Abstract
BackgroundSeveral frameworks now exist to guide intervention development but there remains only limited evidence of their application to health interventions based around use of mobile phones or devices, particularly in a low-resource setting. We aimed to describe our experience of using the Medical Research Council (MRC) Framework on complex interventions to develop and evaluate an adherence support intervention for high blood pressure delivered by SMS text message. We further aimed to describe the developed intervention in line with reporting guidelines for a structured and systematic description.MethodsWe used a non-sequential and flexible approach guided by the 2008 MRC Framework for the development and evaluation of complex interventions.ResultsWe reviewed published literature and established a multi-disciplinary expert group to guide the development process. We selected health psychology theory and behaviour change techniques that have been shown to be important in adherence and persistence with chronic medications. Semi-structured interviews and focus groups with various stakeholders identified ways in which treatment adherence could be supported and also identified key features of well-regarded messages: polite tone, credible information, contextualised, and endorsed by identifiable member of primary care facility staff. Direct and indirect user testing enabled us to refine the intervention including refining use of language and testing of interactive components.ConclusionsOur experience shows that using a formal intervention development process is feasible in a low-resource multi-lingual setting. The process enabled us to pre-test assumptions about the intervention and the evaluation process, allowing the improvement of both. Describing how a multi-component intervention was developed including standardised descriptions of content aimed to support behaviour change will enable comparison with other similar interventions and support development of new interventions. Even in low-resource settings, funders and policy-makers should provide researchers with time and resources for intervention development work and encourage evaluation of the entire design and testing process.Trial registrationThe trial of the intervention is registered with South African National Clinical Trials Register number (SANCTR DOH-27-1212-386; 28/12/2012); Pan Africa Trial Register (PACTR201411000724141; 14/12/2013); ClinicalTrials.gov (NCT02019823; 24/12/2013).
Highlights
Several frameworks exist to guide intervention development but there remains only limited evidence of their application to health interventions based around use of mobile phones or devices, in a low-resource setting
Our experience shows that using a formal intervention development process is feasible in a low-resource multi-lingual setting
The aim of this paper is to describe our experience of using the 2008 Medical Research Council (MRC) framework to develop and test a theory-based behaviour change intervention to support adherence to high blood pressure treatment delivered by mobile phone text message; to reflect on the benefits and challenges of applying this framework in a resource constrained setting, and to describe the final intervention in line with reporting guidelines for a structured and systematic description [13]
Summary
Several frameworks exist to guide intervention development but there remains only limited evidence of their application to health interventions based around use of mobile phones or devices, in a low-resource setting. We aimed to describe our experience of using the Medical Research Council (MRC) Framework on complex interventions to develop and evaluate an adherence support intervention for high blood pressure delivered by SMS text message. Evidence exists that lowering blood pressure substantially reduces this risk, strategies to achieve sustained blood pressure control are complex. These include modifying a range of behaviours related to health including attending clinic appointments, taking medication regularly and persisting with treatment [2,3,4,5]. Systematic reviews of health behaviour change interventions delivered by mobile phones or devices (m-health) have shown small beneficial effects for some conditions in some settings but results are not consistent [7, 8]. Similar results have been found in trials of m-health interventions to support behaviour change for people with high blood pressure, diabetes, and heart disease [11, 12]
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