Identifying Barriers and Facilitators of 13 mHealth Projects in North America and Africa: Protocol for a 5-Year Implementation Science Study

Binyam Tilahun, Kirsten Smillie, Kevin Louis Bardosh, Melanie Murray, Mark Fitzgerald, Victoria Cook, Iraj Poureslami, Jamie Forrest, Richard Lester, Binyam Tilahun, Kirsten Smillie, Kevin Louis Bardosh, Melanie Murray, Mark Fitzgerald, Victoria Cook, Iraj Poureslami, Jamie Forrest, Richard Lester

Abstract

Background: Although many mHealth interventions have shown efficacy in research, few have been effectively implemented and sustained in real-world health system settings. Despite this programmatic gap, there is limited conclusive evidence identifying the factors that affect the implementation and successful integration of mHealth into a health system.

Objective: The aim of this study is to examine the individual, organizational, and external level factors associated with the effective implementation of WelTel, an mHealth intervention designed to support outpatient medication adherence and engagement in care in Africa and North America.

Methods: We will adopt the Consolidated Framework for Implementation Research (CFIR) constructs for evaluation of mHealth implementation including a scoring and monitoring system. We will apply the adapted tool to identify facilitators and barriers to implementation of the WelTel mHealth intervention in order to determine how the technology platform is perceived, diffused, adapted, and used by different mHealth project teams and health system actors in Africa and North America. We will use a mixed-methods approach to quantitatively test whether the factors identified in the CFIR framework are associated with the successful uptake of the mHealth intervention toward implementation goals. We will triangulate these data through interviews and focus group discussion with project stakeholders, exploring factors associated with successful implementation and sustainment of these interventions.

Results: The development of the customized CFIR is finalized and currently is in pilot testing. The initial results of the use of the tool in those 13 implementations will be available in 2019. Continuous conference and peer- reviewed publications will be published in the coming years.

Conclusions: The results of this study will provide an in-depth understanding of individual, organizational, and external level factors that influence the successful implementation of mHealth in different health systems and geographic contexts over time. Via the tool's unique scoring system connected to qualitative descriptors, these data will inform the most critical implementation targets and contribute to the tailoring of strategies that will assist the health system in overcoming barriers to implementation, and ultimately, improve treatment adherence and engagement in care.

Registered report identifier: RR1-10.2196/9633.

Keywords: Africa; North America; digital health; implementation science; mHealth; mobile health; text messaging.

Conflict of interest statement

Conflicts of Interest: The technology platform (WelTel/SMS) has been developed by a nonprofit organization, WelTel mHealth Society, and a private company, WelTel Incorporated. RL has financial as well as professional interests in both organizations.

©Binyam Tilahun, Kirsten Smillie, Kevin Louis Bardosh, Melanie Murray, Mark Fitzgerald, Victoria Cook, Iraj Poureslami, Jamie Forrest, Richard Lester. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 03.07.2018.

Figures

Figure 1
Figure 1
Scoring system that will be used to score each of the Consolidated Framework for Implementation Research (CFIR) constructs (adapted from the original CFIR authors).

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