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Impact of a mHealth Intervention for Peer Health Workers on AIDS Care in Rural Uganda: A Mixed Methods Evaluation of a Cluster-Randomized Trial
Open accessAbstract
Mobile phone access in low and middle-income countries is rapidly expanding and offers an opportunity to leverage limited human resources for health. We conducted a mixed methods evaluation of a cluster-randomized trial exploratory substudy on the impact of a mHealth (mobile phone) support intervention used by community-based peer health workers (PHW) on AIDS care in rural Uganda. 29 PHWs at 10 clinics were randomized by clinic to receive the intervention or not. PHWs used phones to call and text higher level providers with patient-specific clinical information. 970 patients cared for by the PHWs were followed over a 26 month period. No significant differences were found in patients' risk of virologic failure. Qualitative analyses found improvements in patient care and logistics and broad support for the mHealth intervention among patients, clinic staff, and PHWs. Key challenges identified included variable patient phone access, privacy concerns, and phone maintenance.
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“Mobile devices facilitated two‐way communication between all categories of health workers and clients (Chang 2011; Garg 2016; Hampshire 2016; Hirsch‐Moverman 2017), and kept health workers informed about the clients' conditions (Barnabee 2014; Huq 2014).”
From Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis (2020) · cites this paper as Chang 2011
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The exchange broke the hierarchy between health worker categories, when previously unreachable professionals could more easily be reached (Chang 2011; Huq 2014; Khan 2015).”
From Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis (2020) · cites this paper as Chang 2011
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Health workers felt that health promotion and educational messaging directed at clients using mobile health interventions, impacted positively on clients' health behaviours”
From Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis (2020) · cites this paper as Chang 2011
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“As compared to voice calls, reservations about the lack of immediate response via SMS were noted, privacy concerns were raised, and phone maintenance and charging were also problematic.”
From Mobile Health (mHealth) Approaches and Lessons for Increased Performance and Retention of Community Health Workers in Low- and Middle-Income Countries: A Review (2013) · cites this paper as [34]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“A randomized controlled trial delivered SMS to community-based peer health workers in rural Uganda supporting antiretroviral treatment for HIV patients [34]. No virological differences in patient outcome over 26 months were observed, but limited qualitative data showed improvements in patient care, logistics, and broad support from health workers and patients.”
From Mobile Health (mHealth) Approaches and Lessons for Increased Performance and Retention of Community Health Workers in Low- and Middle-Income Countries: A Review (2013) · cites this paper as [34]
Experimental — accuracy not yet measured
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“reported mortality at 11‐ to 12‐month follow‐up (RR 0.82, 95% CI 0.55 to 1.22 and RR 0.94, 95% CI 0.28 to 3.12, respectively; 1157 participants; low‐certainty evidence; Analysis 12.1).”
From Mobile technologies to support healthcare provider to healthcare provider communication and management of care (2020) · cites this paper as Chang 2011
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“reported that healthcare professionals allocated to the intervention were not always able to charge the mobile phone, and that some mobile phones were stolen (Chang 2011; Analysis 15.1).”
From Mobile technologies to support healthcare provider to healthcare provider communication and management of care (2020) · cites this paper as Chang 2011
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Current use of mobile technology by frontline healthcare workers in Uganda [21] and other LMICs [20] was also for purposes other than clinical consultation and decision making.”
From Perception of providers on use of the WHO mental health Gap Action Programme-Intervention Guide (mhGAP-IG) electronic version and smartphone-based clinical guidance in Nigerian primary care settings (2022) · cites this paper as [21]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Similar to our findings, the Uganda study [21] also found phone reliability as a key barrier to mobile application use.”
From Perception of providers on use of the WHO mental health Gap Action Programme-Intervention Guide (mhGAP-IG) electronic version and smartphone-based clinical guidance in Nigerian primary care settings (2022) · cites this paper as [21]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Most studies conducted in LMICs involved the use of short message service (SMS) and voice communication to improve CHWs performance [13, 14].”
