Most appropriate information communication technology for health education in HIV management in rural communities : a systematic review

Abstract

The World Health Organization (WHO) coined the concept of eHealth in 1999. Ever since, information communication technology (ICT) has been explored as a possible means to assist health systems, to improve health education and to increase research. Now, almost two decades later, various types of ICTs have been explored as possible means to increase the health outcomes of overburdened health systems, especially in resource-limited contexts. One such context is the delivery of comprehensive healthcare amidst the Human Immuno-deficiency virus (HIV) epidemic in South Africa. As all South Africans can now receive antiretroviral therapy (ART) irrespective of their viral load, the traditional primary healthcare context has to adapt to incorporate additional complex health interventions. Yet, HIV management - implying prevention, diagnosis, disclosure and ART - goes hand-in-hand with health education. The argument is that an informed patient is an actively participating patient. It is therefore essential to increase patients' active buy-in into their own care. Due to the overburdened health system in South Africa and the limited time that health professionals have with patients, ICT's can be seen as additional mechanisms to extent health education beyond the borders of the clinic. The aim of this research was to identify the most appropriate ICT for health education as part of HIV management in rural communities. Appropriateness was measured by looking at the concepts of ease-of-use and usefulness from the technology acceptance model (TAM) and the 5C's, namely the context, content, capacity, connectivity and community of the eHealth model for developing countries. A rigorous, eight steps, systematic review was conducted by the researcher, following a search strategy based on PICOT. From inclusion and exclusion criteria and the screening of articles' quality and bias a final data set of seven (n=7) articles were isolated for analysis. Rigour was strengthened by having a co-reviewer for inter-rated reliability and a third reviewer was consulted in the event of an arbitrary decision. Two (n=2) articles were excluded as these articles were not available in English. Only primary sources were used. The results indicated that ease-of-use and usefulness were equally noteworthy in the selection of ICTs. Context is the most substantial component to consider as part of the appropriateness of ICT in rural communities. First, understand the context, then the community, capacity and connectivity - only thereafter is the focus on content. mHealth (mobile devices, text messaging, SMS) presents the most appropriate types of ICT for HIV management in rural communities. Yet, mHealth as a vector for health education needs further exploration. Appropriateness of ICT goes hand-in-hand with a realist adaptation to the rural context and to remain resilient to typical rural challenges. Recommendations were formulated based on the results and a policy brief was compiled by the researcher aimed for governmental and non-governmental stakeholders