Acceptability of telemedicine for early surgical site infection diagnosis after cesarean delivery in rural Rwanda: a qualitative study.

Abstract

Background: Telemedicine interventions, while promising for enhancing healthcare access, require an evaluation of feasibility and acceptability to inform field implementation. This qualitative study explored the acceptability of a telemedicine intervention in which surgical incision photos taken by community health workers (CHWs) were sent to hospital-based general practitioners to diagnose surgical site infections (SSIs) following cesarean section in rural Rwanda. As the study timeline coincided with the beginning of the COVID-19 pandemic we additionally asked about their perceptions of telemedicine in this context .

Methods: We conducted qualitative, semi-structured in-depth interviews in Kinyarwanda among 26 individuals (14 women and 12 CHWs) who participated in the telemedicine intervention. The interviews were transcribed verbatim and translated into English. Thematic analysis was applied and parallel inductive coding was used to develop English and Kinyarwanda codebooks. These were consolidated into a master codebook for final coding.

Results: All women and CHWs found the photo-based telemedicine program acceptable, though some concerns were raised. One woman voiced concerns about the reliability of photos in detecting SSIs compared to in-person visits. Women and CHWs reported perceived faster healing associated with the intervention, enhanced access to postoperative care from home, and cost savings as notable benefits of the telemedicine program. Trust in CHWs emerged as a critical factor for community acceptance. While one CHW expressed reservations about implementing the intervention during COVID-19, the majority of CHWs and patients indicated strong acceptance, with some even preferring it.

Conclusion: These findings highlight the acceptance - from both caregivers and patients - of the photo-based telemedicine intervention in a resource-limited context, even amid crises like the COVID-19 pandemic. This acceptance was reinforced with recognized benefits, with trust in CHWs serving as a crucial factor. These insights can inform the development of telemedicine interventions in similar settings.