Using human-centered design to explore telemedicine to improve healthcare engagement among individuals transitioning from prison to community in Malaysia.

BACKGROUND

People who use drugs (PWUD) often underutilize healthcare services due to multifaceted barriers, especially those transitioning from the criminal legal system. The potential of telemedicine to improve healthcare access for PWUD transitioning from prison to the community remains underexplored. This study investigates the acceptability and feasibility of telemedicine among PWUD and their caregivers.

METHODS

We first conducted a cross-sectional survey to explore healthcare utilization patterns and incarceration history. Logistic regression identified factors associated with telemedicine interest. Subsequently, a purposive sample of survey participants (n = 9) provided contextual insights into telemedicine interest. Additionally, key informants-including recently incarcerated PWUD clients (n = 22), community outreach workers (n = 8), and physicians (n = 15)-were interviewed to assess their perspectives.

RESULTS

Among 512 PWUD, prior telemedicine experience was low (9.0%), yet interest was substantial (46%). Those who had been incarcerated showed greater interest in telemedicine (50% vs 37%, p = 0.014). Multivariable analysis indicated that telemedicine interest was associated with seeing a doctor in the past year (OR 2.07, p = 0.007), prior telemedicine experience (OR 8.46, p = 0.001), polysubstance use (OR 1.13, p = 0.046), and higher substance-use stigma (OR 1.15, p = 0.023). Interviews revealed that participants valued telemedicine for its convenience, stigma avoidance, decreased labor burden, and enhanced healthcare access. Both PWUD clients and healthcare workers emphasized the importance of involving trusted community NGOs.

CONCLUSIONS

Telemedicine offers a promising avenue to enhance healthcare access for marginalized populations, potentially overcoming barriers inherent in traditional healthcare settings. For PWUD transitioning from prison, collaboration with peer workers from NGOs, public clinica staff, and civil society partners may foster trust and tailor telemedicine programs to their specific needs.