Designing a digital tuberculosis treatment support and monitoring system for primary care: a user-centered qualitative study of patients, families, and healthcare workers

BACKGROUND: Tuberculosis (TB) treatment requires prolonged adherence, continuous support, and coordinated monitoring within primary healthcare settings, where documentation, communication, and follow-up processes are often fragmented and resource-constrained. Although digital adherence technologies (DATs) have been introduced to support TB care, many systems have been developed with limited integration of stakeholder perspectives and routine healthcare workflows. OBJECTIVE: This study aimed to explore user experiences, implementation challenges, and system requirements to inform the conceptual design of a digital tuberculosis treatment support and monitoring system for primary care. METHODS: A qualitative study situated within a user-centered design framework was conducted in primary healthcare facilities in Banyumas District, Indonesia. Semi-structured interviews were conducted with 18 participants, including six TB patients, six family members, and six TB program nurses. Data were analyzed using thematic analysis. Identified user needs were subsequently translated into functional and non-functional system requirements to inform the conceptual system design. RESULTS: Three interrelated themes emerged across stakeholder groups: maintaining TB treatment adherence as a prolonged and dynamic process, challenges in communication and coordination of family involvement in treatment support, and healthcare worker challenges in monitoring and care coordination. Cross-cutting needs included continuity of support, timely communication, shared visibility of treatment progress, and workflow integration. These findings were translated into functional requirements, including configurable reminders, role-based communication, clinician dashboards, and follow-up documentation tools, as well as non-functional requirements related to usability, privacy, accessibility, and workflow alignment. A conceptual digital treatment support and monitoring system was subsequently developed to support coordinated, role-based care within primary healthcare settings. CONCLUSION: This study provides a structured, user-centered foundation for the conceptual design of a digital tuberculosis treatment support and monitoring system for primary care. By integrating multi-stakeholder perspectives, the proposed framework supports a coordinated approach to treatment support, adherence monitoring, and continuity of care. The systematic translation of qualitative findings into explicit system requirements also offers a transparent and replicable pathway for early-stage digital health development in tuberculosis and other chronic disease contexts.