Challenges and solutions implementing an SMS text message-based survey CASI and adherence reminders in an international biomedical HIV PrEP study (MTN 017)

Brown, William; Giguere, Rebecca; Sheinfil, Alan Z.; Ibitoye, Mobolaji; Balán, Iván C.; Ho, Titcha; Brown, Benjamin; Quispe, Luis Vásquez; Sukwicha, Wichuda; Lama, Javier R.; Carballo‐Diéguez, Alex; Cranston, Ross D.

doi:10.1016/j.jbi.2018.02.018

Cited by 26 publications

(32 citation statements)

References 21 publications

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“…Second, we used one particular software system and a limited range of hardware, which might limit the generalizability of this case study to other platforms. However, other projects in Sub-Saharan Africa have reported similar challenges with other mHealth platforms, leading us to believe that our findings transcend any specific software or hardware [ 24 , 25 ]. Third, new technologies are continually being developed and rapidly improved while academic evaluations such as this one move more slowly, potentially decreasing the relevance of our findings as newer technologies may not face the same challenges our study team experienced.…”

Section: Resultsmentioning

confidence: 73%

“…Goals and feedback , a subconstruct in the inner setting domain, focuses on how well objectives are articulated and communicated to key stakeholders during implementation [ 18 ]. Software systems may not format data for easy management and timely dissemination to stakeholders, as others have observed [ 25 ]. In our project, consolidating, cleaning, analyzing, and disseminating data was time-consuming and required staff with advanced training in epidemiology and data management, as well as external data management and analysis apps, including Excel (Microsoft Corporation) and STATA (Stata Corporation).…”

Section: Resultsmentioning

confidence: 99%

“…Although the CFIR and other determinant frameworks have been widely applied to characterize implementation research [ 21 - 23 ], the CFIR has rarely if ever been used to examine the unique challenges associated with implementing mHealth interventions. Moreover, formal evaluations of mHealth implementation outcomes are especially important in low- and middle-income countries where information technology (IT) resources are more constrained, yet very few analyses of mHealth interventions in these settings have directly examined these challenges [ 24 , 25 ]. We used the CFIR to describe the process of implementing a complex mHealth intervention for tuberculosis (TB) case finding in Kampala, Uganda, in the context of a randomized controlled trial that showed no effect on the primary outcome.…”

Section: Introductionmentioning

confidence: 99%

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Implementing mHealth Interventions in a Resource-Constrained Setting: Case Study From Uganda

Meyer¹,

Armstrong-Hough²,

Babirye³

et al. 2020

JMIR Mhealth Uhealth

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Background Mobile health (mHealth) interventions are becoming more common in low-income countries. Existing research often overlooks implementation challenges associated with the design and technology requirements of mHealth interventions. Objective We aimed to characterize the challenges that we encountered in the implementation of a complex mHealth intervention in Uganda. Methods We customized a commercial mobile survey app to facilitate a two-arm household-randomized, controlled trial of home-based tuberculosis (TB) contact investigation. We incorporated digital fingerprinting for patient identification in both study arms and automated SMS messages in the intervention arm only. A local research team systematically documented challenges to implementation in biweekly site visit reports, project management reports, and minutes from biweekly conference calls. We then classified these challenges using the Consolidated Framework for Implementation Research (CFIR). Results We identified challenges in three principal CFIR domains: (1) intervention characteristics, (2) inner setting, and (3) characteristics of implementers. The adaptability of the app to the local setting was limited by software and hardware requirements. The complexity and logistics of implementing the intervention further hindered its adaptability. Study staff reported that community health workers (CHWs) were enthusiastic regarding the use of technology to enhance TB contact investigation during training and the initial phase of implementation. After experiencing technological failures, their trust in the technology declined along with their use of it. Finally, complex data structures impeded the development and execution of a data management plan that would allow for articulation of goals and provide timely feedback to study staff, CHWs, and participants. Conclusions mHealth technologies have the potential to make delivery of public health interventions more direct and efficient, but we found that a lack of adaptability, excessive complexity, loss of trust among end users, and a lack of effective feedback systems can undermine implementation, especially in low-resource settings where digital services have not yet proliferated. Implementers should anticipate and strive to avoid these barriers by investing in and adapting to local human and material resources, prioritizing feedback from end users, and optimizing data management and quality assurance procedures. Trial Registration Pan-African Clinical Trials Registration PACTR201509000877140; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=877

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Section: Resultsmentioning

confidence: 73%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Implementing mHealth Interventions in a Resource-Constrained Setting: Case Study From Uganda

Meyer¹,

Armstrong-Hough²,

Babirye³

et al. 2020

JMIR Mhealth Uhealth

View full text Add to dashboard Cite

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“…Couples who are trying to achieve pregnancy may be highly motivated and weekly SMS reminders would not be sufficient for appropriately tracking a fertile window. In addition, our participants reported minimal confidentiality and disclosure concerns, which has also been linked with SMS intervention success (43)(44)(45)(46).…”

Section: Discussionmentioning

confidence: 74%

A clinic-based tablet application to support safer conception among HIV serodiscordant couples in Kenya: feasibility and acceptability study

