Patients and healthcare workers’ preferences for using smart lockers in accessing and dispensing chronic disease medication in Nigeria: Findings from a descriptive cross-sectional study

Ibrahim Bola Gobir; Samson Agboola; Havilah Onyinyechi Nnadozie; Helen Adamu; Fatimah Ohunene Sanni; Aisha Adamu; Azeez Akanbi Bello; Angmun Suzzy Otubu; Deus Bazira; Piring’ar Mercy Niyang

doi:10.1371/journal.pone.0303625

. 2024 Jul 5;19(7):e0303625. doi: 10.1371/journal.pone.0303625

Patients and healthcare workers’ preferences for using smart lockers in accessing and dispensing chronic disease medication in Nigeria: Findings from a descriptive cross-sectional study

Ibrahim Bola Gobir ^1,^*, Samson Agboola ², Havilah Onyinyechi Nnadozie ², Helen Adamu ², Fatimah Ohunene Sanni ², Aisha Adamu ², Azeez Akanbi Bello ², Angmun Suzzy Otubu ³, Deus Bazira ¹, Piring’ar Mercy Niyang ¹

Editor: Mohammed Shuaib⁴

PMCID: PMC11226012 PMID: 38968262

Abstract

The use of smart locker technology has been beneficial for patients with chronic diseases who require regular medication and face challenges accessing healthcare facilities due to distance, time, or mobility issues. This study aimed to assess preferences for utilizing Smart Lockers in accessing and dispensing chronic disease medication among healthcare workers (HCWs) and patients in Nigeria. A descriptive cross-sectional survey was conducted between November 8th and December 4th, 2021, across secondary healthcare facilities in five states of Adamawa, Akwa Ibom, Cross River, Benue, and Niger. Among 1,133 participants included in the analysis, 405 were HCWs and 728 were patients with chronic illnesses. Descriptive statistics, including frequencies and percentages, were used to summarize the data, while chi-square tests were employed to assess significant differences between healthcare workers (HCWs) and patients. Results indicated a strong preference among both HCWs and patients for one-on-one counseling as the preferred method for orientating patients on using Smart Lockers, with 53.8% of HCWs and 58.1% of patients expressing this preference (p = 0.25). Additionally, there was a shared preference for hospitals or clinics as secure locations for Smart Lockers, with 68.9% of HCWs and 71.6% of patients preferring this option (p < 0.05). The majority of participants favored receiving notification of drug delivery via phone call, with 49.1% of HCWs and 48.8% of patients expressing this preference (p = 0.63). There was a significant difference in preferences for access hours, the majority (HCWs: 65.4% and patients: 52.6%) favored 24-hour access (p < 0.05). Participants identified patients with HIV within the age range of 18–40 as the most suitable population to benefit from using Smart Lockers for medication dispensing. These findings offer insights into healthcare policies aimed at enhancing medication access and adherence among patients with chronic diseases in Nigeria. The development of models for using smart lockers to dispense chronic disease medications to chronically ill persons in Nigeria and other populations is recommended.

Background

Chronic disease is a sickness that lasts a long time, advances slowly, is caused by genetics, the environment, or poor lifestyle choices, and requires continuous medical care [1]. Chronic diseases were responsible for more than 28 million deaths worldwide in 1990. By 2008, this number had climbed to 36 million, and 39 million in 2016 [2]. Chronic diseases remain the leading cause of death globally [3, 4]. Evidence suggests that chronic disease patients often experience multimorbidity because chronic diseases rarely occur in isolation. The burden of managing the treatment of chronic illnesses includes changes in lifestyle, and behaviours, regular visits to the healthcare professional or clinic, and managing medications [5].

In Nigeria, medication dispensing for chronic diseases traditionally occurs within healthcare facilities, reflecting the historical development of the healthcare system. Patients typically obtain medications directly from hospitals or clinics during visits where healthcare professionals oversee the process. The impact of chronic diseases is worse in developing countries like Nigeria due to limitations in technological advancement for prompt diagnosis and treatment [6]. So therefore, there’s increasing recognition of the need for innovative approaches like smart lockers to improve accessibility and adherence in managing chronic diseases [7].

In the health care context, smart lockers are automated machines that enable patients to access medications without delay rather than wait long hours in the queue at the health facility or pharmacy. The lockers can be placed at locations like shopping malls, retail stores, cinemas, etc., where users can easily access them [8]. Smart lockers and pharmaceutical dispensing devices are newer technologically driven processes that have been tested on a small scale. To decongest the clinics and reduce waiting time, Neo Hutiri developed the Pelebox smart locker, which allows patients access to the automated drug dispensing machine using an automated unique PIN-generating model for patient use only. This one-time unique PIN allows patients to retrieve medication from the machine These automated machines have been tested in Johannesburg, South Africa [9].

Smart lockers have remarkably reduced long waiting hours at health facilities, reduced the financial burden on patients and facilities, and increased adherence to medication among Persons Living with HIV (PLHIV) and chronic disease patients in South Africa. Introducing a similar system in Nigeria will reduce the burden of health services provided to the already overwhelmed healthcare workforce and largely improve the healthcare system [10]. This is because no previous studies have identified, documented, or evaluated using smart lockers in Nigeria for dispensing chronic disease medication. Therefore, this study aimed to assess the patients’ and healthcare workers’ preferences for using Smart Lockers in accessing and dispensing chronic disease medications in Nigeria [11, 12].

Method

Study design and setting

This study employed a cross-sectional study to assess preferences for using Smart Lockers in accessing and dispensing chronic disease medication in Nigeria among patients and healthcare workers (HCWs). The study took place between November 8th and December 4th, 2021, across secondary healthcare facilities in five states: Adamawa, Akwa Ibom, Cross River, Benue, and Niger.

These healthcare facilities were selected based on their specialization in providing care for patients with chronic diseases such as Diabetes, hypertension, HIV, cancer, and Tuberculosis, among others. Identification of these facilities was facilitated through collaboration with Implementing Partners supporting clinical care initiatives in these states.

Study population

The target populations for this study were:

Health Workers: This group includes healthcare professionals responsible for administering medical care and services to individuals diagnosed with chronic diseases.
Persons Living with Chronic Illnesses: This group consists of individuals who have been diagnosed with one or more chronic diseases such as HIV, diabetes, hypertension, chronic kidney disease, Cancer, TB, etc.

Inclusion criteria

People aged 18 years or above who have been diagnosed with a chronic disease requiring medication refills such as HIV, diabetes, hypertension, chronic kidney disease, Cancer, TB, etc. and receive care in the facilities listed in the S1 Appendix.
Healthcare workers responsible for providing care to individuals with chronic illnesses at the facilities listed in the S1 Appendix.

Sample size determination

Healthcare workers (HCWs)

According to a research paper on the health workforce estimated between 2016 to 2030 to understand if Nigeria will have enough workforce [13], the estimated number of HCWs was 621,205. This was used as a proxy for HCWs providing care to chronic illness patients. This was inputted into the Raosoft sample size calculator at a 5% margin of error, 95% confidence interval and 50% response distribution to yield a minimum sample size of 384.

Patients of persons living with chronic illnesses

According to a research paper on patterns of chronic illnesses conducted in Nigeria in 2020 [14], the percentage of chronic diseases in Nigeria is about 64.9% of the population. This was used as a proxy to estimate the population prevalence of chronic diseases given that the population of Nigeria is about 200 million [15]. This was entered into the Raosoft sample size calculator at 4% margin of error, 95% confidence interval and 50% response distribution to yield a minimum sample size of 601.

Selection of participants

The selection of participants involved identifying healthcare workers providing chronic disease care and patients with chronic illnesses through the selected healthcare facilities in the respective states. Stratified random sampling was used to ensure representation, and participants were stratified based on gender (50% male and 50% female) to enhance diversity and inclusivity.

Data collection

Data collection involved the administration of a semi-structured questionnaire to both healthcare workers and patients living with chronic diseases. The questionnaire comprised 37 items designed to gather information on sociodemographic characteristics, accessibility preferences, methods of engagement, operability, and eligible populations that would be most suited to use Smart Lockers for accessing and dispensing chronic disease medication.

Participants were briefed about the survey’s objectives and were required to give their consent before completing the questionnaire. The questionnaire included a section on sociodemographic characteristics, covering gender, age, marital status, and highest educational qualification. No personally identifiable data was collected from the participants.

Data analysis

The data analysis comprised descriptive statistics, including frequencies and percentages, to summarize the demographic characteristics such as gender, age, marital status, and highest educational qualification and responses obtained from both healthcare workers (HCWs) and patients regarding their preferences for accessing and dispensing chronic disease medication using Smart Locker. Furthermore, a chi-square test was conducted to evaluate significant differences between the preferences of HCWs and patients. The significance level was set at p < 0.05, with a 95% confidence interval utilized as the threshold for identifying statistically significant findings. All analyses were performed at a 5% significance level using statistical software, Stata version 15.0 and Microsoft Excel (2016), to ensure accuracy and reliability in the interpretation of the data.

Ethical statement

Informed consent

Participants were provided with detailed information regarding the study objectives, eligibility criteria, data privacy measures, and researchers’ disclaimers on the entry page of the survey. Informed consent was obtained from all participants before proceeding with the survey. Consent was indicated by ticking the "I agree" checkbox on the survey, indicating the participant’s voluntary agreement to participate in the study. Entries from participants who did not meet the inclusion criteria were not processed for data analysis, ensuring that only eligible participants’ data were included.