From Using mobile phones to improve community health workers performance in low-and-middle-income countries (2020) · cites this paper as [14]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“In one study, health workers perceived direct contact as improving relationships between lower‐ and higher‐level workers (Chang 2011).”
From Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis (2020) · cites this paper as Chang 2011
The cited source says what the claim attributes to it.
In the citing paper
“and encouraged truthful reporting (Chang 2011)”
From Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis (2020) · cites this paper as Chang 2011
The cited source says what the claim attributes to it.
In the citing paper
“some felt it was useful”
From Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis (2020) · cites this paper as Chang 2011
The cited source says what the claim attributes to it.
In the citing paper
“Some health workers perceived this as useful in emergency cases (Chang 2011; Hampshire 2016)”
From Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis (2020) · cites this paper as Chang 2011
The cited source says what the claim attributes to it.
In the citing paper
“In one study, health workers thought that clients were motivated to improve their adherence because they were aware that information about their adherence was being relayed to clinic staff by field staff in real time via the mobile devices (Chang 2011).”
From Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis (2020) · cites this paper as Chang 2011
The cited source says what the claim attributes to it.
In the citing paper
“Health workers reported that their access to mobile devices was beneficial to clients and communities who were too poor to own mobile phones (very low confidence in the evidence)”
From Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis (2020) · cites this paper as Chang 2011
The cited source says what the claim attributes to it.
In the citing paper
“including clients not having phones”
From Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis (2020) · cites this paper as Chang 2011
The cited source says what the claim attributes to it.
In the citing paper
“No virological differences in patient outcome over 26 months were observed, but limited qualitative data showed improvements in patient care, logistics, and broad support from health workers and patients.”
The cited source says what the claim attributes to it.
In the citing paper
“Improvements in peer health worker morale and confidence were reported; peer health worker-patient relationships improved, shifting burdens from staff-patient relationships.”
The cited source says what the claim attributes to it.
In the citing paper
“Improvements in peer health worker morale and confidence were reported; peer health worker-patient relationships improved, shifting burdens from staff-patient relationships.”
The cited source says what the claim attributes to it.
In the citing paper
“This is consistent with our results, especially for settings where constant access to electricity might be an issue (Chang 2011).”
From Mobile technologies to support healthcare provider to healthcare provider communication and management of care (2020) · cites this paper as Chang 2011
The cited source says what the claim attributes to it.
In the citing paper
“In an exploratory mixed method process evaluation sub-study to a cluster RCT on the impact on mobile phones on HIV/AIDS care in rural Uganda [21], qualitative data suggested broad support by frontline healthcare workers for the use of mobile phone applications to support their work.”
The cited source says what the claim attributes to it.
In the citing paper
“Other LMICs studies on use of digital technology in healthcare [20–22] have tended to focus on health domains other than mental health.”
The cited source says what the claim attributes to it.
In the citing paper
“The study found out that the mHealth support intervention used by PHWs resulted in improvements in patient care and logistics [14].”
From Using mobile phones to improve community health workers performance in low-and-middle-income countries (2020) · cites this paper as [14]
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Impact evaluation of the RAFT activities remains an “unfinished business” (40–43)”
From The RAFT Telemedicine Network: Lessons Learnt and Perspectives from a Decade of Educational and Clinical Services in Low- and Middle-Incomes Countries (2014) · cites this paper as [42]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Other studies have shown that poor network coverage and signal strength are often a major limitation to implementation of mobile technologies [23, 27, 31, 65, 66].”
From Qualitative Assessment of the Feasibility, Usability, and Acceptability of a Mobile Client Data App for Community-Based Maternal, Neonatal, and Child Care in Rural Ghana (2016) · cites this paper as [66]
Experimental — accuracy not yet measuredIn the citing paper
“A similar advantage of m-health interventions was also reported in a study conducted in Uganda [27], and in a systematic review of the feasibility and effectiveness of m-health strategies in LMICs [45].”
In the citing paper
“and can facilitate task-shifting, and increase health workers morale [25, 27].”
