Abstract
BackgroundAlthough 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.ObjectiveThe 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.MethodsWe 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.ResultsThe 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.ConclusionsThe 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 IdentifierRR1-10.2196/9633
Highlights
BackgroundBillions of dollars are globally spent on health research projects each year, but only a limited number of effective interventions are translated into practice and policy [1,2]
The results of this study will provide an in-depth understanding of individual, organizational, and external level factors that influence the successful implementation of Mobile health (mHealth) in different health systems and geographic contexts over time
In our adoption of WelTel for TB in British Columbia, Canada, we found that WelTel weekly two-way text messaging did not improve latent TB infection (LTBI) completion rates compared to standard LTBI care
Summary
Billions of dollars are globally spent on health research projects each year, but only a limited number of effective interventions are translated into practice and policy [1,2]. The authors showed that bi-directional, weekly text messaging significantly improved adherence to antiretroviral therapy (ART) and increased the proportion of patients with a suppressed HIV viral load in an HIV-positive Kenyan population initiating ART, over a 1-year period [7]. 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
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