Patient baseline survey characteristics.

Background
Digital adherence technologies (DATs) offer promising solutions for monitoring and supporting adherence to complex treatment regimens, including tuberculosis (TB) treatment. However, better understanding is needed of how users engage with DATs and how engagement influences their effectiveness, particularly in real-world settings and among underserved populations.
Objective
Assess user engagement with the Companion app within the Tuberculosis Treatment Support Tools (TB-TST) intervention and explore the types of interactions that promote treatment adherence and address patients’ needs.
Methods
Secure message threads (N = 255) were analyzed as part of a four-site pragmatic clinical trial evaluating the effectiveness of the TB-TST intervention. Pragmatic thematic analysis was applied to chat logs between patients and treatment supporters (TSs) to identify key themes related to application utilization, treatment adherence, technical challenges, and communication patterns.
Results
Key themes that emerged included: experiences of living with TB; COVID-19 pandemic impact; symptom guidance, healthcare coordination, and treatment and intervention adherence and technical issues. Patients frequently sought advice on how to integrate TB treatment into their daily lives, manage side effects, and cope with emotional distress. The communication styles of TSs varied, with personalized and empathetic interactions leading to better patient acceptance. Technical issues and difficulties accessing phone credit and connectivity challenges were barriers to intervention adherence. Recommendations from this analysis emphasize the need for personalized communication, streamlined adherence reporting, timely symptom guidance, expanded mental health support, and improved healthcare coordination to strengthen the intervention.
Conclusion
This study highlights the importance of personalized, empathetic communication, and reliable technology to enhance the effectiveness of DATs. Future DAT solutions should prioritize technological reliability and the human elements of care. Interventions must be adaptable, user-friendly, and capable of addressing diverse patient needs, including offering emotional support and empowering individuals with limited digital literacy.

背景
数字依从性技术（Digital Adherence Technologies, DATs）为监测并支持复杂治疗方案（包括结核病（Tuberculosis, TB）治疗）的依从性提供了极具前景的解决方案。然而，目前仍需进一步明确用户如何与DATs进行交互，以及交互过程如何影响其应用效果，尤其是在真实临床场景与服务不足人群中。

研究目标
评估结核病治疗支持工具（Tuberculosis Treatment Support Tools, TB-TST）干预项目中，用户与陪护应用（Companion app）的交互情况，并探索可提升治疗依从性、满足患者需求的交互类型。

研究方法
本研究作为评估TB-TST干预效果的四中心实效临床试验的一部分，对255条加密聊天记录进行了分析。研究采用实用主义主题分析法，对患者与治疗支持者（Treatment Supporters, TSs）的聊天日志进行编码，以挖掘与应用使用、治疗依从性、技术挑战及沟通模式相关的核心主题。

研究结果
本研究挖掘出的核心主题包括：结核病患者的患病经历、新型冠状病毒肺炎（COVID-19）疫情的影响、症状指导、医疗协调、治疗与干预依从性以及技术问题。患者常咨询如何将结核病治疗融入日常生活、如何应对治疗不良反应及情绪困扰。治疗支持者的沟通风格存在差异，其中个性化且共情式的交互可提升患者对干预项目的接受度。技术故障、手机话费获取困难及网络连接问题均为干预依从性的阻碍因素。本分析提出的建议强调，需通过优化个性化沟通、简化依从性报告流程、提供及时的症状指导、拓展心理健康支持以及完善医疗协调，以强化该干预项目的效果。

结论
本研究凸显了个性化共情沟通与可靠技术对提升DATs应用效果的重要性。未来的DAT解决方案应优先保障技术可靠性，并重视照护中的人文关怀。干预项目需具备可适应性与易用性，且能够满足多样化的患者需求，包括提供情绪支持，以及赋能数字素养不足的人群。