In the citing paper
“and can facilitate task-shifting, and increase health workers morale [25, 27].”
In the citing paper
“Quantitative results from the 970 patients managed (446 in intervention arm, 524 in control), however, failed to show any statistical difference between the intervention and the control arm in terms of the primary outcome (virological failure) (19.4% vs. 16.4% in the intervention and control arms, respectively).”
From Assessing the impact of mHealth interventions in low- and middle-income countries – what has been shown to work? (2014) · cites this paper as [39]
In the citing paper
“Qualitative results suggest improved communication and patient care, because patients could now contact CHWs who would work to treat the patient (if possible), whereas previously their needs would have gone unmet or be borne by clinic staff.”
From Assessing the impact of mHealth interventions in low- and middle-income countries – what has been shown to work? (2014) · cites this paper as [39]
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“At the cliniclevel, making services more responsive to the specific needs of men and women, (for example, having gender-specific peer groups within clinics and offering clinic-based support via mobile phone technology [39]) could reduce rates of drop-out by overcoming these barriers.”
Pokhrel, P., Karmacharya, R., Taylor Salisbury, T., Carswell, K., Kohrt, B. A., Jordans, M. J. D., Lempp, H., Thornicroft, G., & Luitel, N. P. (2021) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-021-01386-0 · Cited by 55
“These technologies have not yet been used widely in LMICs for mental health care delivery; however, the available data demonstrates that mobile app-based clinical guidelines help to improve protocol compliance [24–26] and can facilitate task-shifting, and increase health workers morale [25, 27].”
MethodResultStanton, M. C., Mkwanda, S. Z., Debrah, A. Y., Debrah, L. B., Biritwum, N., Hoerauf, A. M., Cliffe, M., Best, A., Molineux, A., & Kelly‐Hope, L. A. (2015) · BMC Infectious Diseases · doi:10.1186/s12879-015-0946-4 · Cited by 60
“In particular, the combination of community-led health systems and mHealth tools has proven to be successful in improving HIV-infected patient care [15], real-time reporting of malaria cases [16], antimalarial supply monitoring [17] and supporting health worker-patient interactions [18, 19].”
BackgroundOsei, E., Kuupiel, D., Vezi, P. N., & Mashamba-Thompson, T. P. (2021) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-020-01381-x · Cited by 62
Mobile health applications for HIV prevention and care in Africa
Forrest, J. I., Wiens, M. O., Kanters, S., Nsanzimana, S., Lester, R. T., & Mills, E. J. (2015) · Current Opinion in HIV and AIDS · doi:10.1097/coh.0000000000000198 · Cited by 59
“logistics of delivering patient care [24].”
Routine Health Information System (RHIS) improvements for strengthened health system management
Leon, N., Balakrishna, Y., Hohlfeld, A., Odendaal, W., Schmidt, B., Zweigenthal, V., Watkins, J. A., & Daniels, K. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012012.pub2 · Cited by 64
“…2013 Ineligible intervention Boockvar 2017 Ineligible intervention Brugha 1996 Ineligible intervention Cawsey 2000 Ineligible intervention Chang 2011 Ineligible intervention Chen 2007 Ineligible intervention Choi 2004 Ineligible intervention Chrischilles 2014 Ineligible…”
MethodInfluentialPeer Support for People Living With HIV: A Scoping Review
Øgård‐Repål, A., Berg, R. C., & Fossum, M. (2021) · Health Promotion Practice · doi:10.1177/15248399211049824 · Cited by 68
Krah, E., & de Kruijf, J. G. (2016) · Digital Health · doi:10.1177/2055207616679264 · Cited by 59
Peprah, P., Abalo, E. M., Agyemang‐Duah, W., Budu, H. I., Appiah-Brempong, E., Morgan, A. K., & Gyimah, A. A. (2020) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-020-1040-4 · Cited by 58
Gender differentials in readiness and use of mHealth services in a rural area of Bangladesh
Khatun, F., Heywood, A. E., Hanifi, S. M. A., Rahman, M. S., RAY, P. K., Liaw, S., & Bhuiya, A. (2017) · BMC Health Services Research · doi:10.1186/s12913-017-2523-6 · Cited by 60
Thondoo, M., Strachan, D. L., Nakirunda, M., Ndima, S., Muiambo, A., Källander, K., Hill, Z., & The InSCALE Study Group (2015) · JMIR mHealth and uHealth · doi:10.2196/mhealth.4208 · Cited by 54
“This is supported by the “unexpected” finding from a study with HIV/AIDS community workers in Uganda where an mHealth intervention appeared to improve worker morale and job satisfaction [19].”
