Acceptability of a mHealth strategy for hypertension management in a low-income and middle-income country setting: a formative qualitative study among patients and healthcare providers

Abstract

BackgroundUnderstanding contextual needs and preferences is important for a successful design and effective outcome of a mHealth strategy.ObjectivesThis formative study aimed to explore the perspectives of patients and providers on the acceptability of a mHealth (text message) strategy and elicit preferred features of a mHealth strategy for hypertension management.DesignA qualitative study was conducted using in-depth interviews and focus group discussions guided by the technology acceptance model.SettingThe study was conducted at primary healthcare facilities and at a tertiary level referral hospital in Kathmandu, Nepal.ParticipantsA total of 61 participants, patients with hypertension (n=41), their family members (n=5), healthcare workers (n=11) and key informants (n=4) were included. We purposively recruited patients with hypertension aged 30–70 who attended the selected healthcare facilities to obtain maximum variation based on their age, sex and literacy.ResultsThe respondents perceived the mHealth strategy to be useful as it would reinforce medication compliance and behaviour change. Participants valued the trustworthiness of information from health authorities that could be delivered privately. Some implementation challenges were identified including a lack of technical manpower, resources for software development, gaps in recording a patient’s essential information and digital illiteracy. Solutions proposed were having system-level preparedness for recording the patient’s details, establishing a separate technical department in the hospital and involving a family member to assist illiterate/elderly patients. In addition, participants preferred text messages in the local language, containing comprehensive contextual content (disease, treatment, cultural foods and misconceptions) delivered at regular intervals (2–3 times/week) preferably in the morning or evening.ConclusionsWe found that a simple text messaging strategy was acceptable for hypertension management in this low/middle-income country setting. However, meticulous planning must address the needs of a diverse range of participants to ensure the mHealth strategy is acceptable to wider groups.

Effectiveness and Acceptability of a Mobile Phone Text Messaging Intervention to Improve Blood Pressure Control (TEXT4BP) among Patients with Hypertension in Nepal: A Feasibility Randomised Controlled Trial

“…Another recent systematic review and meta-analysis that focused on 24 randomised trials using mHealth interventions among hypertensive patients provided evidence of a greater reduction of both SBP -3.78 mmHg and DBP -1.57 mmHg among the mHealth intervention groups [40]. However, most of these studies (22) were from HICs, and only 10 studies used text messages as an intervention; the other studies used interventions based on apps and other types of mHealth.…”

“…Intervention development and delivery were informed by formative qualitative studies [22,23], and used a well-tested model of behaviour change, the COM-B model (Capability, Opportunity and Motivation-Behaviour) of the behaviour change wheel and behaviour change techniques (BCTs) [29]. We first mapped the enablers and barriers for medication adherence and change in lifestyle identified in the formative study [22] under the components of COM-B model. The content of the SMS intervention was developed using relevant behaviour change techniques (BCTs) to systematically address enablers and barriers.…”

“…Formative studies [22,23] informed our intervention through input from patients with hypertension, health care providers and key informants. However, participants were not invited to comment on the study design or contribute to research results and dissemination.…”

“…Our intervention development followed a vigorous co-designed method, informed by the COM-B behaviour change model [29] and evidence of formative studies [22,23], which ensured the robustness of our intervention. We have previously described the details of the intervention and delivery [24] that can be replicated.…”

“…The potential of mobile phones in the management of hypertension has yet to be evaluated in Nepal. Our formative work in Nepal [22,23] found health workers and patients with hypertension to be highly receptive towards mobile phone interventions, such as messaging to reinforce the value of medication adherence (based on theories of behaviour modification). We therefore assessed the effectiveness and acceptability of a text message intervention to improve BP control (TEXT4BP) and treatment adherence among patients with hypertension attending a tertiary hospital in Nepal.…”