Confidentiality

To uphold participant confidentiality, all entries were recorded anonymously. Personally identifiable information was not collected from participants during the survey. Privacy of the subjects’ information was strictly maintained throughout the study duration.

Risks and benefits

Participants were informed that there were no adverse effects associated with participating in the study that would compromise their rights or welfare. Additionally, there were no direct benefits offered to participants for their involvement in the study.

Results

A total of 1,180 survey entries were received, and 47 (4.0%) responses were excluded from data analysis because they did not meet the inclusion criteria. Of the 1,133 responses included in the analysis, 405 were received from HCWs, and 728 were from persons living with chronic illnesses in Nigeria.

Table 1 and (Fig 1) show the demographic characteristics of the participants with chronic diseases and healthcare workers in 5 states in Nigeria. Most of the respondents in the patient survey were female (55.9%), while a higher percentage of healthcare workers (HCWs) were male (51.4%). In terms of age distribution, 67.9% of healthcare workers (HCWs) were between the age group of 18–35 years., whereas 50.1% of patients were aged between 36 and 60 years 48.9% of the healthcare workers (HCWs) were single, and 57.6% of patients were married. Moreover, most participants had Post-Secondary Education (86.9%) among healthcare workers (HCWs), while a higher percentage had completed Secondary Education (40.5%) among patients.

Table 1. Demographics of the participants of patients with chronic diseases and health care workers in 5 states in Nigeria.

Variables	HCWs, n = 405	Patients, n = 728
Gender
Male	208 (51.4%)	321 (44.1%)
Female	197 (48.6%)	407 (55.9%)
Age
18–35	275 (67.9%)	338 (46.4%)
36–60	125 (30.9%)	365 (50.1%)
> 60	5 (1.2%)	25 (3.4%)
Marital Status
Single	198 (48.9%)	187 (25.7%)
Married	197 (48.6%)	419 (57.6%)
Separated	10 (2.5%)	122 (16.8%)
Highest Educational Qualification
No formal Education	2 (0.5%)	97 (13.3%)
Primary Education	7 (1.7%)	135 (18.5%)
Secondary Education	44 (10.9%)	295 (40.5%)
Post-Secondary Education	352 (86.9%)	201 (27.6%)

Open in a new tab

Among healthcare workers (HCWs), (Table 2) and (Fig 2) indicate that pharmacists or other pharmacy staff were the most preferred personnel to load drugs into the smart lockers, with a response rate of 64.7%. This preference was significantly higher compared to the Monitoring and Evaluation (M&E) staff, who had the lowest response rate at 1.5%. The next most preferred personnel were those specifically employed for this purpose, with HIV case managers having a response rate of 16.3% and other specific staff at 14.1%. In contrast, nurses and other professions had lower response rates at 1.7%.

Table 2. The most suitable personnel to load the drugs into the smart lockers in 5 states in Nigeria.

Personnel	HCWs, n = 405
HIV Case Manager	57 (14.1%)
Monitoring and Evaluation (M&E)staff	6 (1.5%)
Nurse	7 (1.7%)
Pharmacist or other pharmacy staff	262 (64.7%)
Specific staff employed for this sole purpose	66 (16.3%)
Others	7 (1.7%)

Open in a new tab

Others: Trained personnel and staff

The preference for one-on-one counselling in (Fig 3) was identified as the best method for orientating patients on using Smart Lockers for accessing and dispensing chronic disease medication. This was significantly high among both healthcare workers (HCWs) at 53.8% and patients at 58.1%. This shared preference suggests a strong inclination towards utilizing Smart Lockers for medication dispensing. Moreover, there was no significant difference observed between HCWs and patients regarding this preference (p = 0.25). Regarding the preferred location for smart lockers in (Fig 4), a hospital or clinic emerged as the top choice among participants. Patients exhibited a higher preference for this option (71.6%) compared to HCWs (68.9%). In (Fig 5), the difference was statistically significant (p < 0.05),in terms of notification methods for drug delivery. The majority of both HCWs (49.1%) and patients (48.8%) favoured receiving a phone call. Notably, there was no significant difference between HCWs and patients in this regard (p = 0.63). However, in (Fig 6) a difference was observed concerning access hours for Smart Lockers. While the majority (HCWs: 65.4% and patients: 52.6%) favoured 24-hour access for drug pick-up, there was a significant difference between the two populations (p < 0.05). In (Fig 7), participants identified patients with HIV as the most suitable population to benefit from using smart lockers(HCWs: 43.2%, Patients: 45.9%) and finaly in (Fig 8), participants within the age range of 18–40 were identified to have the highest number of prefarred usage for smart lockers (HCWs: 81.0%, Patients: 70.5%), (Table 3).

Table 3. Preferences for the use of smart lockers in dispensing chronic disease medications in 5 states in Nigeria.

Variables	HCWs, n = 405	Patients, n = 728	p-value
How might patient orientation be conducted on the use of the smart lockers?
Through audio-visuals	93 (23.0%)	147 (20.2%)	p = 0.25
Through printed material	91 (22.5%)	146 (20.1%)
One-on-one counselling by Healthcare Provider	218 (53.8%)	423 (58.1%)
Others¹	3 (0.7%)	12 (1.6%)
What would be the best location for placing the smart lockers for access to patients?
Bus stop	2 (0.5%)	17 (2.3%)	p < 0.05
Community pharmacy	102 (25.2%)	139 (19.1%)
Hospital or Clinic	279 (68.9%)	521 (71.6%)
Police station	5 (1.2%)	6 (0.8%)
Religious institution	9 (2.2%)	34 (4.7%)
Others²	8 (2.0%)	11 (1.5%)
How best might patients receive notification of drug dispensing?
Email	34 (8.4%)	47 (6.5%)	p = 0.63
Text Message	165 (40.7%)	314 (43.1%)
Phone call	199 (49.1%)	355 (48.8%)
Others³	7 (1.7%)	12 (1.6%)
What operating time would you recommend for patients to access the smart lockers?
Morning (6 am– 12 noon)	77 (19.0%)	166 (22.8%)	p < 0.05
Afternoon (12 noon– 4 pm)	43 (10.6%)	89 (12.2%)
Evening (4 pm– 10 pm)	20 (4.9%)	90 (12.4%)
24-hour access	265 (65.4%)	383 (52.6%)
What patients might benefit from using the smart lockers to collect their medication?
Patients with HIV	175 (43.2%)	334 (45.9%)	p < 0.05
Patients with Cancer	41 (10.1%)	71 (9.8%)
Patients with Diabetes	49 (12.1%)	81 (11.1%)
Patients with Hypertension	47 (11.6%)	95 (13.0%)
Patients with Tuberculosis	90 (22.2%)	106 (14.6%)
Others⁴	3 (0.7%)	41 (5.7%)
For which of these age groups can the smart lockers be used in dispensing medication?
1–12 years	1 (0.2%)	8 (1.1%)	p < 0.05
13–17 years	5 (1.2%)	14 (1.9%)
18–40 years	328 (81.0%)	513 (70.5%)
41–60 years	55 (13.6%)	128 (17.6%)
Above 60 years	16 (4.0%)	24 (3.3%)
Others⁵	0 (0.0%)	41 (5.6%)

Open in a new tab

Others¹: Unspecified.

Others²: Any convenient location, Bank, Post office.

Others³: Religious announcements, cluster collectors, disseminating information to other patients, face-to-face, home visits.

Others⁴: Asthmatic, Surgical cases, Malaria, Hepatitis with stroke

Others⁵: Unspecified

Discussion

The study explored patients’ and healthcare workers’ preferences for using Smart Lockers in accessing and dispensing chronic disease medications in Nigeria. Before now, there has been a need for research aimed at evaluating the efficacy of a system like smart lockers in the Nigerian healthcare space. Part of the justification for our study stems from the absence of prior investigations into the utilization of smart lockers for the distribution of chronic disease medication within Nigeria. According to our survey findings, smart lockers can be strategically placed close to a secure clinic or hospital, allowing patients in the surrounding area 24-hour access to pick up their prescription drugs. Medication can be administered by calling the patients. Patients, or end users, need to be trained on how to use the smart lockers; one-on-one counselling from their HCW was identified as the best course of action. According to Angell and others [16], the quality of healthcare systems in low-middle-income countries like Nigeria is poor. This contributes to the increase in the burden of illnesses and global health costs. There is an increasing focus on strengthening health systems by investing in improving the quality of health services and creating equitable access to high-quality, people-centred care in building trust in the health system. To achieve these goals, the perspectives, and preferences of patients and HCWs must be considered [17].

The preference from patients and HCWs regarding the populations best suited to use the Smart Lockers for chronic disease dispensing indicates that persons living with HIV between 18 and 40 years are the most suitable populations to use the Smart Lockers. This is likely due to the prevalence of HIV in Nigeria, with the highest HIV prevalence rates recorded among women between the ages of 25 and 34 [18]. This may also be because most respondents in the survey were between the ages of 18 and 40. Additionally, decentralized care, such as community-based drug delivery and ART refills from community pharmacies, is popular in managing diseases such as HIV and Tuberculosis in Nigeria, unlike other chronic diseases [19]. This would indicate a lesser resistance to adopting smart lockers as another model for decentralized care. However, the incidence of other chronic diseases, such as diabetes, hypertension, and stroke, is higher in older populations aged 36–60 and above 60 years [20, 21]. There is increasing advocacy for improving person-centred care for older adults with chronic illnesses by transferring care from healthcare facilities to home and community-based models [22].