ResultBediang, G., Perrin, C., Ruiz de Castañeda, R., Kamga, Y., Sawadogo, A., Bagayoko, C. O., & Geissbuhler, A. (2014) · Frontiers in Public Health · doi:10.3389/fpubh.2014.00180 · Cited by 53
Tomlinson, M., Hunt, X., & Rotheram‐Borus, M. J. (2018) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.13650 · Cited by 52
Mixed methods for telehealth research
Caffery, L. J., Martin‐Khan, M., & Wade, V. (2016) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x16665684 · Cited by 51
“MMR is suitable for program evaluation and translational research, and has been credited with helping move findings to policy and normal service delivery.(3,4) Within the telehealth field, there has been a rapid increase in the number of MMR studies reported in the literature (Figure 1).”
BackgroundJo, Y., Labrique, A. B., LeFevre, A. E., Mehl, G. L., Pfaff, T., Walker, N., & Friberg, I. K. (2014) · PLoS ONE · doi:10.1371/journal.pone.0102224 · Cited by 52
“and training, where limited numbers of skilled health workers are available [47].”
BackgroundSiedner, M. J., Santorino, D., Lankowski, A. J., Kanyesigye, M., Bwana, M., Haberer, J. E., & Bangsberg, D. R. (2015) · BMC Medicine · doi:10.1186/s12916-015-0397-1 · Cited by 50
“In contrast, prior mHealth evaluations for HIV care delivery have either relied on health care workers as the end users, as opposed to patients themselves [27, 37], or focused on notifications to improve adherence [18, 19, 38].”
BackgroundYasmin, F., Nahar, N., Banu, B., Ali, L., Sauerborn, R., & Souares, A. (2020) · BMC Health Services Research · doi:10.1186/s12913-020-05387-z · Cited by 48
Healthcare Workers’ Perspectives of mHealth Adoption Factors in the Developing World: Scoping Review
Addotey-Delove, M., Scott, R. E., & Mars, M. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20021244 · Cited by 59
Vulnerabilities in mHealth implementation: a Ugandan HIV/AIDS SMS campaign
Chib, A., Wilkin, H., & Hoefman, B. (2013) · Global Health Promotion · doi:10.1177/1757975912462419 · Cited by 47
Mobile phone–based clinical guidance for rural health providers in India
Gautham, M., Iyengar, M. S., & Johnson, C. W. (2015) · Health Informatics Journal · doi:10.1177/1460458214523153 · Cited by 46
“21,22 The use of mobile technology has the potential to transform the way health service is delivered across the globe.”
BackgroundOjagbemi, A., Daley, S., Kola, L., Taylor Salisbury, T., Feeney, Y., Makhmud, A., Lempp, H., Thornicroft, G., & Gureje, O. (2022) · BMC Primary Care · doi:10.1186/s12875-022-01869-7 · Cited by 28
“Chang LW, Kagaayi J, Arem H, Nakigozi G, Ssempijja V, Serwadda D, et al. Impact of a mHealth intervention for peer health workers on AIDS care in rural Uganda: a mixed methods evaluation of a cluster-randomized trial.”
