“Even if You Know Everything You Can Forget”: Health Worker Perceptions of Mobile Phone Text-Messaging to Improve Malaria Case-Management in Kenya

Abstract

This paper presents the results of a qualitative study to investigate the perceptions and experiences of health workers involved in a a cluster-randomized controlled trial of a novel intervention to improve health worker malaria case-management in 107 government health facilities in Kenya. The intervention involved sending text-messages about paediatric outpatient malaria case-management accompanied by “motivating” quotes to health workers’ mobile phones. Ten malaria messages were developed reflecting recommendations from the Kenyan national guidelines. Two messages were delivered per day for 5 working days and the process was repeated for 26 weeks (May to October 2009). The accompanying quotes were unique to each message. The intervention was delivered to 119 health workers and there were significant improvements in correct artemether-lumefantrine (AL) management both immediately after the intervention (November 2009) and 6 months later (May 2010). In-depth interviews with 24 health workers were undertaken to investigate the possible drivers of this change. The results suggest high acceptance of all components of the intervention, with the active delivery of information in an on the job setting, the ready availability of new and stored text messages and the perception of being kept ‘up to date’ as important factors influencing practice. Applying the construct of stages of change we infer that in this intervention the SMS messages were operating primarily at the action and maintenance stages of behaviour change achieving their effect by creating an enabling environment and providing a prompt to action for the implementation of case management practices that had already been accepted as the clinical norm by the health workers. Future trials testing the effectiveness of SMS reminders in creating an enabling environment for the establishment of new norms in clinical practice as well as in providing a prompt to action for the implementation of the new case-management guidelines are justified.

Integrating mHealth at point of care in low- and middle-income settings: the system perspective

“…Successful integration of mHealth projects into the health system requires both front-line and end-users to adopt the technology into their clinical practice and workflow, and changing clinical behaviour can be extremely difficult in any resource setting. Pilot projects are typically introduced to front-line users by in-service training, but these have been shown to be insufficient to produce clinical practice change, and any change that is produced quickly disappears unless there is adequate on-site support [34]. In fact, a systematic review showed that educational material alone has no impact on clinical behaviour [34].…”

“…Pilot projects are typically introduced to front-line users by in-service training, but these have been shown to be insufficient to produce clinical practice change, and any change that is produced quickly disappears unless there is adequate on-site support [34]. In fact, a systematic review showed that educational material alone has no impact on clinical behaviour [34]. Failure to plan for appropriate on-going on-site support will lead to failure beyond the initial pilot phase.…”

Enhancing HIV Treatment Access and Outcomes Amongst HIV Infected Children and Adolescents in Resource Limited Settings

“…Through a public–private partnership South African HIV treatment guidelines are available through Google Play (Android devices) or the App Store (iOS devices) and preliminary data show that 6006 healthcare workers were empowered through the app and more than 200,000 people accessed the application (www.openmedicineproject.org) during its first month of implementation. The benefits of mobile technology was also demonstrated in Kenya where short reminder cell phone messages to healthcare providers maintained knowledge and enabled the implementation of guidelines more successfully, compared with once off training only (Jones et al 2012). Increased exposure to information could create new opportunities for HIV-related care to become habit/routine.…”

Predicting Participant Consent in mHealth Trials – A Caregiver’s Perspective

“…One example of a study employing RCTs to examine the efficacy of mHealth include Watts et al, (2013) who conducted a RCT comparing the delivery modality (mobile phone/tablet or fixed computer) of a cognitive behavioural therapy intervention for the treatment of depression. Other examples based in developing countries can be found in the work of Chang et al, (2011), Hoffman et al, (2010, Jones et al,(2012), Lester et al,(2010); Mbuagbaw et al,(2012), Pop-Eleches et al, (2011), & Zurovac et al, (2011. …”