Process evaluation of a mobile health intervention for people with diabetes in low income countries – the implementation of the TEXT4DSM study

Abstract

Introduction Evidence about mobile health (mHealth) approaches to manage diabetes shows modest effects on outcomes, but little is known about implementation variability. This is a process evaluation of an mHealth intervention to improve diabetes self-management through Short Message Service (SMS) provision in three diabetes care programmes in the Democratic Republic of Congo (DRC), Cambodia and the Philippines. Methods The intervention involved Diabetes Self-Management Support via text messages. The content and process of the intervention is based upon the core principles of diabetes self-management and behaviour theory. In each country, messages were sent by project managers to 240 participants in each country, who were randomly assigned to the intervention group. Contracts were negotiated with national phone providers and open access software was used to send the messages. Participants received a mobile phone and SIM card. We analysed data about the implementation process over a one year period. Results The mean monthly number of messages delivered to recipients' phones was 67.7% of the planned number in DRC, 92.3% in Cambodia and 83.9% in the Philippines. A telephone check revealed problems with one-third of the phones, including breakage, loss and cancelled subscriptions. The number of people reached at least once was 177 (70.0%) in DRC; 147 (60.7%) in Cambodia; five in the Philippines (2.0%). Those reached each time was 144 in DRC (56.9%), 28 (9.9%) in Cambodia, none in the Philippines. People used their phone more frequently than before the intervention. Discussion Implementation of the intervention meets constraints at every step in the process. Barriers relate to the technology, the context and the participants.

Review of patients perspective’s of m-health adoption factors in the developing world. Development of a framework

“…Research methods used in the 54 reviewed resources were: 25 qualitative papers , 9 surveys [42][43][44][45][46][47][48][49][50], 7 mixed methods [51][52][53][54][55][56][57], 4 experimental [52,[58][59][60], 3 usability assessments [8,61,62], 2 cohort studies [63,64], and 4 cross sectional studies [65][66][67][68]. Collectively they reported the spectrum of factors that affect patient adoption.…”

“…Collectively they reported the spectrum of factors that affect patient adoption. The papers reported a variety of m-health uses, including assisting communication and information management [18,22,24,28,31,33,40,54,61], HIV/AIDs and tuberculosis drug adherence [21, 26, 27, 38, 39, 44, 45, 48, 50-52, 57-60, 67-69], maternal health support [8,19,21,25,27,29,41,49,50,62], mental health support [35,43,55,64], and monitoring malaria [47,65]. Data were abstracted and adoption factors initially summarised and grouped under headings based on 11 common uses of m-Health extracted from the results.…”

“…English speakers predominate as users of the www [97] and, as a result, much of the content remains in English, which poses a concern if patients are to relate to and adopt mhealth content. Most people in the developing world will choose their local languages over English for information dissemination because they consider English di cult to understand [55]. The issue of language used by healthcare service providers to communicate to patients, whether written or spoken, can become a barrier to care and m-health adoption when patients are not con dent in communicating in its use or understanding [22,61].…”

A Proposed Framework of Factors Affecting Patient Adoption of mHealth in the Developing World.

“…Research methods used in the 54 reviewed resources were 25 qualitative papers [6,21,22,48,60,37,31,29,43,82,85,87,38,51,14,44,53,54,49,10,32,33,46,34,84], 9 surveys [7,8,45,4,16,13,23,28,18], mixed methods 7 [9,27,47,86,88,89,90], experimental 4 [19,26,36,91], 3 usability assessments [92,15,5], 2 cohort studies [11,41], and 4 were cross sectional [17,<...>…”

Validation of the Chinese Non‐pharmacological Therapy Experience Scale in persons with intellectual disability

“…Researchers are aiming to better understand the key components in an intervention process and the fidelity in the implementation of that intervention (i.e. whether the intervention was delivered as planned) (Arends, Bode, Taal, & Van de Laar, ; Trigwell et al, ; Van Olmen et al, ). In this way, they can improve the process of implementing the intervention (Driediger et al, ; Liu et al, ).…”