While most respondents advocate placing the lockers within a health institution such as a hospital, clinic, or community pharmacy, very few were open to using other locations such as bus stops, religious institutions, and police stations. This may be due to concerns relating to safety, privacy, and stigmatization [23]. Literature suggests that the rates of stigmatization differ based on the health condition, with persons suffering from HIV, Tuberculosis, and mental health conditions being among the most severely affected by stigmatization. These factors are often linked to a lack of awareness, beliefs, and institutionalized practices within healthcare facilities and communities [24, 25]. Decentralizing care and bringing the lockers to non-health-related institutions further expose patients to stigmatization and lack of privacy risks.

The patients and HCWs reported that they preferred smart lockers in a hospital or clinic. The sentiments behind this preference may be similar to those reported by Peng and others [26], who found that patients living with chronic diseases preferred to access care through primary healthcare (PHC) services, provided that the distance to the service provider was short and that they had access to capable HCWs. The use of designated areas in the community close to the patients, such as religious institutions or retail pharmacies for drug pick-ups for chronic non-communicable diseases, is reported to limit the patient’s need for physician consultation to issues such as an error in prescription, delay in delivery and adverse drug reactions [27].

Results of our study also indicated that one-on-one counselling would be the most effective method of orientating patients using smart lockers. This may be linked to factors such as the literacy level of patients and their comprehension of health-related information disseminated through mediums such as audio-visual tools and printed materials. Most patients in our study reported having completed a secondary school education (40.5%). Patient literacy has been suggested to influence individuals’ health-seeking attitudes, impacting their ability to read, understand and act upon health-related information [28]. Additionally, many patients rely heavily on the opinions of their HCWs and are more likely to adopt treatment measures that a trusted physician suggests. This is especially applicable in the case of chronically ill persons who require ongoing care and have developed a strong relationship with their HCWs over time [29]. Having one-on-one contact with a Healthcare provider may overcome the barriers to understanding information about using smart lockers and increase their likelihood of adopting smart lockers for collecting their medication. A study by Donelan and others [30] indicates that healthcare services should be made available to patients at any time of the day, considering the technological advancement the world is experiencing. Telemedicine affords a patient access to the physician without time restrictions and not necessarily having to go into the hospital [31]. This points to the agreement found in this study from HCW and patients’ responses to access time to smart lockers. Most patients and HCWs have the same line of thought that smart lockers for drug dispensing should be placed at the hospitals or clinics and made operational for 24 hours for easy access.

Furthermore, the usage of questionnaires may have resulted in self-selection bias, as respondents may have an essentially distinctive characteristic that affected their decision to prefer or not to prefer the use of smart lockers.

Due to the characteristics of the hospitals chosen and the fact that the HIV program provides the most extensive organized chronic care programs in those locations, the study has some limitations that may limit the generalizability of the findings to other chronic diseases.

In our study, most respondents disclosed that a phone call would be the best method for notifying patients when their drugs are dispensed. The use of smartphones has been reported to enhance patient drug adherence. Short Message Service (SMS) and synchronized data transmission applications enable healthcare providers to send reminders and keep up with patients’ drug adherence [32]. However, the ownership of mobile phones and smartphones in Nigeria is limited. Limited network access in certain areas may also hinder the quick and seamless transmission of electronic mail and SMS [33]. This may be considered the reason why most of the respondents prefer receiving a phone call notification when their drugs are dispensed. This would be easier to track and ensure that the patients are adequately informed when their prescriptions are dispensed.

Proxy estimates were used to determine sample sizes and assess chronic disease prevalence, potentially introducing bias. Collaboration with specific healthcare facilities and Implementing Partners may lead to selection bias, limiting generalizability. The cross-sectional design prevents establishing causality in the study. Self-reported data may be subject to social desirability or recall bias, impacting response accuracy. The study’s focus on specific states may limit its applicability to broader populations in Nigeria.

Conclusion

Our study provides valuable insights into the preferences for utilizing Smart Lockers in accessing and dispensing chronic disease medication among healthcare workers (HCWs) and patients in Nigeria. The strong preference for one-on-one counselling as the preferred method for orientating patients on using Smart Lockers underscores the importance of personalized education and support in implementing new healthcare technologies. Additionally, the shared preference for hospitals or clinics as secure locations for Smart Lockers highlights the significance of infrastructure and accessibility in medication management initiatives. The majority of participants revealed that receiving notification of drug delivery via phone call, differences in preferences for access hours suggest the need for tailored approaches to accommodate varying schedules and preferences among HCWs and patients. Notably, patients with HIV within the age range of 18–40 were identified as the most suitable population to benefit from Smart Lockers usage, indicating potential areas for targeted intervention and implementation strategies.

Overall, these findings contribute to the growing body of literature on innovative approaches to medication access and adherence in chronic disease management. By understanding and addressing the preferences and needs of both HCWs and patients, healthcare policymakers and providers can optimize the implementation of Smart Lockers technology to enhance medication accessibility and improve health outcomes among individuals living with chronic diseases in Nigeria.

Supporting information

S1 File. Feasibility and acceptability of “smart lockers” for dispensing chronic disease medication in Nigeria.

(PDF)

pone.0303625.s001.pdf^{(576.7KB, pdf)}

S2 File

(XLSX)

pone.0303625.s002.xlsx^{(177.7KB, xlsx)}

S3 File. STROBE statement—Checklist of items that should be included in reports of cross-sectional studies.

(DOCX)

pone.0303625.s003.docx^{(24.5KB, docx)}

S4 File. PLOS ONE clinical studies checklist.

(DOCX)

pone.0303625.s004.docx^{(25.1KB, docx)}

S5 File. Inclusivity in global research.

(DOCX)

pone.0303625.s005.docx^{(66.8KB, docx)}

S1 Appendix. Distribution of states and facilities.

(DOCX)

pone.0303625.s006.docx^{(16.2KB, docx)}

Acknowledgments

We would like to thank all those who contributed in one way or another to the collection and analysis of this data.

Data Availability

Data set supporting the findings of this study are available within the paper and its Supporting information files.

Funding Statement

-IBG -GU-HRP-502 - Georgetown ICF_Smart Locker_IBG_12142021 -Georgetown University Medical Center Dean of Research -https://cghpi.georgetown.edu/ -No, the funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.

