Publication date: May 23, 2026
Background: Mobile health has been increasingly integrated into tuberculosis care to support patient education, communication, and treatment engagement. However, evidence remains limited regarding whether positive engagement with mHealth is associated with knowledge, attitudes, and practices among patients with multidrug-resistant tuberculosis. This study aimed to examine the association between positive mHealth engagement and knowledge, attitude, practice, and total KAP among patients with multidrug-resistant tuberculosis, and to evaluate the psychometric properties of the engagement score used as the primary exposure variable. Methods: A cross-sectional study was conducted among patients with multidrug-resistant tuberculosis. A positive mHealth engagement score was constructed from 12 mHealth-related items after harmonizing item directionality so that higher scores indicated more favorable engagement. The 12 items reflected five behavioural domains: intensity of use, ease and acceptability of use, functional engagement (communication with providers, access to health information, and perceived benefit for disease self-management), continuity of use, and barriers to sustained engagement. The composite score was computed as the mean of the 12 standardised items, with higher values indicating more positive engagement. Internal consistency was assessed using Cronbach’s alpha and corrected item-total correlations, and structural validity was explored using principal component analysis. Adjusted linear regression models were used to examine associations between the engagement score and Knowledge, Attitude, Practice, and total KAP scores, controlling for age, sex, and occupation. Sensitivity analyses were performed after excluding a poorly performing item, and tertile analyses were used to assess dose-response patterns. Results: The positive mHealth engagement score showed good internal consistency, with a Cronbach’s alpha of 0. 852. One item demonstrated poor psychometric performance, and Cronbach’s alpha increased to 0. 864 after its exclusion. The data were suitable for dimensionality assessment, with a Kaiser-Meyer-Olkin value of 0. 870 and a significant Bartlett’s test. Principal component analysis identified a dominant first component explaining 43. 29% of the total variance. Using the refined score, higher positive mHealth engagement was significantly associated with higher Knowledge scores (β = 2. 06; 95% CI: 1. 28-2. 85; p
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Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | Multidrug-Resistant Tuberculosis |
| disease | MESH | tuberculosis |
| pathway | KEGG | Tuberculosis |
| drug | DRUGBANK | Tropicamide |