Acceptability and appropriateness of remote patient monitoring and self-administered pulse oximetry among COVID-19 patients in Honduras: a mixed methods study

Introduction

During the COVID-19 pandemic, the Honduras Secretariat of Health (SESAL) and partners conducted a randomized trial to assess the impact of remote patient monitoring with versus without self-administered pulse oximetry in high-risk populations in urban Honduras. Acceptability and appropriateness were examined to inform future adaptation of the intervention to other cultural and epidemiological contexts where remote monitoring and home-based technology use can reduce barriers to healthcare access.

Methods

This mixed methods study included trial participants, staff, and SESAL staff working in COVID-19 triage centers. Data sources include trial data, computer-aided self-interviews, and in-depth interviews. The trial was implemented between March 2022 and January 2023. Quantitative and qualitative integration occurred during study design, analysis, interpretation, and reporting, and a joint display enables analysis and interpretation.

Results

1,767 study participants completed a discharge questionnaire. Thirty-four healthcare providers completed a computer-aided self-interview, and 16 of these additionally participated in an in-depth qualitative interview.

Participants and providers demonstrated strong understanding of interventions and expressed positive affective attitudes, although SESAL staff attitudes were somewhat less positive. Trial participants were satisfied with the care they received and 94.9% reported a willingness to participate in the future. Some study and SESAL staff expressed concern over participant comprehension and self-administration of pulse oximeters, which led some to report reluctance to enroll patients in the future. In contrast, participants reported successfully using and understanding pulse oximeter readings. Healthcare providers were confident in their ability to implement the intervention in a clinical environment, but a few expressed concerns about its appropriateness, when asked to consider its implementation versus competing health priorities.

Conclusion

Overall, study participants and healthcare providers found remote monitoring and self-administered pulse oximetry acceptable ways to monitor for deterioration during the acute phase of a COVID-19 infection. Findings showed that an intervention can be appropriate from a participant perspective but that appropriateness may be less clearcut from a provider perspective due to competing priorities, despite the interventions being highly acceptable. The approach shows promise for adaptation in other settings experiencing health emergencies where technology penetration is high and healthcare availability does not align with demand, but appropriateness considerations should be explored prior to implementation.

What is already known about this topic

(Summarize the state of scientific knowledge on this subject before you did your study and why this study needed to be done)

Uptake of remote patient monitoring and telehealth in Latin America accelerated during the COVID-19 pandemic, however, most descriptions of these processes and their outcomes do not include acceptability and appropriateness assessments. The acceptability and appropriateness of self-administered pulse oximetry for COVID-19 patient monitoring in LMIC has been questioned given limited local resources, lack of quality-assured devices, and low reading and health literacy, which could lead to improper use or inability to interpret results.

What this study adds

(summarize what we know now because of this study that we did not know before)

The high levels of acceptability among both participants and healthcare providers demonstrate that remote monitoring, with or without self-administered pulse oximetry, can be acceptable in LMIC if interventions are adapted to the local context using feedback from target population, and education and ongoing support are provided.

How this study might affect research, practice, or policy

(summarize implications of the study)

Assessing the acceptability and appropriateness of these interventions facilitates future adaptation and application, promoting remote healthcare access for patients with mild illnesses in contexts where health systems are overburdened and telephone-based communication is prevalent, whether during health emergencies or to monitor patients with acute or chronic conditions at home.