Abstract:
The growth in the number of mobile phone subscribers globally has provided
healthcare service providers in both private and public sectors an opportunity to
leverage on technology and engage Persons Living with HIV (PLHIV) in mobile
phone communication using Short Message Service (SMS) sometimes without their
knowledge or consent. Telemedicine is use of mobile technology to promote health
outcomes. However, the use of telemedicine in Kenya appears not to have been fully
investigated and especially if communication to patients is being done ethically with
full acceptance of those who enroll onto SMS apps that send SMS to PLHIV.
Although guidelines exist on ethical standards, whether they are actually put in place
or not have also hitherto been undocumented in Kenya. This was therefore a gap in
research that this study intended to fill and document. The main aim of this study
was to establish the ethical considerations in using text message services to
communicate with persons living with HIV in Siaya County, Kenya. Use of Text
Message Service in Kenya to promote health outcomes among Persons Living with
HIV (PLHIV) is a relatively new phenomenon. The objectives of this study were: (1)
to establish the effect of informed consent in using text message services to
communicate with persons living with HIV in Siaya County, Kenya, (2) to determine
the effect of voluntary participation in using text message services to communicate
with persons living with HIV; (3) to investigate the effect of confidentiality in using
text message services to communicate with PLHIV; (4) to examine the effect of data
security in using text message services to communicate with PLHIV and lastly (5)
to determine the moderating effect of perceived usefulness of using text message
services to communicate with PLHIV. The population was PLHIV in Kenya, while
the target population was 21 health centres, which had registered PLHIV in Text for
Adherence (T4A) platform out of 101. Using stratified random sampling 374
respondents were selected from a population of 12,886. The study used a descriptive
research design. This was a mixed method research. Data was collected through a
field survey and one SMS system developer and supporter. The study used
Technology Readiness Theory, Diffusion of Innovations and Utilitarian Theory of
Ethics. One set of a questionnaire and an interview schedule were used to collect
data. Descriptive and inferential statistics were used to analyze data. Informed
consent was the only significant ethical consideration related to communication.
Linear Regression on 5 hypotheses tests were significant and therefore rejected the
null hypotheses (0.035, 0.038. 0.039,0016 and 0.014 respectively- all <0.05). The
study has established that using SMS to communication to PLHIV improves their
health status. Therefore, this study points to the need to make enrolment to SMS
apps mandatory. It also concluded that it was important for individuals enrolling into
those SMS apps to consent. The findings and recommendations may be used by the
SMS apps developers, the government and may as well have implications for policy
changes in using SMS in health promotion generally in Kenya and globally.
