using mobile phones following the use of an app to monitor tuberculosis treatment adherence: Longitudinal study. JMIR mHealth uHealth [Internet]. 2019;7(2). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85064499437&doi=10.2196%2F11638&partnerID=40&md5=3e5cedb08030535eb016915f87efe5c3

Lam CK, Fluegge K, Macaraig M, Burzynski J. Cost savings associated with video directly observed therapy for treatment of tuberculosis. Int J Tuberc Lung Dis [Internet]. 2019;23(11):1149–54. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85074956414&doi=10.5588%2Fijtld.18.0625&partnerID=40&md5=ff50d485f6988ab08a6e30c0a573b8f5

Guo X, Yang Y, Takiff HE, Zhu M, Ma J, Zhong T, et al. A Comprehensive App That Improves Tuberculosis Treatment Management Through Video-Observed Therapy: Usability Study. JMIR mHealth uHealth. 2020 Jul;8(7).

Thomas BE, Vignesh Kumar J, Onongaya C, Bhatt SN, Galivanche A, Periyasamy M, et al. Explaining differences in the acceptability of 99DOTS, a cell phone-based strategy for monitoring adherence to tuberculosis medications: Qualitative study of patients and health care providers. JMIR mHealth uHealth [Internet]. 2020;8(7). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85088908014&doi=10.2196%2F16634&partnerID=40&md5=c1e54780f691bae82b50243905de24e7

Musiimenta A, Tumuhimbise W, Atukunda E, Mugaba A, Linnemayr S, Haberer J. Digital Adherence Technologies Linked to Mobile Money Incentives for Medication Adherence Among People Living With Tuberculosis: Mixed Methods Feasibility and Acceptability Study. JMIR Hum Factors [Internet]. 2024;11. Available from: https://www.proquest.com/scholarly-journals/digital-adherence-technologies-linked-mobile/docview/3066835608/se-2?accountid=31533

Liu T, Zhan Y, Chen S, Zhang W, Jia J. Cost-effectiveness analysis of digital therapeutics for home-based cardiac rehabilitation for patients with chronic heart failure: model development and data analysis. Cost Eff Resour Alloc [Internet]. 2023;21:1–16. Available from: https://www.proquest.com/scholarly-journals/cost-effectiveness-analysis-digital-therapeutics/docview/2890074825/se-2?accountid=31533

Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: Translating evidence into action. Health Aff. 2001;20(6).

Kawonga M, Blaauw D, Fonn S. The influence of health system organizational structure and culture on integration of health services: The example of HIV service monitoring in South Africa. Health Policy Plan. 2016;31(9).

Geiger K, Bergman A, Farley JE. Evaluating Integrated Care for People Living with HIV and Multidrug-Resistant Tuberculosis in South Africa: A Case-Based Approach Using the Chronic Care Model. J Assoc Nurses AIDS Care. 2021;32(6).

Rabinovich L, Molton JS, Ooi WT, Paton NI, Batra S, Yoong J. Perceptions and Acceptability of Digital Interventions Among Tuberculosis Patients in Cambodia: Qualitative Study of Video-Based Directly Observed Therapy. J Med Internet Res [Internet]. 2020 Jul;22(7). Available from: https://www.proquest.com/scholarly-journals/perceptions-acceptability-digital-interventions/docview/2601575537/se-2?accountid=31533

Stop TB Partnership. The Potential Impact of the Covid-19 Response on Tuberculosis in High-Burden Countries: a Modelling Analysis. Dev by Stop TB Partnersh Collab with Imp Coll Avenir Heal Johns Hopkins Univ USAID. 2020;

Falzon D, Timimi H, Kurosinski P, Migliori GB, Van Gemert W, Denkinger C, et al. Digital health for the end TB strategy: Developing priority products and making them work. Eur Respir J. 2016;48(1).

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2024-12-13

How to Cite

1.
Husna AR, Nursalam N, Hidayat AAA, Makhfudli M. Patient-Centered Digital Interventions for Self-Care Ability Among People with Pulmonary Tuberculosis: A Systematic Review. PRIJNR [Internet]. 2024 Dec. 13 [cited 2024 Dec. 19];29(1):24-43. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/270467