References

1.CDC (2021). National Center for Chronic Disease Prevention and Health Promotion. About Chronic Diseases. Retrieved 25 March 2022 from https://www.cdc.gov/chronicdisease/about/index.htm.
2.Anderson E., & Durstine J. L. (2019). Physical activity, exercise, and chronic diseases: A brief review. Sports Medicine and Health Science, 1(1), 3–10. doi: 10.1016/j.smhs.2019.08.006 [DOI] [PMC free article] [PubMed] [Google Scholar]
3.Kunnumakkara A. B., Sailo B. L., Banik K., Harsha C., Prasad S., Gupta S. C., et al. (2018). Chronic diseases, inflammation, and spices: how are they linked? Journal of translational medicine, 16(1), 14. doi: 10.1186/s12967-018-1381-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
4.World Health Organization (2020). WHO reveals leading causes of death and disability worldwide: 2000–2019. Retrieved 25 March 2020 from https://www.who.int/news/item/09-12-2020-who-reveals-leading-causes-of-death-and-disability-worldwide-2000-2019.
5.Sav A., Salehi A., Mair F.S. et al. Measuring the burden of treatment for chronic disease: implications of a scoping review of the literature. BMC Med Res Methodol 17, 140 (2017). doi: 10.1186/s12874-017-0411-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
6.Hajat C., & Stein E. (2018). The global burden of multiple chronic conditions: A narrative review. Preventive medicine reports, 12, 284–293. doi: 10.1016/j.pmedr.2018.10.008 [DOI] [PMC free article] [PubMed] [Google Scholar]
7.Faronbi J. O., Ademuyiwa I. Y., & Olaogun A. A. (2020). Patterns of chronic illness among older patients attending a university hospital in Nigeria. Ghana medical journal, 54(1), 42–47. doi: 10.4314/gmj.v54i1.7 [DOI] [PMC free article] [PubMed] [Google Scholar]
8.De Villiers K. Bridging the health inequality gap: an examination of South Africa’s social innovation in health landscape. Infect Dis Poverty 10, 19 (2021). doi: 10.1186/s40249-021-00804-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
9.Yusuff KB, Abd’ Wassi Sanni. Itinerant vending of medicines inside buses in Nigeria: vending strategies, dominant themes and medicine-related information provided. PubMed. 2011 Jul 1; [PMC free article] [PubMed]
10.Mash R., Christian C., & Chigwanda R. V. (2021). Alternative mechanisms for delivery of medication in South Africa: A scoping review. South African family practice: official journal of the South African Academy of Family Practice/Primary Care, 63(1), e1–e8. doi: 10.4102/safp.v63i1.5274 [DOI] [PMC free article] [PubMed] [Google Scholar]
11.Kiousis, V., Nathanail, E., Karakikes, I. (2019). Assessing Traffic and Environmental Impacts of Smart Lockers Logistics Measure in a Medium-Sized Municipality of Athens. In: Nathanail, E., Karakikes, I. (eds) Data Analytics: Paving the Way to Sustainable Urban Mobility. CSUM 2018. Advances in Intelligent Systems and Computing, vol 879. Springer, Cham. 10.1007/978-3-030-02305-8_74. [DOI]
12.Ephraim-Emmanuel B, Adigwe A, Oyeghe R, Ogaji D (2018) 2875. Quality of health care in Nigeria: a myth or a reality. International Journal of Research in Medical Science- doi: 10.18203/2320-6012.ijrms20183621 [DOI] [Google Scholar]
13.Adebayo O., Labiran A., Emerenini F. C. and Omoruyi L. (2016). Health Workforce for 2016–2030: Will Nigeria have enough? International Journal of Innovative Healthcare Research. 4(1), 9–16. [Google Scholar]
14.Angell B., Sanuade O., Adetifa I.M.O., Okeke I.N., Adamu A.L., Aliyu M.H., et al. (2022). Population health outcomes in Nigeria compared with other west African countries, 1998–2019: a systematic analysis for the Global Burden of Disease Study. The Lancet, [online] 399(10330), pp.1117–1129. doi: 10.1016/S0140-6736(21)02722-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
15.Institute for Health Metrics and Evaluation (IHME) (2020). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, 2020. Retrieved 6 April 2022 from http://vizhub.healthdata.org/gbd-compare.
16.Federal Ministry of Health, Nigeria. Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) 2018: Technical Report. Abuja, Nigeria. October 2019. Accessed 11 April 2022 from http://ciheb.org/media/SOM/Microsites/CIHEB/documents/NAIIS-Report-2018.pdf
17.Rabkin M., Strauss M., Mantell J. E., Mapingure M., Masvawure T. B., Lamb M. R., et al. (2020). Optimizing differentiated treatment models for people living with HIV in urban Zimbabwe: Findings from a mixed methods study. PloS one, 15(1), e0228148. doi: 10.1371/journal.pone.0228148 [DOI] [PMC free article] [PubMed] [Google Scholar]
18.Magadzire B.P., Marchal B. & Ward K. (2016). Novel models to improve access to medicines for chronic diseases in South Africa: an analysis of stakeholder perspectives on community-based distribution models. Journal of Pharmaceutical Policy and Practice, 9, 28 doi: 10.1186/s40545-016-0082-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
19.Muthelo L., Nemagumoni T., Mothiba T.M., Phukubje A.T. and Mabila L.N. (2020). Experiences of Professional Nurses Regarding the Implementation of a Central Chronic Medicine Dispensing and Distribution Program at Primary Health Care Facilities in South Africa. The Open Public Health Journal, 13(1), pp.477–483. doi: 10.2174/1874944502013010477 [DOI] [Google Scholar]
20.Zhao J., Yan C., Han D., Wu Y., Liao H., Ma Y., et al. (2022). Inequity in the healthcare utilization among latent classes of elderly people with chronic diseases and decomposition analysis in China. BMC Geriatrics, 22(1). doi: 10.1186/s12877-022-03538-x [DOI] [PMC free article] [PubMed] [Google Scholar]
21.Nolte E., Merkur S., Anders Anell and European Observatory On Health Systems And Policies (2020). Achieving person-centred health systems: evidence, strategies and challenges. Cambridge; New York, Ny: Cambridge University Press. [Google Scholar]
22.Dong R, Leung C, Naert MN, Naanyu V, Kiptoo P, Matelong W, et al. (2021) Chronic disease stigma, skepticism of the health system, and socio-economic fragility: Qualitative assessment of factors impacting receptiveness to group medical visits and microfinance for non-communicable disease care in rural Kenya. PLoS ONE 16(6): e0248496. doi: 10.1371/journal.pone.0248496 [DOI] [PMC free article] [PubMed] [Google Scholar]
23.Idemudia E. S., Olasupo M. O., & Modibo M. W. (2018). Stigma and chronic illness: A comparative study of people living with HIV and/or AIDS and people living with hypertension in Limpopo Province, South Africa. Curationis, 41(1), e1–e5. doi: 10.4102/curationis.v41i1.1879 [DOI] [PMC free article] [PubMed] [Google Scholar]
24.Nyblade L., Stockton M.A., Giger K., Bond V., Ekstrand M. L., Mc Lean R., et al. (2019). Stigma in health facilities: why it matters and how we can change it. BMC Med 17, 25. doi: 10.1186/s12916-019-1256-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
25.Peng Y, Jiang M, Shen X, Li X, Jia E, Xiong J. (2020). Preferences for Primary Healthcare Services Among Older Adults with Chronic Disease: A Discrete Choice Experiment. Patient Prefer Adherence;14:1625–1637. doi: 10.2147/PPA.S265093 [DOI] [PMC free article] [PubMed] [Google Scholar]
26.Krzyzaniak N., Bajorek B. A global perspective of the roles of the pharmacist in the NICU (2017). International Journal of Pharmacy Practice, Volume 25, Issue 2, April 2017, Pages 107–120, doi: 10.1111/ijpp.12284 [DOI] [PubMed] [Google Scholar]
27.Grilo, A. M., Santos, M. C. d., Isabel Gomes, A., & Rita, J. S. (2017). Promoting Patient-Centered Care in Chronic Disease. In (Ed.), Patient Centered Medicine. IntechOpen. 10.5772/67380 [DOI]
28.Coventry P. A., Fisher L., Kenning C., Bee P., & Bower P. (2014). Capacity, responsibility, and motivation: a critical qualitative evaluation of patient and practitioner views about barriers to self-management in people with multimorbidity. BMC health services research, 14, 536. doi: 10.1186/s12913-014-0536-y [DOI] [PMC free article] [PubMed] [Google Scholar]
29.Pritchard D. E., Moeckel F., Villa M. S., Housman L. T., McCarty C. A., and McLeod H. L. (2017). Strategies for integrating personalized medicine into healthcare practice. Personalized Medicine, 14, 2, 141–152. doi: 10.2217/pme-2016-0064 [DOI] [PubMed] [Google Scholar]
30.Donelan K., Barreto E. A., Sossong S., Michael C., Estrada J. J., Cohen A. B., et al. (2019). Patient and clinician experiences with telehealth for patient follow-up care. The American journal of managed care, 25(1), 40–44. [PubMed] [Google Scholar]
31.Reed M. E., Huang J., Graetz I., Lee C., Muelly E., Kennedy C., et al. (2020). Patient Characteristics Associated With Choosing a Telemedicine Visit vs Office Visit With the Same Primary Care Clinicians. JAMA network open, 3(6), e205873. doi: 10.1001/jamanetworkopen.2020.5873 [DOI] [PMC free article] [PubMed] [Google Scholar]
32.Al-Hassany L, Kloosterboer SM, Dierckx B, Koch BCP (2019). Assessing methods of measuring medication adherence in chronically ill children–a narrative review. Patient Preference and Adherence; 13:1175–1189. doi: 10.2147/PPA.S200058 [DOI] [PMC free article] [PubMed] [Google Scholar]
33.Forenbacher Ivan, Husnjak Siniša, Ivan Cvitić Ivan Jovović, (2019). Determinants of mobile phone ownership in Nigeria. Telecommunications Policy,43, 7, 101812. doi: 10.1016/j.telpol.2019.03.00 [DOI] [Google Scholar]

PLoS One. doi: 10.1371/journal.pone.0303625.r001

Decision Letter 0

Mohammed Shuaib

2 Jan 2024

PONE-D-23-39195Patients and Healthcare Workers' Preferences for Using Smart Lockers in Dispensing Chronic Disease Medication in NigeriaPLOS ONE

Dear Dr. Gobir,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Feb 16 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Mohammed Shuaib

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2.Please include a complete copy of PLOS’ questionnaire on inclusivity in global research in your revised manuscript. Our policy for research in this area aims to improve transparency in the reporting of research performed outside of researchers’ own country or community. The policy applies to researchers who have travelled to a different country to conduct research, research with Indigenous populations or their lands, and research on cultural artefacts. The questionnaire can also be requested at the journal’s discretion for any other submissions, even if these conditions are not met. Please find more information on the policy and a link to download a blank copy of the questionnaire here: https://journals.plos.org/plosone/s/best-practices-in-research-reporting. Please upload a completed version of your questionnaire as Supporting Information when you resubmit your manuscript.

3. Please expand the acronym “GUMC” (as indicated in your financial disclosure) so that it states the name of your funders in full.

This information should be included in your cover letter; we will change the online submission form on your behalf.

4. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Yes

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is an important work on dispensing medication for chronic disease through the use of smart lockers. The authors did a good job of putting in context and justifying the need for such kind of service in Nigeria or similar contexts in sub-Saharan Africa. The authors aimed to describe preferences for using smart lockers in dispensing medication for chronic disease patients and potential caregivers of these patients.

Comments and Issues

1. It would been better if this study was enlarged into a feasibility study and used mixed methods approaches. That would enrich the quantitative data. This is just a lamenting comment and nothing can be done about it.