BackgroundMethodResultInfluentialTaking mHealth Solutions to Scale: Enabling Environments and Successful Implementation
Franz‐Vasdeki, J., Pratt, B. A., Newsome, M. H., & Germann, S. (2015) · Journal of Mobile Technology in Medicine · doi:10.7309/jmtm.4.1.8 · Cited by 43
Ethical issues in mHealth research involving persons living with HIV/AIDS and substance abuse
Labrique, A. B., Kirk, G. D., Westergaard, R. P., & Merritt, M. W. (2013) · AIDS Research and Treatment · doi:10.1155/2013/189645 · Cited by 40
“Hindawi Publishing Corporation AIDS Research and Treatment Volume 2013, Article ID 189645, 6 pages http://dx.doi.org/10.1155/2013/189645”
BackgroundInfluentialShuvo, T. A., Islam, R., Hossain, S., Evans, J. A., Khatun, F., Ahmed, T., Gazi, R., & Adams, A. M. (2015) · Innovation and Entrepreneurship in Health · doi:10.2147/ieh.s88809 · Cited by 42
“Some instances of eHealth applications in LMICs include increasing access to primary health care, providing realtime diagnosis and treatment, conveying health education, assisting in emergency medical response, and enabling data collection as part of disease surveillance.(10,11) While eHealth is highlighted as an exci…”
BackgroundUncovering the invisible patient work system through a case study of breast cancer self-management
Gorman, R. K., Wellbeloved-Stone, C. A., & Valdez, R. S. (2018) · Ergonomics · doi:10.1080/00140139.2018.1503339 · Cited by 42
“This finding aligns with well-documented evidence that mHealth and other forms of CHIT, such as the patient portal, can have positive impacts on adherence work (Burke et al. 2012; Chang et al. 2011; Sullivan et al. 2016; TurnerMcGrievy et al. 2013).”
ResultA review of tuberculosis at the wildlife-livestock-human interface in Zambia
Malama, S., Muma, J. B., & Godfroid, J. (2013) · Infectious Diseases of Poverty · doi:10.1186/2049-9957-2-13 · Cited by 44
Aamir, J., Ali, S. M., Boulos, M. N. K., Anjum, N., & Ishaq, M. (2017) · Health Policy and Technology · doi:10.1016/j.hlpt.2017.11.005 · Cited by 44
Telehealth Interventions for HIV in Low- and Middle-Income Countries
Phan, J. M., Kim, S.-M., Linh, Đ. T. T., Cosimi, L. A., & Pollack, T. (2022) · Current HIV/AIDS Reports · doi:10.1007/s11904-022-00630-0 · Cited by 40
TulaSalud: An m-health system for maternal and infant mortality reduction in Guatemala
Martínez-Fernández, A., Lobos-Medina, I., Díaz-Molina, C. A., Chen-Cruz, M. F., & Prieto-Egido, I. (2015) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x15575830 · Cited by 39
“These studies were mostly focused on improving health processes and only a few of them analysed the impact on health indicators, such as HIV virological failure.(15) Moreover, only two projects were found working to improve maternal and infant health care.”
BackgroundHickey, M. D., Odeny, T., Petersen, M. L., Neilands, T. B., PADIAN, N. S., Ford, N. P., Matthay, Z. A., Hoos, D., Doherty, M. C., Beryer, C., et al. (2017) · Implementation Science · doi:10.1186/s13012-017-0630-8 · Cited by 40
Optimizing Network Connectivity for Mobile Health Technologies in sub-Saharan Africa
Siedner, M. J., Lankowski, A., Musinga, D., Jackson, J., Muzoora, C., Hunt, P. W., Martin, J. N., Bangsberg, D. R., & Haberer, J. E. (2012) · PLoS ONE · doi:10.1371/journal.pone.0045643 · Cited by 36
“However there are several barriers to successful implementation of these applications including behavioral [17], low end-user literacy [18], and technical [19] issues.”
Reviewing mHealth in Developing Countries: A Stakeholder Perspective
Eze, E., Gleasure, R., & Heavin, C. (2016) · Procedia Computer Science · doi:10.1016/j.procs.2016.09.276 · Cited by 37
“In terms of mPrevention/Education, studies documented the opportunity afforded Patients to reach out whenever they had emotional problems or felt like talking to a HCW 21,43 .”
