Evaluation of the implementation process of the mobile health platform 'WelTel' in six sites in East Africa and Canada using the modified consolidated framework for implementation research (mCFIR)

Samia El Joueidi, Kevin Bardosh, Richard Musoke, Binyam Tilahun, Maryam Abo Moslim, Katie Gourlay, Alissa MacMullin, Victoria J Cook, Melanie Murray, Gilbert Mbaraga, Sabin Nsanzimana, Richard Lester, Samia El Joueidi, Kevin Bardosh, Richard Musoke, Binyam Tilahun, Maryam Abo Moslim, Katie Gourlay, Alissa MacMullin, Victoria J Cook, Melanie Murray, Gilbert Mbaraga, Sabin Nsanzimana, Richard Lester

Abstract

Background: Health systems globally are investing in integrating secure messaging platforms for virtual care in clinical practice. Implementation science is essential for adoption, scale-up, spread and maintenance of complex evidence-based solutions in clinics with evolving priorities. In response, the mobile Health (mHealth) Research Group modified the existing consolidated framework for implementation research (CFIR) to evaluate implementation of virtual health tools in clinical settings. WelTel® is an evidence-based digital health platform widely deployed in various geographical and health contexts. The objective is to identify the facilitators and barriers for implementing WelTel and to assess the application of the mCFIR tool in facilitating focus groups in different geographical and health settings.

Methods: Both qualitative and descriptive quantitative approaches were employed. Six mCFIR sessions were held in three countries with 51 key stakeholders. The mCFIR tool consists of 5 Domains and 25 constructs and was distributed through Qualtrics Experience Management (XM). "Performance" and "Importance" scores were valued on a scale of 0 to 10 (Mean ± SD). Descriptive analysis was conducted using R computing software. NVivo 12 Pro software was used to analyze mCFIR responses and to generate themes from the participants' input.

Results: We observed a parallel trend in the scores of Importance and Performance. Of the five Domains, Domain 4 (End-user Characteristics) and Domain 3 (Inner Settings) scored highest in Importance (8.9 ± 0.5 and 8.6 ± 0.6, respectively) and Performance (7.6 ± 0.7 and 7.2 ± 1.3, respectively) for all sites. Domain 2 (Outer Setting) scored the lowest in both Importance and Performance for all sites (7.6 ± 0.4 and 5.6 ± 1.8). The thematic analysis produced the following themes: for areas of strengths, the themes brought up were timely diagnosis and response, cost-effectiveness, and user-friendliness. As for areas for improvement, the themes discussed were training, phone accessibility, stakeholder engagement, and literacy.

Conclusion: The mCFIR tool allowed for a comprehensive understanding of the barriers and facilitators to the implementation, reach, and scale-up of digital health tools. Amongst several important findings, we observed the value of bringing the perspectives of both end users (HCPs and patients) to the table across Domains.

Trial registration: NCT02603536 - November 11, 2015: WelTelOAKTREE: Text Messaging to Support Patients With HIV/AIDS in British Columbia (WelTelOAKTREE). NCT01549457 - March 9, 2012: TB mHealth Study-Use of Cell Phones to Improve Compliance in Patients on LTBI Treatment.

Keywords: Consolidated framework for implementation research; Global health; Implementation science; Virtual health; WelTel; mHealth.

Conflict of interest statement

Principal Investigator Dr. Richard Lester has a financial and professional interest in WelTel Incorporated, a company for which he is Chief Scientific Officer. WelTel Incorporated is subcontracted to provide the SMS software platform and maintenance for the project. WelTel Incorporated is a company founded by Dr. Lester's wife, Dr. Gabrielle Serafini. The company develops software and related technologies to support mobile health (mHealth) through SMS-based, patient engagement platforms. WelTel Inc. has been contracted by this research project to provide the software and the implementation service. As Chief Scientific Officer of WelTel Inc., Dr. Lester advises on the research and development aspects of WelTel Inc. and communicates with the scientific and customer communities concerning the evidence ¬base and utility of the software.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Heat map of the reported Performance and Importance scores per domain and per site
Fig. 2
Fig. 2
Heat map of the reported Performance and Importance per construct and per site
Fig. 3
Fig. 3
Heat map of the reported scores of Performance and Importance  per domain and per participant type for the East African Sites
Fig. 4
Fig. 4
Heat map of the reported scores of Performance and Importance per construct and per site for all three East African sites
Fig. 5
Fig. 5
Heat map of the reported scores of Performance for “Goal Attainment” and “Impact Assessment” per site
Fig. 6
Fig. 6
Tree map of the identified Strengths and Barriers to the implementation of WelTel in the 3 East African sites