2. Make a single background section:

- Remove the subdivisions such as the "problem statement", "justification", and "aim and objectives" i.e merge all these portions

- Revise the text to remove redundancies. For example, current lines 131 to 133 come back again in lines 135 and 136 (despite the slight rewrite) and it comes again as aim and objectives. There are a lot of these types of repetitions.

3. About the sample size determination:

- The two references 9 and 23 do not provide any information on how the sample size was calculated. Citation 9 is actually for a single hospital.

- Also, what is the expected point estimate wished to be estimated with a 5% margin error?

- Lines 184 to 185 are for data collection. Move them.

4. Line 66 in the current background, is written: "Nigerians have a 20% chance of dying untimely from chronic diseases". This is a wrong interpretation of the "probability of dying between the age of 30 and 70 years from NCD". Please see the WHO definition of premature mortality from NCD.

5. In the data analysis subsection

- Line 196. Do not write STATA it is Stata. See the Stata documentation. Ok?

- Please clarify the line 195.

6. Results section:

- Table 1 is it possible to add for the HCW their cadres (eg: physicians, nurses etc)? For the patients, it would be good if we had their type of NCD.

- Table 4 is basically a repetition of table 2. Only p-values were added. I do not think we need these p-values.

Reviewer #2: Title:

Patients and Healthcare Workers' Preferences for Using Smart Lockers in Dispensing

Chronic Disease Medication in Nigeria

Overall comments

I congratulate the authors on the manuscript that assessed patients and health worker preferences for using smart lockers. More client centered models of service delivery are needed now more than ever as people living with HIV age with the disease and present with chronic diseases. In this regard, this paper addresses a very important topic as more integrated models of care for chronic diseases are sought. The paper is well written. Below are a few comments for clarification.

Title: would be great if the title included the study design used. The revised title could be “Patients and Healthcare Workers' Preferences for Using Smart Lockers in Dispensing Chronic Disease Medication in Nigeria—findings from a descriptive cross-sectional study” or something similar.

Abstract: Summarizes the study but it’s difficult to follow the research the way results are described. The results for HCWs and for patients need to be presented separately. It’s not clear what patients and clients were asked about. How many patients had different chronic diseases?

While the abstract mentions 6 states but only five are listed namely, Adamawa, Akwa Ibom, Cross River, Benue, and Niger. Line 30, add “individuals or participants or respondents” after 1,133. Line 31 and 32, the percentages should be replaced with absolute number or used in addition to absolute numbers. Line 32, the sentence that ends “are the most suitable population to use the smart lockers” is written like a conclusion rather than a finding. Please clarify what the sentence means or rewrite.

Does this statement “Out of the 180 responses received for” mean that the questionnaires were sent by mail? Does the statement also imply that some research respondents were included even though they were not HCWs or were not living with an NCD? The results section of the abstract needs to be restructured with findings on preferences presented separately for HCWs and for clients.

It’s not clear from reading the findings how the 1st concluding statement was reached at.

Introduction: Generally, well written but can be shortened. I find line 91-97 irrelevant or too broad and could be excluded so that smart lockers are described in the health care context. The “problem statement” and “justification” are all parts of the introduction. The subheadings are not necessary in the manuscript. Rather, the two sections should be consolidated into the introduction. Similarly, the aims and objectives can be added to the introduction usually as the last statement. E.g. This study described……... There is also no need for numbering since it’s one objective.

Methods:

The methods section is very comprehensive. As mentioned elsewhere, the multiple small headings are distractive. Several statements need to be contextualized as non-Nigerian readers may not know what secondary facilities are. So, a brief description of the levels of health facilities and referral patterns would be useful including what services are provided at primary, secondary and tertiary center.

Similarly, implementing partners should be explained as it applies to only HIV. Line 155, mention if this was a self-administered questionnaire. Clarify if HCWs and patients answered the same questionnaire. If not, what differed in the questionnaires.

Line 162, write in past tense. For patients, please clarify the age criteria. Were children excluded?

162-164: The two sentences should be combined by saying. This study included patients with chronic diseases and HCWs who manage them.

Sampling: Apart from patients with HIV, it’s not clear how patients with other chronic conditions were selected since to the best of my knowledge HIV patients receive care in different clinics from those with other conditions. Was there a deliberate attempt to select people from different clinics? Or were only people with HIV and another chronic condition selected?

Ethical statement: should just indicate that informed consent was obtained from all participants. Not sure what line 202 refers to or whether it’s needed.

Results are well written. The tables are clear, but they should be comprehensively labeled including more details, for examples Table 1: “Demographics of the participants”. The correct label should be “ Demographics of the participants pf patients with chronic diseases and HCWs in 5 states in Nigeria, YYYY). Apply this kind of naming to all tables and figures.

Line 223, it’s difficult to believe that any HCWs would be 18 years of age. Please clarify and the methods section could include what HCWs were included nurses, doctors etc. and why these were selected.

Table 2, the statement “The patients that might benefit from using the smart lockers to collect their medication” should be rewritten as “What patients that might benefit from using the smart lockers to collect their medication”. While this question is useful for HCWs, it was not right to ask people living with a chronic disease who they thought would benefit from the lockers.

Table 2 and 4 seem duplicative. Could be consolidated.

Line 280-282, what difference is being described?

Discussion:

A typical discussion should start with a description of what the study was about and what was done. Based on this the discussion should be rewritten to discuss the results rather than a general argument.

Reviewer #3: 1. More information is required in the background on traditional method of dispensing in order to bring out clearly its' challenges and support the need for an advanced technology;

2. 5 states were listed in the methods and not 6 as was stated in the preceding abstract;

3. It was not clear why these states were chosen and not others. There are 36 states in Nigeria and I will expect a spread in the choice but here we have 2 states from South West alone. This could represent bias in the study. Again, the chosen states are not the most viable socio=economically to support a new dispensing technology. The states are not the most populated such that there will be many outpatients that will stay for long hours to receive medications;

4. PLWHIV require specialized care from Consultants, which could only be obtained in tertiary health facilities in Nigferia and not secondary;

5. To qualify as a 'Nigerian' research, a state is to be selected from each of the 6 geopolitical zones of the country, else you should simply add 'some' or 'certain' States in Nigeria;

6. It was not clear whether the questionnaire is self administered or interviewer as as many in the patient group have only secondary education or below as their qualification and may not be able to comprehend the questionnaire easily;

7. Are these smart lockers manually or digitally operated?

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Orvalho Augusto

Reviewer #2: No

Reviewer #3: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PLoS One. 2024 Jul 5;19(7):e0303625. doi: 10.1371/journal.pone.0303625.r002

Author response to Decision Letter 0

12 Feb 2024

Dear Dr Orvalho Augusto, Reviewer 2 and Reviewer 3,

We express our gratitude for your valuable feedback and the chance to submit a revised draft of our manuscript, now titled Patients and Healthcare Workers' Preferences for Using Smart Lockers in Dispensing Chronic Disease Medication in Nigeria—Findings from a Descriptive Cross-Sectional Study. The meticulous attention to detail, as well as the time and resources dedicated to offering constructive comments and reviews, is sincerely appreciated. We have diligently incorporated changes to address the majority of the suggestions provided, ensuring that we contextualize some of the comments within the paper. Your input has significantly enhanced the quality and comprehensiveness of our work.

The following are the responses to the journal requirements:

1. The manuscript has been adjusted to reflect the PLOS One filing system requirement.

2. The PLOS questionnaire on inclusivity in global research does not apply because the research was conducted locally.

3. The acronym GUMC has been expanded accordingly.

4. Captions have been included at the end of the document.

Reviewer 1 (Orvalho Augusto): Thank you for your response, the subdivisions in this section have been merged. Lines 131 to 133 and lines 135 to 136 have been adjusted.

Reviewer 1 (Orvalho Augusto): Thank you for your response, the 50% expected response point is included in the sample size determination.

Reviewer 1 (Orvalho Augusto): We are appreciative of your feedback. The statement has been corrected to reflect the WHO definition of premature mortality.

Reviewer 1 (Orvalho Augusto): Thank you for pointing this out in line 195. It has been corrected.

Reviewer 1 (Orvalho Augusto): Thank you for your response. During the study, we considered the HCW as a unit providing care to patients living with chronic diseases, therefore, we did not collect the cadre of the participating HCWs, we only sampled their opinion on the suitable personnel for loading drugs into the smart lockers.

Table 2 and 4 have been harmonized.

Reviewer 2: Thank you for your suggestion on the topic. the title has been adjusted to reflect “Patients and Healthcare Workers' Preferences for Using Smart Lockers in Dispensing Chronic Disease Medication in Nigeria—findings from a descriptive cross-sectional study”

Reviewer 2: Thank you for your comments on this, we asked both the HCWs and patients same sets of questions on the preference of smart lockers in order to get an insight from HCWs who provide services and patients who receive services.

In addition HCW participants were exclusively asked on the suitable personnel for loading the smart lockers. Adjust lastly to reflect changes

Reviewer 2: Thank you for your question, the patients with these chronic diseases were examined.

728 (Table1)

Reviewer 2: Thank you for your feedback, this adjustment has been made to reflect 5 states as conducted in the study.

Thank you for pointing this out. “Participants have been included after 1,133 in line 30 in the manuscript”

Reviewer 2: Thank you and this is noted. Absolute numbers have been included in lines 31 and 32

Reviewer 2: The comment is appreciated, the statement on line 32 has been re-worded as findings.