Yasmin, F., Ali, L., Banu, B., Rasul, F. B., Sauerborn, R., & Souares, A. (2020) · BMC Health Services Research · doi:10.1186/s12913-019-4811-9 · Cited by 47
Mahmood, H., McKinstry, B., Luz, S. F., Fairhurst, K., Nasim, S., & Hazir, T. (2020) · Journal of Global Health · doi:10.7189/jogh.10.020438 · Cited by 46
“Kenya have used mHealth in Acquired Immunodeficiency Syndrome (AIDS) care through text messaging [20-23].”
MethodInvestigating combination HIV prevention: isolated interventions or complex system
Brown, G., Reeders, D., Dowsett, G. W., Ellard, J., Carman, M., Hendry, N. A., & Wallace, J. E. (2015) · Journal of the International AIDS Society · doi:10.7448/ias.18.1.20499 · Cited by 35
“There have been substantial investments into the evaluation of large-scale combination prevention programmes in some low-income countries with generalized epidemics [48 50] as well as developments in the use of implementation and operations research [51].”
BackgroundSupervision of Community Health Workers
Crigler, L., Gergen, J., & Perry, H. B. (2013) · Cited by 33
Manyati, T. K., & Mutsau, M. (2021) · African Journal of Science, Technology, Innovation and Development · doi:10.1080/20421338.2020.1765479 · Cited by 29
Joos, O., Silva, R., Amouzou, A., Moulton, L. H., Perin, J., Bryce, J., & Mullany, L. C. (2016) · PLoS ONE · doi:10.1371/journal.pone.0145238 · Cited by 34
“We observed measurable improvements in the documentation of matched pregnancy outcomes associated with regular, unidirectional SMS of two intensity levels sent to CHWs in rural Malawi.”
BackgroundInfluentialHunt, X., Tomlinson, M., Sikander, S., Skeen, S., Marlow, M., Toit, S. D., & Eisner, M. (2020) · Frontiers in Artificial Intelligence · doi:10.3389/frai.2020.543305 · Cited by 37
“Indeed, the potential of mHealth, as has been widely proposed (Chang et al., 2011; Chib et al., 2015; Morgan et al., 2017), could lie in its capacity to reach underserved populations (although current analyses have cast some doubt on this, see Jennings and Gagliardi, 2013; Morgan et al., 2017).”
BackgroundSalisbury, T. T., Kohrt, B. A., Bakolis, I., Jordans, M. J. D., Hull, L., Luitel, N. P., McCrone, P., Sevdalis, N., Pokhrel, P., Carswell, K., et al. (2021) · JMIR Research Protocols · doi:10.2196/24115 · Cited by 34
Chang, L. W., Kagaayi, J., Nakigozi, G., Serwada, D., Quinn, T. C., Gray, R. H., Bollinger, R. C., Reynolds, S. J., & Holtgrave, D. (2013) · AIDS Care · doi:10.1080/09540121.2012.722600 · Cited by 28
“The mHealth Intervention substudy consisted of some PHWs receiving a mobile phone for texting patients’ clinical data to centralized staff and improving communication (Chang et al., 2011, 2008).”
BackgroundMethodSelf-citationMobile health solutions in developing countries: a stakeholder perspective
Eze, E., Gleasure, R., & Heavin, C. (2018) · Health Systems · doi:10.1080/20476965.2018.1457134 · Cited by 32
“In addition, two of these studies (Chang et al., 2011; Mavhu et al., 2017) focused on mData-Collection.”
