A process evaluation of an eHealth intervention to strengthen the circle of tuberculosis care in Shigatse, Tibet, China

Tuberculosis (TB) is an ongoing global health threat that has been exacerbated by the COVID-19 pandemic. People with TB need comprehensive medical and social supports to ensure they can maintain and complete TB treatment. TB programs globally have turned to eHealth to bridge gaps in access and strengthen the circle of care around people with TB. This study evaluates the implementation of an intervention aimed at improving TB care in Shigatse, using the CFIR framework to identify factors influencing its success. The intervention included the use of e-Monitor boxes and WeChat for patient engagement. Data were collected through interviews with patients, treatment supporters, and health workers. Key challenges identified included inadequate infrastructure, digital literacy barriers, and unclear roles due to recent TB service delivery reforms. Enablers included strong social structures, proximity to village doctors, and government support for free TB treatment. Results showed that while older patients faced difficulties with digital tools, younger family members often assisted, enhancing engagement. Health workers' training and the timing of training sessions were critical to the intervention's success. The study concludes that despite challenges, the intervention was generally well-received and effective, with recommendations for ongoing training and adaptation to local contexts.