Reviewer 2: Thank you for your response, it was 1,180 responses. The responses were received through electronic mails, social media platforms such as WhatsApp, LinkedIn, Instagram, and Facebook.

Reviewer 2: Thank you for your feedback on this, Line 91-97 have been removed and the sectionized problem statement and justification have been consolidated into the introduction.

Reviewer 2: Your response on this is deeply appreciated, the objectives statement has been adjusted to reflect just the objective and the numbering has been removed.

Reviewer 2: Thank you for your comments on this. The survey was conducted within the sites of the Implementing partners (IPs) not exclusively to the patients and healthcare workers of the Implementing Partners. Secondly, both the HCWs and patients answered the same sets of questions. Additionally, HCW participants were exclusively asked on the suitable personnel for loading the smart lockers.

Reviewer 2: Thank you for noting this comment, the participants were people above the age of 18 and children were not involved.

Reviewer 2: Thank you for pointing this out the lines 162-164inclusive of the study population have been merged into one statement.

Reviewer 2: Thank you for your comments on this, the survey was conducted within the sites of the Implementing partners (IPs) not exclusively to the patients and healthcare workers of the Implementing Partners.

Reviewer 2: This comment is appreciated. The ethical statement has been adjusted including adjustment to line 202.

Reviewer 2: Thank you for this comment on the titles of the tables. The titles of the tables have been adjusted as suggested.

Reviewer 2: Thank you, this is noted. The titles of the tables have been adjusted. The age band in this category was 18-35 years of age not limited to 18 years.

Reviewer 2: The basis for the selection of healthcare workers was the healthcare workforce that manages chronic disease at the clinics.

Reviewer 2: Thank you for your comment on what HCW/patients might benefit from using smart lockers, this has been addressed.

Reviewer 2: Thank you for noting this in this comment, tables 2 and 4 have been consolidated.

Reviewer 2: Thank you for your comments. The difference in lines 280-282 is addressed.

Reviewer 2: We are appreciative of your comment about the discussion, our discussion section has been adjusted accordingly.

Reviewer 3: Thank you. Further information has been provided in the background concerning traditional method of dispensing drugs.

Reviewer 3: Thank you for your comment, the number of states has been adjusted accordingly.

Reviewer 3: Thank you for your response. The participants were selected or identified through implementing partners in the country. These partners manage healthcare facilities within the 5 States captured in the study.

Reviewer 3: Thank you for your comment. This is noted.

Reviewer 3: Thank you for this comment. This is noted and adjusted.

Reviewer 3: Thank you for your comment on the questionnaire. The questionnaire was self-administered through electronic mail, social media networking sites and groups, through platforms, such as WhatsApp, Facebook, Instagram, and LinkedIn. The smart lockers will be both manually and digitally operated.

Reviewer 3: Thank you for this comment on sharing the TIFF format for figures within the document, but currently, this is not applicable as there are tables in the document but no figures.

We look forward to hearing from you in due time regarding our submission and to responding to any further questions and comments you may have.

Sincerely,

Ibrahim Bola Gobir.

Attachment

Submitted filename: Response letter to reviewers on PLOS ONE 13_2_2024.docx

pone.0303625.s007.docx^{(18.7KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0303625.r003

Decision Letter 1

Mohammed Shuaib

4 Mar 2024

PONE-D-23-39195R1Patients and Healthcare Workers' Preference for Using Smart Lockers in Dispensing Chronic Disease Medication in Nigeria: Findings from a Descriptive Cross-Sectional StudyPLOS ONE

Dear Dr. Gobir,

Please submit your revised manuscript by Apr 18 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

We look forward to receiving your revised manuscript.

Kind regards,

Mohammed Shuaib

Academic Editor

PLOS ONE

Additional Editor Comments:

This paper talks about an important topic and has considered some of the feedback from Reviewer 2. However, it looks like not all the comments have been dealt with. Please look at Reviewer 2's old and new comments again and update the manuscript .

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #2: No

**********

6. Review Comments to the Author

Reviewer #2: General comments:

Thank you for the opportunity to review the revised manuscript. The revised manuscript, documenting patients’ and health care workers’ preferences in accessing and dispensing chronic disease medications, reads better than the original draft.

The authors have addressed some of the prior comments, but the paper can be further improved by addressing some omissions, removing many distracting subheadings, and restructuring the discussion. Of note, the authors have not addressed key comments and have not explained why. While this paper is improved, the discussion section still needs revision.

As noted in my initial review, this paper addresses a topic of great importance regarding access to HIV and chronic disease medications. This innovation could help resource constrained countries accommodate the growing population of individuals needing medications for chronic diseases. As such, the authors should be given another opportunity to revise the paper

Title:

Line 1: Consider adding the word “accessing” to the title. So, the title can read “Patients and Healthcare Workers' Preference for Using Smart Lockers in Accessing and Dispensing Chronic Disease Medication in Nigeria: Findings from a Descriptive Cross-Sectional study”

Abstract:

Line 30, under results, the word “participants” should be added before the brackets.

Line 47, the sentence is incomplete. The two sentences could be combined or the first one revised to be meaningful.

Background:

Well written and addressed previous comments but can be shortened.

Line 113: The multiple subtitles are distracting. For example, there is no need to put the title “problem statement”. It’s supposed to be part of the introduction and could be removed for better flow.

Line 126: Similarly, the subtitle “justification” is not required. Its usually part of research proposals and not part of manuscripts

Line 140--143: please present as a sentence for easy reading. There is one objective, its not necessary to number one item. This is usually the last part of the background section

Methods

All comments addressed.

Results:

No comments. All prior comments addressed

Discussion:

The discussion should start with why the study was conducted, your key findings and discussion of the findings.

Acknowledgement section:

Written too informally. Could be shortened with a simple sentence that read “The authors would like to thank all those who contributed in one way or another to the collection and analysis of this data

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

**********

PLoS One. 2024 Jul 5;19(7):e0303625. doi: 10.1371/journal.pone.0303625.r004

Author response to Decision Letter 1

12 Mar 2024

Response to reviewer 2's comments

Thank you for taking the time to review our manuscript titled “Patients and Healthcare Workers' Preferences for Using Smart Lockers in Accessing and Dispensing Chronic Disease Medication in Nigeria: Findings from a Descriptive Cross-Sectional Study”, submitted to PLOS ONE We appreciate your insightful comments and constructive feedback, which have greatly contributed to improving the quality of our work.

Reviewer 2: Thank you for this response, The title has been revised as suggested.

Reviewer 2: Thank you for your comment. The word “participants” has been included in the bracket.

Reviewer 2: We appreciate your feedback. The statement has been adjusted to sound more meaningful.

Reviewer 2: Your comment is appreciated, in the background of our study, the paragraphs have been adjusted.

Reviewer 2: Thank you for your comment. This adjustment was made during the previous revision and the subtitles merged into the background.

Reviewer 2: We are appreciative of your feedback. This adjustment was made during the previous revision, and the sections were merged into the background.

Reviewer 2: Thank you for your comment. This adjustment to the methods was made during the previous revision.

Reviewer 2: Thank you for your response. The discussion session has been adjusted.

Reviewer 2: Thank you for your suggestion on the acknowledgement. It has been adopted.

Attachment

Submitted filename: Response letter to reviewers on PLOS ONE 13_2_2024.docx

pone.0303625.s008.docx^{(18.7KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0303625.r005

Decision Letter 2

Mohammed Shuaib

5 Apr 2024

PONE-D-23-39195R2Patients and Healthcare Workers' Preferences for Using Smart Lockers in Accessing and Dispensing Chronic Disease Medication in Nigeria: Findings from a Descriptive Cross-Sectional StudyPLOS ONE

Dear Dr. Gobir,

==============================

The paper addresses a significant topic concerning access to HIV and chronic disease medications, which underscores its importance in healthcare. However, it's concerning that some comments from the reviewer have not been adequately addressed in the latest round of revisions. It's crucial for the authors to take seriously the comments provided by the reviewer in previous rounds

Table 1, 2, and 3 require graphical representation to enhance the presentation of results and facilitate easier comprehension for readers. Incorporating visual aids such as graphs or charts can help convey complex information more effectively and improve the overall readability of the manuscript.

Additionally, while the paper is generally well-written, there may be some small errors that need to be addressed during proofreading. It's essential to ensure that the manuscript is free from grammatical errors, typos, and formatting issues before final submission.

==============================

Please submit your revised manuscript by May 20 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

We look forward to receiving your revised manuscript.

Kind regards,

Mohammed Shuaib

Academic Editor

PLOS ONE

Additional Editor Comments:

Background section:

1. Streamline the background section by eliminating unnecessary details and redundant phrases.

2. Break down lengthy sentences into shorter, more digestible segments to enhance readability.

3. Focus on highlighting the gap in existing literature regarding the use of smart lockers in Nigeria and emphasize the potential benefits of implementing such systems in healthcare.

Study Design section:

1. Provide additional context to explain why the descriptive cross-sectional design was chosen and how it aligns with the broader study objectives.

2. Clarify by adding additional paragraph the criteria used for selecting healthcare workers and patients to ensure consistency with the study's objectives.