BackgroundInfluentialSmith, B., Harms, W. D., Burres, S., Korda, H., Rosen, H., & Davis, J. M. (2012) · Health Informatics Journal · doi:10.1177/1460458212445349 · Cited by 28
“(21) Do you have what you need to successfully handle the problem? 1 - Definitely NO”
BackgroundCombined qualitative and quantitative research designs
Seymour, J. E. (2012) · Current Opinion in Supportive and Palliative Care · doi:10.1097/spc.0b013e328358214e · Cited by 27
Wirtz, A. L., Logie, C. H., & Mbuagbaw, L. C. E. (2022) · Epidemiologic Reviews · doi:10.1093/epirev/mxac008 · Cited by 25
Hailemariam, T., Atnafu, A., Gezie, L. D., Kaasbøll, J., Klein, J., & Tilahun, B. C. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-09629-8 · Cited by 27
“Moreover, using digital health solutions has paramount benefits in improving CHWs performance [28, 29], reducing errors [30], increasing motivation [31], and creating learning opportunities [31].”
MethodGgita, J. M., Ojok, C., Meyer, A. J., Farr, K., Shete, P. B., Ochom, E., Turimumahoro, P., Babirye, D., Mark, D., Dowdy, D. W., et al. (2018) · The International Journal of Tuberculosis and Lung Disease · doi:10.5588/ijtld.17.0521 · Cited by 25
“…for scale-up 10,11 , including information about mobile phone ownership 12 in key populations; access to phone networks and charging facilities 13,14 ; proficiency with phones; expectations about confidentiality; messaging preferences 15,16,17 ; and how these factors affect uptake and usage…”
BackgroundLutwama, G. W., Kok, M. C., & Jacobs, E. (2021) · Conflict and Health · doi:10.1186/s13031-021-00422-0 · Cited by 25
“For example in Mozambique, coordination and communication between the CHWs and the formal health workers enhanced accountability towards the community and the health system [56] and in Uganda, improved communication between CHWs and clinicians through m-health improved the quality of care [57].”
BackgroundCormick, G., Ciganda, A., Cafferata, M. L., Ripple, M. J., Sosa‐Estáni, S., Buekens, P. M., Belizán, J. M., & Althabe, F. (2015) · BMC Research Notes · doi:10.1186/s13104-015-1498-9 · Cited by 23
Bhardwaj, A., Subba, P., Rai, S., Bhat, C., Ghimire, R., Jordans, M. J. D., Green, E., Vasudevan, L., & Kohrt, B. A. (2020) · BMC Research Notes · doi:10.1186/s13104-020-05148-5 · Cited by 20
Web and Mobile Based HIV Prevention and Intervention Programs Pros and Cons - A Review.
Kalhori, S. R. N., Mehraeen, E., Noori, T., & Gozali, E. (2017) · PubMed · Cited by 20
Nigatu, T., Meressa, S., Debela, T. F., Enyew, D. B., Bedada, A. N., Kebebew, S. D., Weldeab, A. N., Daka, D. W., Willems, H., & Alemu, T. (2023) · Frontiers in Digital Health · doi:10.3389/fdgth.2023.1162239 · Cited by 25
“Resource constraints and staff attrition were found to be major barriers to optimal implementation and use of mobile technologies in primary healthcare in line with the findings of this study (36, 38, 40, 46, 48, 50).”
ResultApplication of mHealth to improve service delivery and health outcomes: Opportunities and challenges
Vesel, L., Hipgrave, D. B., Dowden, J., & Kariuki, W. (2015) · African Population Studies · doi:10.11564/29-1-718 · Cited by 22
“Mobile phones can break down gender and social barriers, reduce logistical inefficiencies, and foster the capacity of CHWs to provide high quality care (Jennings and Gagliardi, 2013; Tomlinson et al., 2009; Chang et al., 2011).”
BackgroundExperiences of community health workers on adopting mHealth in rural Malawi: A qualitative study
Kachimanga, C., Mulwafu, M., Ndambo, M. K., Harare, J., Murkherjee, J., Kulinkina, A. V., Mbae, S. M., Ndarama, E. P. L., van den Akker, T., & Abejirinde, I. O. (2024) · Digital Health · doi:10.1177/20552076241253994 · Cited by 23
“51 – 53 For example, Chang et al. 54 report improved morale, job satisfaction, and a sense of empowerment among CHWs in a mHealth CHW program in Uganda.”