Velloza¹,

Ngure²,

Kiptinness³

et al. 2019

mHealth

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Background: HIV serodiscordant couples are at heightened risk of HIV transmission when attempting to conceive, yet reproductive goals can outweigh concerns about HIV exposure. Safer conception strategies support fertility desires while minimizing HIV transmission risk and novel mHealth tools can optimize their use. The objective of this analysis is to examine the feasibility and usability of short message service (SMS) messages and a mobile application to support safer conception for HIV serodiscordant couples. Methods: We enrolled 74 heterosexual HIV serodiscordant couples with immediate pregnancy desires into a pilot safer conception intervention study in Thika, Kenya. Prior to pregnancy, women received daily 6-item SMS surveys to capture fertility indicators (e.g., menses, basal body temperature) and sexual behavior. The intervention also provided daily oral pre-exposure prophylaxis (PrEP) for the HIV-negative partner and in-depth counseling to accompany publicly-provided antiretroviral therapy (ART) for the HIV-infected partner. Couples attended monthly visits until pregnancy occurred. We measured PrEP use with medication event monitoring system (MEMS) caps and ART use via quarterly viral load quantification. We imported SMS, MEMS, and viral load data into an Android tablet application designed specifically for this setting for couples to view during clinic visits and included predictions of peak fertility days using SMS data. We used descriptive statistics to summarize SMS response data and developed a Google Analytics platform to monitor tablet application usage during follow-up. We also conducted semi-structured interviews with a purposive sample of 5 healthcare providers and 19 couples. Qualitative data were analyzed using a modified constant comparative approach to identify themes related to mHealth intervention feasibility and acceptability. Results: In our sample, 34 (45.9%) couples had an HIV-infected female partner. The median age of the female partner was 30 years [interquartile range (IQR), 27-35 years], education was 10 years (IQR, 8-12 years), and partnership duration was 3 years (IQR, 2-7 years). Couples were followed for a median of 218 days (IQR, 116-348 days) prior to pregnancy. Participants completed 13,181 of 16,905 (78.0%) SMS surveys surveys sent with a median of 167 completed surveys (IQR, 74-299) per participant. Most participants completed at least 75% of the total SMS messages received (N=58; 77.3%). The tablet application was opened by counselors 1,806 times during the study period (March 2016 through April 2018). In qualitative interviews, the SMS messages were reportedly easy to respond to and "part of the daily routine". Few participants had concerns about message confidentiality. mHealth tools were also found to be acceptable for mHealth, 2019 Page 2 of 14 © mHealth. All rights reserved. mHealth 2019;5:4 mhealth.amegroups.com tracking fertility indicators and enhancing provider-patient communication. Conclusions: mHealth strategies are feasible to use and acceptable to support th...

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“…Health workers are also increasingly utilizing SMS based reminder systems to improve health service uptake and continuity of care. Hence, simple and effective SMS based mHealth interventions that can be integrated in the existing health systems are required to increase caregiver's attendance for timely immunization of children in Ethiopia [31].…”

Section: Discussionmentioning

confidence: 99%

Development of automated text-message reminder system to improve uptake of childhood vaccination in North-West, Ethiopia

Mekonnen

Hussien

Tilahun

et al. 2019

OJPHI

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Introduction: Non-attendance and delay for vaccination schedules remains a big challenge to healthcare workers. Among the frequently mentioned reasons for missed vaccination in children is the lack of communication between child caretakers and health workers. This necessitates developing an appropriate and uninterrupted vaccine delivery strategy with more focus on demand side interventions like forgetfulness.Objectives: This paper aimed to develop and test an automated mobile text message reminder system in the local context.Methods: Before development of the system, interview and document reviews were used for requirement gathering. This system is developed using iterative development process through phases of requirement analysis, design, development, testing and refinement. Front end application was developed using Java technologies while back end applications were developed with Oracle database. Finally, pilot testing was done on 30 participants before actual implementation.Results: The automated system has been developed based on requirements. The text message reminder system has two components: 1. Web based application for client registration and automatic reminder scheduling; 2.SMS application for automatic SMS text messaging. In the final testing, all the messages (100%) were delivered to the piloted mothers. Message speeds for each individual client ranged on average from 5 second to 30 seconds.Conclusion: Text message reminder system has been developed for routine childhood immunization program in Ethiopian context. Text message interventions should be carefully developed, tested and refined before implementation to ensure they are written in the most appropriate way for their target population.

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Challenges and solutions implementing an SMS text message-based survey CASI and adherence reminders in an international biomedical HIV PrEP study (MTN 017)

Abstract: We identified factors that aid international implementation and operation of SMS-CASI for real-time adherence monitoring. The challenges and solutions we present can aid other researchers to develop and manage an international multilingual SMS-based adherence reminder and CASI system.

Cited by 26 publications

References 21 publications

Implementing mHealth Interventions in a Resource-Constrained Setting: Case Study From Uganda

Implementing mHealth Interventions in a Resource-Constrained Setting: Case Study From Uganda

A clinic-based tablet application to support safer conception among HIV serodiscordant couples in Kenya: feasibility and acceptability study

Development of automated text-message reminder system to improve uptake of childhood vaccination in North-West, Ethiopia

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