3. Justify by adding additional paragraph the method used for determining the sample size, addressing any limitations associated with proxy estimates and assumptions.

Data Analysis section:

1. Offer more detail by adding additional paragraph on the specific variables analyzed during the study and the statistical tests performed.

2. Describe any assumptions made during the data analysis process and explain the rationale behind selecting Stata version 15 for analysis.

Discussion section :

1. Emphasize the study's objective of addressing the lack of research on smart locker implementation for chronic disease medication in Nigeria, highlighting its potential to alleviate healthcare burdens.

2. Discuss the overwhelming preference for smart locker use among persons living with HIV aged 18 to 40, underscoring the need for decentralized care models and the familiarity with community-based drug delivery.

3. Address the practicality by adding additional paragraph of one-on-one counseling for patient orientation on smart locker use, considering its effectiveness in overcoming barriers to understanding and the importance of ensuring patient adherence to medication regimens.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: I Don't Know

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #2: Yes

**********

6. Review Comments to the Author

Reviewer #2: (No Response)

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

**********

Attachment

Submitted filename: PONE-D-23-39195_R2_reviewer.pdf

pone.0303625.s009.pdf^{(2.9MB, pdf)}

PLoS One. 2024 Jul 5;19(7):e0303625. doi: 10.1371/journal.pone.0303625.r006

Author response to Decision Letter 2

24 Apr 2024

Thank you for providing valuable feedback and allowing us to resubmit a revised manuscript draft titled "Patients and Healthcare Workers' Preferences for Using Smart Lockers in Accessing and Dispensing Chronic Disease Medication in Nigeria: Findings from a Descriptive Cross-Sectional Study." Your thorough review has undoubtedly enhanced the quality and clarity of our work. A graphical representation has been provided to enhance the presentation of results for Tables 1, 2, and 3. The paper has been proofread and readjusted to remove errors.

Below, we have provided a detailed response to each point raised, outlining the revisions made to strengthen the manuscript.

Thank you for your comment. A graphical representation has been provided to enhance the presentation of results for Tables 1, 2, and 3

Thank you for your comment. The paper has been proofread and readjusted to remove errors.

Thank you for your suggestion. No changes were made to the financial disclosure statement.

Your comment on the background is well appreciated. The background of the study has been streamlined as requested.

Your comment is well received. Lengthy sentences have been made shorter and concise as prescribed.

Thank you for your comment, existing gaps in literature regarding our study is captured in the latter of the background section on page 5

Thank you for your comment on the study design. Additional context to explain why the descriptive cross-sectional design has been captured in the method section on page 6, this is captured through an explanation of our study population.

Your comment is very well appreciated on the inclusion criteria. Additional context has been provided in the inclusion criteria captured on page 6

Thank you for your comment. An additional paragraph has been added in the method section describing the selection of participants. The sample size was for both healthcare workers and patients have been included in the section as well.

Your comment is very well appreciated and received. An additional statement has been provided under the paragraph for each variable analyzed during the study and the statistical test performed on page 7.

Thank you for your comment. We have explained in the methods section on page 8, the assumptions made during the data analysis and the justification for using Stata 15 for analysis.

Your comment is well received and appreciated. On page 15 emphasis on the lack of research on smart lockers and implementation has been included as a preamble to discussing our findings.

Thank you for your comment. The preference for smart lockers among persons living with HIV aged 18-40 among most suitable settings is included in line 261 – 268

Thank you for your observation. The practicality of one-on-one counselling for patient orientation is discussed on page 17 lines 291-309

Attachment

Submitted filename: Response Letter to Reviewers_Man 3_21st April 2024.docx

pone.0303625.s010.docx^{(15.8KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0303625.r007

Decision Letter 3

Mohammed Shuaib

30 Apr 2024

Patients and Healthcare Workers' Preferences for Using Smart Lockers in Accessing and Dispensing Chronic Disease Medication in Nigeria: Findings from a Descriptive Cross-Sectional Study

PONE-D-23-39195R3

Dear Dr. Gobir,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Mohammed Shuaib

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: I Don't Know

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #2: Yes

**********

6. Review Comments to the Author

Reviewer #2: (No Response)

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

**********

PLoS One. doi: 10.1371/journal.pone.0303625.r008

Acceptance letter

Mohammed Shuaib

27 Jun 2024

PONE-D-23-39195R3

PLOS ONE

Dear Dr. Gobir,

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team.

At this stage, our production department will prepare your paper for publication. This includes ensuring the following:

* All references, tables, and figures are properly cited

* All relevant supporting information is included in the manuscript submission,

* There are no issues that prevent the paper from being properly typeset

If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps.

Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

If we can help with anything else, please email us at customercare@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Mohammed Shuaib

%CORR_ED_EDITOR_ROLE%

PLOS ONE

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

S1 File. Feasibility and acceptability of “smart lockers” for dispensing chronic disease medication in Nigeria.

(PDF)

pone.0303625.s001.pdf^{(576.7KB, pdf)}

S2 File

(XLSX)

pone.0303625.s002.xlsx^{(177.7KB, xlsx)}

S3 File. STROBE statement—Checklist of items that should be included in reports of cross-sectional studies.

(DOCX)

pone.0303625.s003.docx^{(24.5KB, docx)}

S4 File. PLOS ONE clinical studies checklist.

(DOCX)

pone.0303625.s004.docx^{(25.1KB, docx)}

S5 File. Inclusivity in global research.

(DOCX)

pone.0303625.s005.docx^{(66.8KB, docx)}

S1 Appendix. Distribution of states and facilities.

(DOCX)

pone.0303625.s006.docx^{(16.2KB, docx)}

Attachment

Submitted filename: Response letter to reviewers on PLOS ONE 13_2_2024.docx

pone.0303625.s007.docx^{(18.7KB, docx)}

Attachment

Submitted filename: Response letter to reviewers on PLOS ONE 13_2_2024.docx

pone.0303625.s008.docx^{(18.7KB, docx)}

Attachment

Submitted filename: PONE-D-23-39195_R2_reviewer.pdf

pone.0303625.s009.pdf^{(2.9MB, pdf)}

Attachment

Submitted filename: Response Letter to Reviewers_Man 3_21st April 2024.docx

pone.0303625.s010.docx^{(15.8KB, docx)}

Data Availability Statement

Data set supporting the findings of this study are available within the paper and its Supporting information files.

[pone.0303625.ref001] 1.CDC (2021). National Center for Chronic Disease Prevention and Health Promotion. About Chronic Diseases. Retrieved 25 March 2022 from https://www.cdc.gov/chronicdisease/about/index.htm.

[pone.0303625.ref002] 2.Anderson E., & Durstine J. L. (2019). Physical activity, exercise, and chronic diseases: A brief review. Sports Medicine and Health Science, 1(1), 3–10. doi: 10.1016/j.smhs.2019.08.006 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0303625.ref003] 3.Kunnumakkara A. B., Sailo B. L., Banik K., Harsha C., Prasad S., Gupta S. C., et al. (2018). Chronic diseases, inflammation, and spices: how are they linked? Journal of translational medicine, 16(1), 14. doi: 10.1186/s12967-018-1381-2 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0303625.ref004] 4.World Health Organization (2020). WHO reveals leading causes of death and disability worldwide: 2000–2019. Retrieved 25 March 2020 from https://www.who.int/news/item/09-12-2020-who-reveals-leading-causes-of-death-and-disability-worldwide-2000-2019.

[pone.0303625.ref005] 5.Sav A., Salehi A., Mair F.S. et al. Measuring the burden of treatment for chronic disease: implications of a scoping review of the literature. BMC Med Res Methodol 17, 140 (2017). doi: 10.1186/s12874-017-0411-8 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0303625.ref006] 6.Hajat C., & Stein E. (2018). The global burden of multiple chronic conditions: A narrative review. Preventive medicine reports, 12, 284–293. doi: 10.1016/j.pmedr.2018.10.008 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0303625.ref007] 7.Faronbi J. O., Ademuyiwa I. Y., & Olaogun A. A. (2020). Patterns of chronic illness among older patients attending a university hospital in Nigeria. Ghana medical journal, 54(1), 42–47. doi: 10.4314/gmj.v54i1.7 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0303625.ref008] 8.De Villiers K. Bridging the health inequality gap: an examination of South Africa’s social innovation in health landscape. Infect Dis Poverty 10, 19 (2021). doi: 10.1186/s40249-021-00804-9 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0303625.ref009] 9.Yusuff KB, Abd’ Wassi Sanni. Itinerant vending of medicines inside buses in Nigeria: vending strategies, dominant themes and medicine-related information provided. PubMed. 2011 Jul 1; [PMC free article] [PubMed]

[pone.0303625.ref010] 10.Mash R., Christian C., & Chigwanda R. V. (2021). Alternative mechanisms for delivery of medication in South Africa: A scoping review. South African family practice: official journal of the South African Academy of Family Practice/Primary Care, 63(1), e1–e8. doi: 10.4102/safp.v63i1.5274 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0303625.ref011] 11.Kiousis, V., Nathanail, E., Karakikes, I. (2019). Assessing Traffic and Environmental Impacts of Smart Lockers Logistics Measure in a Medium-Sized Municipality of Athens. In: Nathanail, E., Karakikes, I. (eds) Data Analytics: Paving the Way to Sustainable Urban Mobility. CSUM 2018. Advances in Intelligent Systems and Computing, vol 879. Springer, Cham. 10.1007/978-3-030-02305-8_74. [DOI]

[pone.0303625.ref012] 12.Ephraim-Emmanuel B, Adigwe A, Oyeghe R, Ogaji D (2018) 2875. Quality of health care in Nigeria: a myth or a reality. International Journal of Research in Medical Science- doi: 10.18203/2320-6012.ijrms20183621 [DOI] [Google Scholar]

[pone.0303625.ref013] 13.Adebayo O., Labiran A., Emerenini F. C. and Omoruyi L. (2016). Health Workforce for 2016–2030: Will Nigeria have enough? International Journal of Innovative Healthcare Research. 4(1), 9–16. [Google Scholar]

[pone.0303625.ref014] 14.Angell B., Sanuade O., Adetifa I.M.O., Okeke I.N., Adamu A.L., Aliyu M.H., et al. (2022). Population health outcomes in Nigeria compared with other west African countries, 1998–2019: a systematic analysis for the Global Burden of Disease Study. The Lancet, [online] 399(10330), pp.1117–1129. doi: 10.1016/S0140-6736(21)02722-7 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0303625.ref015] 15.Institute for Health Metrics and Evaluation (IHME) (2020). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, 2020. Retrieved 6 April 2022 from http://vizhub.healthdata.org/gbd-compare.