References

    1. WHO. Digital health in TB care and control [Internet]. 2015. Retrieved May 20, 2020, from .
    1. Deloitte. Global mobile consumer trends, 2nd edition Mobile continues its global reach into all aspects of consumers’ lives [Internet]. 2017 p. 05. Retrieved May 18, 2020, from .
    1. Zajicek H, Meyers A. Digital health entrepreneurship. In: Rivas H, Wac K, editors. Digital health internet. Cham: Springer; 2018. pp. 271–287.
    1. Bradway M, Carrion C, Vallespin B, Saadatfard O, Puigdomènech E, Espallargues M, et al. mHealth Assessment: conceptualization of a global framework. JMIR MHealth UHealth. 2017;5(5):e60. doi: 10.2196/mhealth.7291.
    1. Lanham HJ, Leykum LK, Taylor BS, McCannon CJ, Lindberg C, Lester RT. How complexity science can inform scale-up and spread in health care: understanding the role of self-organization in variation across local contexts. Soc Sci Med. 2013;93:194–202. doi: 10.1016/j.socscimed.2012.05.040.
    1. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):50. doi: 10.1186/1748-5908-4-50.
    1. Bardosh KL, Murray M, Khaemba AM, Smillie K, Lester R. Operationalizing mHealth to improve patient care: a qualitative implementation science evaluation of the WelTel texting intervention in Canada and Kenya. Glob Health. 2017;13(1):87. doi: 10.1186/s12992-017-0311-z.
    1. Tilahun B, Smillie K, Bardosh KL, Murray M, Fitzgerald M, Cook V, et al. Identifying barriers and facilitators of 13 mHealth projects in North America and Africa: protocol for a 5-year implementation science study. JMIR Res Protoc. 2018;7(7):e162. doi: 10.2196/resprot.9633.
    1. Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, et al. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. The Lancet. 2010;376(9755):1838–1845. doi: 10.1016/S0140-6736(10)61997-6.
    1. Kenya National Bureau of Statistics. Kenya Demographic and Health Survey 2014 [Internet]. 2015. p. 131. Retrieved June 06, 2020, from .
    1. We ACTx for Hope [Internet]. .
    1. Lester RT. Ask, don’t tell—mobile phones to improve HIV care. N Engl J Med. 2013;369(19):1867–1868. doi: 10.1056/NEJMc1310509.
    1. City Population [Internet]. 2019. Retrieved June 06, 2020, from .
    1. Empowering Local Data Use for Decision Making: The Case of Wamba Health Centre [Internet]. AMREF Health Africa; 2019. Retrieved May 11, 2020, from .
    1. Lester R. Implementing an Innovative Evidence-based Mobile Health (mHealth) Intervention to Improve Engagement and Adherence to HIV Prevention and Care Services in Rwanda. In Rwanda; 2019. Retrieved June 12, 2020, from .
    1. van der Kop ML, Memetovic J, Smillie K, Coleman J, Hajek J, Van Borek N, et al. Use of the WelTel mobile health intervention at a tuberculosis clinic in British Columbia: a pilot study. J Mob Technol Med. 2013;2(3):7–14. doi: 10.7309/jmtm.2.3.3.
    1. Johnston JC, van der Kop ML, Smillie K, Ogilvie G, Marra F, Sadatsafavi M, et al. The effect of text messaging on latent tuberculosis treatment adherence: a randomised controlled trial. Eur Respir J. 2018;51(2):1701488. doi: 10.1183/13993003.01488-2017.
    1. Smillie K, Van Borek N, Abaki J, Pick N, Maan EJ, Friesen K, et al. A qualitative study investigating the use of a mobile phone short message service designed to improve HIV adherence and retention in care in Canada (WelTel BC1)☆. J Assoc Nurses AIDS Care. 2014;25(6):614–625. doi: 10.1016/j.jana.2014.01.008.
    1. the WelTel BC1 Study Team. Murray MCM, Oshaughnessy S, Smillie K, Van Borek N, Graham R, et al. Health care providers’ perspectives on a weekly text-messaging intervention to engage HIV-positive persons in Care (WelTel BC1) AIDS Behav. 2015;19(10):1875–1887. doi: 10.1007/s10461-015-1151-6.
    1. Campbell AR, Kinvig K, Côté HC, Lester RT, Qiu AQ, Maan EJ, et al. Health care provider utilization and cost of an mHealth intervention in vulnerable people living with HIV in Vancouver, Canada: prospective study. JMIR MHealth UHealth. 2018;6(7):e152. doi: 10.2196/mhealth.9493.
    1. Gagnon M-P, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc. 2016;23(1):212–220. doi: 10.1093/jamia/ocv052.
    1. Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res. 2016;51(1):48–75. doi: 10.1111/1475-6773.12327.
    1. Ariens LF, Schussler-Raymakers FM, Frima C, Flinterman A, Hamminga E, Arents BW, et al. Barriers and facilitators to eHealth use in daily practice: perspectives of patients and professionals in dermatology. J Med Internet Res. 2017;19(9):e300. doi: 10.2196/jmir.7512.
    1. Hunting G, Shahid N, Sahakyan Y, Fan I, Moneypenny CR, Stanimirovic A, et al. A multi-level qualitative analysis of Telehomecare in Ontario: challenges and opportunities. BMC Health Serv Res. 2015;15(1):544. doi: 10.1186/s12913-015-1196-2.
    1. Odendaal WA, Anstey Watkins J, Leon N, Goudge J, Griffiths F, Tomlinson M, et al. Health workers’ perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis. Cochrane Effective Practice and Organisation of Care Group, editor. Cochrane Database Syst Rev [Internet]. 2020 Mar 26 [cited 2021 May 19]; 10.1002/14651858.CD011942.pub2
    1. Althubaiti A. Information bias in health research: definition, pitfalls, and adjustment methods. J Multidiscip Healthc. 2016 doi: 10.2147/JMDH.S104807.
    1. Nachega JB, Leisegang R, Kallay O, Mills EJ, Zumla A, Lester RT. Mobile health technology for enhancing the COVID-19 response in Africa: a potential game changer? Am J Trop Med Hyg. 2020;103(1):3–5. doi: 10.4269/ajtmh.20-0506.

Source: PubMed

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