Ethical Considerations in Using Text Message Services to Communicate with Persons Living with HIV in Siaya County, Kenya

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.