Experiences and intentions of Ugandan household tuberculosis contacts receiving test results via text message: an exploratory study

Ggita, Joseph; Katahoire, Anne; Meyer, Amanda; Nansubuga, Elizabeth; Nalugwa, Talemwa; Turimumahoro, Patricia; Ochom, Emmanuel; Ayakaka, Irene; Haberer, Jessica; Katamba, Achilles; Armstrong-Hough, Mari; Davis, J. Lucian

doi:10.1186/s12889-020-8427-0

Cited by 6 publications

(5 citation statements)

References 21 publications

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“…As previously reported [ 30 ], the mHealth trial showed no improvement in the primary outcome of completing TB evaluation. Although household contacts and health workers spoke positively about the mobile app and text messaging, low rates of delivery and uptake of text-messaged instructions were observed [ 26 , 31 ]. Fingerprinting was also deemed acceptable, but implementation challenges resulted in inconsistent and declining use of the technology over time [ 27 ].…”

Section: Methodsmentioning

confidence: 99%

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: Methodsmentioning

confidence: 99%

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

Meyer¹,

Armstrong-Hough²,

Babirye³

et al. 2020

JMIR Mhealth Uhealth

Self Cite

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“…More generally, several systematic reviews have shown that there is substantial evidence for the utility of mobile phone reminders to improve antiretroviral therapy adherence for people living with HIV in East Africa [ 14 , 15 ]. Studies in Uganda suggest that SMS text messaging is also a feasible and acceptable platform to support tuberculosis medication adherence [ 16 , 17 ] and testing [ 18 , 19 ]. Given the rapid rise in mobile phone ownership and the types of phones available and the importance of tailored interventions, there is a pressing need to examine the current state of mobile phones among AYAs in East Africa.…”

Section: Introductionmentioning

confidence: 99%

The Promise and Peril of Mobile Phones for Youth in Rural Uganda: Multimethod Study of Implications for Health and HIV

Kreniske¹,

Basmajian²,

Nakyanjo³

et al. 2021

J Med Internet Res

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Background In East Africa, where landlines are used by 1% of the population and access to the internet is limited, owning a cell phone is rapidly becoming essential for acquiring information and resources. Our analysis illuminates the perils and potential promise of mobile phones with implications for future interventions to promote the health of adolescents and young adults (AYAs) and to prevent HIV infection. Objective The aim of this study is to describe the current state of AYAs’ phone use in the region and trace out the implications for mobile health interventions. Methods We identified 2 trading centers that were representative of southern Uganda in terms of key demographics, proportion of cell phone ownership, and community HIV prevalence. We stratified the sample of potential informants by age group (15-19 years and 20-24 years), gender, and phone ownership and randomly sampled 31 key informant interview participants within these categories. In addition, we conducted 24 ethnographic participant observations among AYAs in the communities of study. Results AYA frequently reported barriers to using their phones, such as difficulty accessing electricity. Nearly all AYAs used mobile phones to participate in the local economy and communicate with sexual partners. Phone use was frequently a point of contention between sexual partners, with many AYAs reporting that their sexual partners associated phone use with infidelity. Few AYAs reported using their phones for health-related purposes, with most getting health information in person from health workers. However, most AYAs reported an instance when they used their phone in an emergency, with childbirth-related emergencies being the most common. Finally, most AYAs reported that they would like to use their phones for health purposes and specifically stated that they would like to use their mobile phones to access current HIV prevention information. Conclusions This study demonstrates how mobile phones are related to income-generating practices in the region and communication with sexual partners but not access to health and HIV information. Our analysis offers some explanation for our previous study, which suggested an association between mobile phone ownership, having multiple sexual partners, and HIV risk. Mobile phones have untapped potential to serve as tools for health promotion and HIV prevention.

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“…Using quantitative short-survey instruments, such as the acceptability of implementation measure (AIM) [ 63 ] or the system usability scale (SUS) [ 64 ] to assess the implementation of these technologies might have allowed us to detect and correct such problems earlier. Additionally, household contacts found reporting of TB testing results less than acceptable as it did not permit direct and easy connection to CHWs (the toll-free, reply-only “HELP” function was insufficient) [ 38 ]. Even after receiving negative test results, contacts wanted a health worker to speak directly with them to confirm and explain the results, partly because of mistrust of the accuracy of results sent by SMS.…”

Section: Resultsmentioning

confidence: 99%

mHealth to improve implementation of TB contact investigation: a case study from Uganda

Gupta

Turimumahoro

Ochom

et al. 2023

Implement Sci Commun

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Background Implementation science offers a systematic approach to adapting innovations and delivery strategies to new contexts but has yet to be widely applied in low- and middle-income countries. The Fogarty Center for Global Health Studies is sponsoring a special series, “Global Implementation Science Case Studies,” to address this gap. Methods We developed a case study for this series describing our approach and lessons learned while conducting a prospective, multi-modal study to design, implement, and evaluate an implementation strategy for TB contact investigation in Kampala, Uganda. The study included formative, evaluative, and summative phases that allowed us to develop and test an adapted contact investigation intervention involving home-based sample collection for TB and HIV testing. We concurrently developed a multi-component mHealth implementation strategy involving fingerprint scanning, electronic decision support, and automated reporting of test results via text message. We then conducted a household-randomized, hybrid implementation-effectiveness trial comparing the adapted intervention and implementation strategy to usual care. Our assessment included nested quantitative and qualitative studies to understand the strategy’s acceptability, appropriateness, feasibility, fidelity, and costs. Reflecting on this process with a multi-disciplinary team of implementing researchers and local public health partners, we provide commentary on the previously published studies and how the results influenced the adaptation of international TB contact investigation guidelines to fit the local context. Results While the trial did not show improvements in contact investigation delivery or public health outcomes, our multi-modal evaluation strategy helped us identify which elements of home-based, mHealth-facilitated contact investigation were feasible, acceptable, and appropriate and which elements reduced its fidelity and sustainability, including high costs. We identified a need for better tools for measuring implementation that are simple, quantitative, and repeatable and for greater attention to ethical issues in implementation science. Conclusions Overall, a theory-informed, community-engaged approach to implementation offered many learnings and actionable insights for delivering TB contact investigation and using implementation science in low-income countries. Future implementation trials, especially those incorporating mHealth strategies, should apply the learnings from this case study to enhance the rigor, equity, and impact of implementation research in global health settings.

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Experiences and intentions of Ugandan household tuberculosis contacts receiving test results via text message: an exploratory study

Cited by 6 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

The Promise and Peril of Mobile Phones for Youth in Rural Uganda: Multimethod Study of Implications for Health and HIV

mHealth to improve implementation of TB contact investigation: a case study from Uganda

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