Perspectives on app-assisted self-testing using rapid diagnostic tests among community members, health care providers

Abstract

Self-testing using rapid diagnostic tests (RDTs), integrated with mobile phone–based apps, offers potential to improve health outcomes in low-resource settings, including sub-Saharan Africa. Despite its advantages, uptake remains limited because of concerns about accuracy, accessibility, and integration within existing health care systems. This study aimed to assess the acceptability of self-testing using RDTs for various health conditions, both independently and app-assisted, among community members, health care providers (HCPs), and community and public health leaders in Kenya, South Africa, and Zambia. From May 15 to August 24, 2023, we conducted an exploratory qualitative study across rural and urban areas in the 3 countries. We used key informant interviews with community leaders and public health leaders in the ministries or departments of health, in-depth interviews (IDIs) with HCPs, and IDIs and focus group discussions (FGDs) with community members. Using framework analysis, we categorized data guided by the Theoretical Framework of acceptability to assess affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy toward self-testing using RDTs, with and without assistance from an app, across countries and participant types. Results: The study involved 178 participants, including 24 key informants, 41 HCPs, and 113 community members who participated in 55 IDIs and 11 FGDs across the 3 countries. Self-testing, both standalone and app-assisted, was highly acceptable to community members, HCPs, and community and public health leaders in the 3 countries for its ability to empower individuals, enhance access to health care, and improve efficiencies in health care delivery. Self-testing was aligned with values of privacy, confidentiality, and autonomy and increased reach to under-resourced areas. Participants valued its potential to save time, reduce opportunity costs, and facilitate early diagnosis and treatment, while easing burdens on the health care systems. Participants perceived the benefits of self-testing to outweigh possible risks, including human error, false readings, and emotional distress from unexpected results, especially if linked by an app to real-time guidance and improved health care coordination. Apps were praised for modernity, convenience, and ability to streamline processes for users and health care systems. foreseeable challenges included resistance from less tech-savvy individuals, ethical concerns such as misuse of self-tests, technological barriers, data security, training needs, and insufficient digital and physical infrastructure for equitable implementation. Regular education, system support, integration, and community trust were identified as critical for success. Self-testing, both alone and app-assisted, was viewed as acceptable and relevant for increasing health care accessibility and efficiency in these low-resource settings. However, to optimize its benefits, efforts must address challenges related to test accuracy, infrastructure development, data privacy, and integration into existing health care systems. Policies should further emphasize education, support, user-friendly design, and minimal costs to ensure equitable access and effective implementation across diverse populations.