BackgroundAddotey-Delove, M., Scott, R. E., & Mars, M. (2020) · Informatics in Medicine Unlocked · doi:10.1016/j.imu.2020.100460 · Cited by 20
The Role of Social Support Among People Living with HIV in Rural Mozambique
Cummings, B., Gutin, S., Jaiantilal, P., Correia, D., Malimane, I., & Rose, C. D. (2014) · AIDS Patients Care and STDs · doi:10.1089/apc.2014.0193 · Cited by 22
Thomas, D. S. K., Daly, K., Nyanza, E. C., Ngallaba, S. E., & Bull, S. S. (2020) · Digital Health · doi:10.1177/2055207620905409 · Cited by 17
Odendaal, W., Lewin, S. A., McKinstry, B., Tomlinson, M., Jordaan, E., Mazinu, M., Haig, P., Thorson, A. E., & Atkins, S. A. (2020) · Global Health Action · doi:10.1080/16549716.2020.1717410 · Cited by 18
“tries (LMICs) to help solve health system challenges [17,19,20].”
BackgroundKarera, M. G. D., Omar, M., Nabirye, E., Namukwaya, E., & Allsop, M. J. (2022) · Health Policy and Technology · doi:10.1016/j.hlpt.2022.100608 · Cited by 19
van Heerden, A. C. (2014) · University of the Witwatersrand, Johannesburg Institutional Repository on DSpace (University of the Witwatersrand, Johannesburg) · Cited by 15
Laar, A. S., Harris, M. L., Shifti, D. M., & Loxton, D. J. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08512-2 · Cited by 17
“Barriers to mHealth SRH services provision Barriers to mHealth service provision mainly consisted of infrastructural challenges [40, 41, 43] including limited and unreliable network connectivity [39–41, 44, 45], limited power for charging mobile phones [37, 40, 47].”
BackgroundResultInfluential
Metadata
- Authors
- Chang, L. W., Kagaayi, J., Arem, H., Nakigozi, G., Ssempijja, V., Serwadda, D., Quinn, T. C., Gray, R. H., Bollinger, R. C., & Reynolds, S. J.
- Affiliations
- Johns Hopkins University (US)
- Rakai Health Sciences Program (UG)
- National Institutes of Health (US)
- Corresponding author
- Chang, Larry W.
- ORCID
- Venue
- AIDS and Behavior
- Published
- 2011-07-08
- Volume
- 15
- Issue
- 8
- Pages
- 1776-1784
- ISSN
- 1090-7165 (ISSN-L)
- 1573-3254
- PMC
- PMC3265752
- OpenAlex
- W2042543641
- Cited by
- 184
- References
- 26
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 8 · 2023: 11 · 2022: 20 · 2021: 10 · 2020: 23 · 2019: 7 · 2018: 10 · 2017: 17 · 2016: 15 · 2015: 16 · 2014: 18 · 2013: 12 · 2012: 10
- FWCI
- 24.38
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- AIDS and Behavior (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Funders
- Doris Duke Charitable Foundation
- U.S. President’s Emergency Plan for AIDS Relief
- National Institutes of Health
- National Institute of Mental Health (K23MH086338)
- National Institute of Allergy and Infectious Diseases (2T32-AI07291, T32AI007291, ZIAAI000361)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24HD042854)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Physical Sciences › Computer Science › Information Systems › ICT in Developing Communities
- Keywords
- mobile health, HIV care, mobile telephony, community health workers, virological failure, rural health care, privacy concerns, health worker support, Uganda
- MeSH terms
- Acquired Immunodeficiency Syndrome, Communication, Community Health Services, Female, Health Personnel, Humans, Male, Middle Aged, Peer Group, Rural Population, Uganda, Cluster Analysis, Randomized Controlled Trials as Topic, Telemedicine, Anti-HIV Agents, Cell Phone
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