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Mobile health treatment support intervention for HIV and tuberculosis in Mozambique: Perspectives of patients and healthcare workers
Örebro University, Orebro University School of Business, Örebro University, Sweden. Department of Mathematics and Informatics, Eduardo Mondlane University, Maputo, Mozambique.ORCID iD: 0000-0001-8933-2906
Örebro University, Orebro University School of Business, Örebro University, Sweden.ORCID iD: 0000-0002-3713-346X
Örebro University, Orebro University School of Business, Örebro University, Sweden.ORCID iD: 0000-0002-1337-2394
2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 4, e0176051Article in journal (Refereed) Published
Abstract [en]

Background: Studies have been conducted in developing countries using SMS to communicate with patients to reduce the number of missed appointments and improve retention in treatment, however; very few have been scaled up. One possible reason for this could be that patients or staff are dissatisfied with the method in some way. This paper reports a study of patients' and healthcare workers' (HCW) views on an mHealth intervention aiming to support retention in antiretroviral therapy (ART) and tuberculosis (TB) treatment in Mozambique.

Methods: The study was conducted at five healthcare centres in Mozambique. Automated SMS health promotions and reminders were sent to patients in a RCT. A total of 141 patients and 40 HCWs were interviewed. Respondents rated usefulness, perceived benefits, ease of use, satisfaction, and risks of the SMS system using a Likert scale questionnaire. A semi-structured interview guide was followed. Interviews were transcribed and thematic analysis was conducted.

Results: Both patients and HCW found the SMS system useful and reliable. Most highly rated positive effects were reducing the number of failures to collect medication and avoiding missing appointments. Patients' confidence in the system was high. Most perceived the system to improve communication between health-care provider and patient and assist in education and motivation. The automatic recognition of questions from patients and the provision of appropriate answers (a unique feature of this system) was especially appreciated. A majority would recommend the system to other patients or healthcare centres. Risks also were mentioned, mostly by HCW, of unintentional disclosure of health status in cases where patients use shared phones.

Conclusions: The results suggest that SMS technology for HIV and TB should be used to transmit reminders for appointments, medications, motivational texts, and health education to increase retention in care. Measures must be taken to reduce risks of privacy intrusion, but these are not a main obstacle for scaling up systems of this kind.

Place, publisher, year, edition, pages
Public Library of Science , 2017. Vol. 12, no 4, e0176051
National Category
Information Systems, Social aspects
Identifiers
URN: urn:nbn:se:oru:diva-57686DOI: 10.1371/journal.pone.0176051ISI: 000399875200064PubMedID: 28419149ScopusID: 2-s2.0-85017624472OAI: oai:DiVA.org:oru-57686DiVA: diva2:1096121
Available from: 2017-05-17 Created: 2017-05-17 Last updated: 2017-05-22Bibliographically approved
In thesis
1. Integration of Mobile Technologies with Routine Healthcare Services in Mozambique
Open this publication in new window or tab >>Integration of Mobile Technologies with Routine Healthcare Services in Mozambique
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Mobile technologies are emerging as one way to help address health challenges in many countries, including in Least Developed Countries. Mobile technology can reach a large share of the population but in order to provide effective support to healthcare services, technology, information collection and dissemination, and work processes need to be well aligned. The thesis uses a design science methodological approach and mixes qualitative and quantitative data analysis to address the question of, How can mobile technologies be effectively integrated with routine healthcare services?

The study concerns the design, implementation, and evaluation of a mobile technology-based system, called SMSaúde, with the aim of improving the care of patients with HIV/AIDS and tuberculosis in Mozambique. The work started with the elicitation of functional and user requirements, based on focus group discussions. An important challenge, as in many mHealth interventions, was the integration with routine healthcare services and the existing IT systems, as well as developing a scalable technical structure. The system has now been in routine use since 2013 in more than 16 healthcare clinics in Mozambique. Evaluation was done by a randomised controlled study. Analysis of patient records showed that retention in care in urban areas was significantly higher in the intervention group than in the control group. In a user study both patients and health professionals were very positive to the system. The thesis contributes to research by demonstrating how information system artefacts can be constructed and successfully implemented in resource-constrained settings. The practical contributions include the designed artefact itself as well as improved healthcare practices and mHealth policy recommendations.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2017. 136 p.
Series
Örebro Studies in Informatics, 13
Keyword
mobile technologies, mobile health, mHealth, Least Developed Countries, Mozambique, mobile phones, information systems artefact, design science research
National Category
Information Systems, Social aspects
Identifiers
urn:nbn:se:oru:diva-56948 (URN)978-91-7529-195-6 (ISBN)
Public defence
2017-06-12, Örebro universitet, Musikhögskolan, Hörsal M, Fakultetsgatan 1, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2017-04-04 Created: 2017-04-04 Last updated: 2017-05-24Bibliographically approved

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