Cargando…
Implementing mHealth Interventions in a Resource-Constrained Setting: Case Study From Uganda
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...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
JMIR Publications
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7385635/ https://www.ncbi.nlm.nih.gov/pubmed/32673262 http://dx.doi.org/10.2196/19552 |
_version_ | 1783563826986221568 |
---|---|
author | Meyer, Amanda J Armstrong-Hough, Mari Babirye, Diana Mark, David Turimumahoro, Patricia Ayakaka, Irene Haberer, Jessica E Katamba, Achilles Davis, J Lucian |
author_facet | Meyer, Amanda J Armstrong-Hough, Mari Babirye, Diana Mark, David Turimumahoro, Patricia Ayakaka, Irene Haberer, Jessica E Katamba, Achilles Davis, J Lucian |
author_sort | Meyer, Amanda J |
collection | PubMed |
description | 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 |
format | Online Article Text |
id | pubmed-7385635 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | JMIR Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-73856352020-08-12 Implementing mHealth Interventions in a Resource-Constrained Setting: Case Study From Uganda Meyer, Amanda J Armstrong-Hough, Mari Babirye, Diana Mark, David Turimumahoro, Patricia Ayakaka, Irene Haberer, Jessica E Katamba, Achilles Davis, J Lucian JMIR Mhealth Uhealth Original Paper 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 JMIR Publications 2020-07-13 /pmc/articles/PMC7385635/ /pubmed/32673262 http://dx.doi.org/10.2196/19552 Text en ©Amanda J Meyer, Mari Armstrong-Hough, Diana Babirye, David Mark, Patricia Turimumahoro, Irene Ayakaka, Jessica E Haberer, Achilles Katamba, J Lucian Davis. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 13.07.2020. https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included. |
spellingShingle | Original Paper Meyer, Amanda J Armstrong-Hough, Mari Babirye, Diana Mark, David Turimumahoro, Patricia Ayakaka, Irene Haberer, Jessica E Katamba, Achilles Davis, J Lucian Implementing mHealth Interventions in a Resource-Constrained Setting: Case Study From Uganda |
title | Implementing mHealth Interventions in a Resource-Constrained Setting: Case Study From Uganda |
title_full | Implementing mHealth Interventions in a Resource-Constrained Setting: Case Study From Uganda |
title_fullStr | Implementing mHealth Interventions in a Resource-Constrained Setting: Case Study From Uganda |
title_full_unstemmed | Implementing mHealth Interventions in a Resource-Constrained Setting: Case Study From Uganda |
title_short | Implementing mHealth Interventions in a Resource-Constrained Setting: Case Study From Uganda |
title_sort | implementing mhealth interventions in a resource-constrained setting: case study from uganda |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7385635/ https://www.ncbi.nlm.nih.gov/pubmed/32673262 http://dx.doi.org/10.2196/19552 |
work_keys_str_mv | AT meyeramandaj implementingmhealthinterventionsinaresourceconstrainedsettingcasestudyfromuganda AT armstronghoughmari implementingmhealthinterventionsinaresourceconstrainedsettingcasestudyfromuganda AT babiryediana implementingmhealthinterventionsinaresourceconstrainedsettingcasestudyfromuganda AT markdavid implementingmhealthinterventionsinaresourceconstrainedsettingcasestudyfromuganda AT turimumahoropatricia implementingmhealthinterventionsinaresourceconstrainedsettingcasestudyfromuganda AT ayakakairene implementingmhealthinterventionsinaresourceconstrainedsettingcasestudyfromuganda AT habererjessicae implementingmhealthinterventionsinaresourceconstrainedsettingcasestudyfromuganda AT katambaachilles implementingmhealthinterventionsinaresourceconstrainedsettingcasestudyfromuganda AT davisjlucian implementingmhealthinterventionsinaresourceconstrainedsettingcasestudyfromuganda |