[pone.0303625.ref016] 16.Federal Ministry of Health, Nigeria. Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) 2018: Technical Report. Abuja, Nigeria. October 2019. Accessed 11 April 2022 from http://ciheb.org/media/SOM/Microsites/CIHEB/documents/NAIIS-Report-2018.pdf

[pone.0303625.ref017] 17.Rabkin M., Strauss M., Mantell J. E., Mapingure M., Masvawure T. B., Lamb M. R., et al. (2020). Optimizing differentiated treatment models for people living with HIV in urban Zimbabwe: Findings from a mixed methods study. PloS one, 15(1), e0228148. doi: 10.1371/journal.pone.0228148 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0303625.ref018] 18.Magadzire B.P., Marchal B. & Ward K. (2016). Novel models to improve access to medicines for chronic diseases in South Africa: an analysis of stakeholder perspectives on community-based distribution models. Journal of Pharmaceutical Policy and Practice, 9, 28 doi: 10.1186/s40545-016-0082-6 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0303625.ref019] 19.Muthelo L., Nemagumoni T., Mothiba T.M., Phukubje A.T. and Mabila L.N. (2020). Experiences of Professional Nurses Regarding the Implementation of a Central Chronic Medicine Dispensing and Distribution Program at Primary Health Care Facilities in South Africa. The Open Public Health Journal, 13(1), pp.477–483. doi: 10.2174/1874944502013010477 [DOI] [Google Scholar]

[pone.0303625.ref020] 20.Zhao J., Yan C., Han D., Wu Y., Liao H., Ma Y., et al. (2022). Inequity in the healthcare utilization among latent classes of elderly people with chronic diseases and decomposition analysis in China. BMC Geriatrics, 22(1). doi: 10.1186/s12877-022-03538-x [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0303625.ref021] 21.Nolte E., Merkur S., Anders Anell and European Observatory On Health Systems And Policies (2020). Achieving person-centred health systems: evidence, strategies and challenges. Cambridge; New York, Ny: Cambridge University Press. [Google Scholar]

[pone.0303625.ref022] 22.Dong R, Leung C, Naert MN, Naanyu V, Kiptoo P, Matelong W, et al. (2021) Chronic disease stigma, skepticism of the health system, and socio-economic fragility: Qualitative assessment of factors impacting receptiveness to group medical visits and microfinance for non-communicable disease care in rural Kenya. PLoS ONE 16(6): e0248496. doi: 10.1371/journal.pone.0248496 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0303625.ref023] 23.Idemudia E. S., Olasupo M. O., & Modibo M. W. (2018). Stigma and chronic illness: A comparative study of people living with HIV and/or AIDS and people living with hypertension in Limpopo Province, South Africa. Curationis, 41(1), e1–e5. doi: 10.4102/curationis.v41i1.1879 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0303625.ref024] 24.Nyblade L., Stockton M.A., Giger K., Bond V., Ekstrand M. L., Mc Lean R., et al. (2019). Stigma in health facilities: why it matters and how we can change it. BMC Med 17, 25. doi: 10.1186/s12916-019-1256-2 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0303625.ref025] 25.Peng Y, Jiang M, Shen X, Li X, Jia E, Xiong J. (2020). Preferences for Primary Healthcare Services Among Older Adults with Chronic Disease: A Discrete Choice Experiment. Patient Prefer Adherence;14:1625–1637. doi: 10.2147/PPA.S265093 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0303625.ref026] 26.Krzyzaniak N., Bajorek B. A global perspective of the roles of the pharmacist in the NICU (2017). International Journal of Pharmacy Practice, Volume 25, Issue 2, April 2017, Pages 107–120, doi: 10.1111/ijpp.12284 [DOI] [PubMed] [Google Scholar]

[pone.0303625.ref027] 27.Grilo, A. M., Santos, M. C. d., Isabel Gomes, A., & Rita, J. S. (2017). Promoting Patient-Centered Care in Chronic Disease. In (Ed.), Patient Centered Medicine. IntechOpen. 10.5772/67380 [DOI]

[pone.0303625.ref028] 28.Coventry P. A., Fisher L., Kenning C., Bee P., & Bower P. (2014). Capacity, responsibility, and motivation: a critical qualitative evaluation of patient and practitioner views about barriers to self-management in people with multimorbidity. BMC health services research, 14, 536. doi: 10.1186/s12913-014-0536-y [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0303625.ref029] 29.Pritchard D. E., Moeckel F., Villa M. S., Housman L. T., McCarty C. A., and McLeod H. L. (2017). Strategies for integrating personalized medicine into healthcare practice. Personalized Medicine, 14, 2, 141–152. doi: 10.2217/pme-2016-0064 [DOI] [PubMed] [Google Scholar]

[pone.0303625.ref030] 30.Donelan K., Barreto E. A., Sossong S., Michael C., Estrada J. J., Cohen A. B., et al. (2019). Patient and clinician experiences with telehealth for patient follow-up care. The American journal of managed care, 25(1), 40–44. [PubMed] [Google Scholar]

[pone.0303625.ref031] 31.Reed M. E., Huang J., Graetz I., Lee C., Muelly E., Kennedy C., et al. (2020). Patient Characteristics Associated With Choosing a Telemedicine Visit vs Office Visit With the Same Primary Care Clinicians. JAMA network open, 3(6), e205873. doi: 10.1001/jamanetworkopen.2020.5873 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0303625.ref032] 32.Al-Hassany L, Kloosterboer SM, Dierckx B, Koch BCP (2019). Assessing methods of measuring medication adherence in chronically ill children–a narrative review. Patient Preference and Adherence; 13:1175–1189. doi: 10.2147/PPA.S200058 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0303625.ref033] 33.Forenbacher Ivan, Husnjak Siniša, Ivan Cvitić Ivan Jovović, (2019). Determinants of mobile phone ownership in Nigeria. Telecommunications Policy,43, 7, 101812. doi: 10.1016/j.telpol.2019.03.00 [DOI] [Google Scholar]

PERMALINK

Patients and healthcare workers’ preferences for using smart lockers in accessing and dispensing chronic disease medication in Nigeria: Findings from a descriptive cross-sectional study

Ibrahim Bola Gobir

Samson Agboola

Havilah Onyinyechi Nnadozie

Helen Adamu

Fatimah Ohunene Sanni

Aisha Adamu

Azeez Akanbi Bello

Angmun Suzzy Otubu

Deus Bazira

Piring’ar Mercy Niyang

Roles

Abstract

Background

Method

Study design and setting

Study population

Inclusion criteria

Sample size determination

Healthcare workers (HCWs)

Patients of persons living with chronic illnesses

Selection of participants

Data collection

Data analysis

Ethical statement

Informed consent

Confidentiality

Risks and benefits

Results

Table 1. Demographics of the participants of patients with chronic diseases and health care workers in 5 states in Nigeria.

Fig 1. Demographic characteristics of the participants.

Table 2. The most suitable personnel to load the drugs into the smart lockers in 5 states in Nigeria.

Fig 2. The most suitable personnel to load the drugs into the smart lockers.

Fig 3. Preferred orientation method.

Fig 4. The best location for accessibility.

Fig 5. Preferred notification for drug pick-up.

Fig 6. Preferred access hours.

Fig 7. Patients who might benefit.

Fig 8. Age groups to use smart lockers.

Table 3. Preferences for the use of smart lockers in dispensing chronic disease medications in 5 states in Nigeria.

Discussion

Conclusion

Supporting information

Acknowledgments

Data Availability

Funding Statement

References

Decision Letter 0

Mohammed Shuaib

Roles

Author response to Decision Letter 0

Decision Letter 1

Mohammed Shuaib

Roles

Author response to Decision Letter 1

Decision Letter 2

Mohammed Shuaib

Roles

Author response to Decision Letter 2

Decision Letter 3

Mohammed Shuaib

Roles

Acceptance letter

Mohammed Shuaib

Roles

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

Similar articles

Cited by other articles

Links to NCBI Databases