{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:19:07Z","timestamp":1790140747067,"version":"4.0.1"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T00:00:00Z","timestamp":1753315200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000056","name":"National Institute of Nursing Research","doi-asserted-by":"publisher","award":["K23NR017210"],"award-info":[{"award-number":["K23NR017210"]}],"id":[{"id":"10.13039\/100000056","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015691","name":"Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI147129 Iribarren, Rubinstein"],"award-info":[{"award-number":["R01AI147129 Iribarren, Rubinstein"]}],"id":[{"id":"10.13039\/100015691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\nBackground<\/jats:title>\nDigital 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.<\/jats:p>\n<\/jats:sec>\n\nObjective<\/jats:title>\nAssess 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\u2019 needs.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nSecure message threads (N\u2009=\u2009255) 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.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nKey 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.<\/jats:p>\n<\/jats:sec>\n\nConclusion<\/jats:title>\nThis 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.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0326492","type":"journal-article","created":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T17:34:17Z","timestamp":1753378457000},"page":"e0326492","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Enhancing tuberculosis treatment support: A thematic analysis of interactive messages in a digital adherence technology trial to identify needs, challenges, and strategies for improvement"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4285-5061","authenticated-orcid":true,"given":"Javier","family":"Roberti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1948-3634","authenticated-orcid":true,"given":"Priscilla","family":"Carmiol-Rodr\u00edguez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique","family":"Chan-Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar Alfonso","family":"Aguilar-Vidrio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1584-1060","authenticated-orcid":true,"given":"Agnes A.","family":"Suyanto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Sprecher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5653-5766","authenticated-orcid":true,"given":"Fernando","family":"Rubinstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2980-0717","authenticated-orcid":true,"given":"Sarah","family":"Iribarren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,7,24]]},"reference":[{"issue":"3","key":"pone.0326492.ref001","article-title":"Evaluating user experiences of the secure messaging tool on the Veterans Affairs\u2019 patient portal system","volume":"16","author":"JN Haun","year":"2014","journal-title":"J Med Internet Res"},{"issue":"6","key":"pone.0326492.ref002","first-page":"1390","article-title":"Barriers, facilitators, and interventions for medication adherence across chronic conditions with the highest non-adherence rates: a scoping review with recommendations for intervention development","volume":"10","author":"P Konstantinou","year":"2020","journal-title":"Transl Behav Med"},{"issue":"12","key":"pone.0326492.ref003","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2022-010512","article-title":"Can digital adherence technologies reduce inequity in tuberculosis treatment success? 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