The DOI matches its Crossref record; 24 of the 26 references it cites were found in a registry or an index.
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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“For CBR workers, mobile phone-based mHealth interventions could potentially improve communication with supervisors and peers, decrease travel time, and improve treatment quality (Aranda-Jan et al., 2014; Chang et al., 2011; Macrohon & Cristobal, 2011).”
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“mHealth approaches in resource-constrained settings are often accompanied by many difficulties that could hinder their acceptance and uptake (eg, incomplete mobile phone access owing to lack of a personal mobile phone, charging challenges, or theft) [58].”
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Mobile Health in Uganda: A Case Study of the Medical Concierge Group
Kamulegey, L., Ssebwana, J., Abigaba, W., Bwanika, J. M., & Musinguzi, D. (2019) · East Africa Science · doi:10.24248/easci.v1i1.12 · Cited by 3
Proposing Parameters for Evaluating Sustainability of mHealth Systems in Developing Countries
Muhambe, T. (2018) · INTERNATIONAL JOURNAL OF COMPUTERS & TECHNOLOGY · doi:10.24297/ijct.v17i1.7140 · Cited by 3
“The failure of mHealth projects have been attributed to the lack of sufficient expertise in the design, development, implementation, maintenance and capacity to provide technical support for the implemented mHealth systems [24, 33, 35, 36].”
BackgroundPhippard, T. M. (2012) · Lirias · Cited by 3
An Evaluation of a Peer Supervision Pilot Project among Community Health Workers in Rural UgandaPreprint
Watsemba, A., Nakibaala, G., Ssali, B. S., Namugera, F., Katushabe, P., Loiseau, J., Zzimbe, E., & Kaddu, P. (2020) · doi:10.21203/rs.3.rs-20011/v1 · Cited by 3
How Technology Shapes the Crowd: Participation in the 2014 South African Election
Ferree, K. E., Gibson, C. C., Jung, D. F., Long, J. D., & McIntosh, C. (2017) · eScholarship (California Digital Library) · Cited by 2
Eze, E., Gleasure, R., & Heavin, C. (2019) · AJIS. Australasian journal of information systems/AJIS. Australian journal of information systems/Australian journal of information systems · doi:10.3127/ajis.v23i0.1815 · Cited by 2
“Other forms of mHealth initiatives exist, e.g. those focused on data gathering (Chang et al., 2011; Medhanyie et al., 2015) or those focused on remote diagnosis and treatment (Hufnagel, 2012; Knoble & Bhusal, 2015).”
BackgroundThe impact of mHealth interventions
Britt, R. K., Maddox, J., Kanthawala, S., & Hayes, J. L. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-816958-2.00012-5 · Cited by 2
Exploring Mobile Technology to Enhance Birth Outcomes in Rural Mozambique: Pilot Study Results
Rema, M. T. (2022) · Digital Archive @ GSU · doi:10.57709/4108861 · Cited by 2
Addotey-Delove, M., Scott, R. E., & Mars, M. (2020) · doi:10.21203/rs.2.17194/v2 · Cited by 2
“Maintaining the privacy of data during collection, storage, and sharing for all patient groups was noted as critical for the adoption and sustainability of m-health systems [9, 11,21,24,30,36].”
BackgroundAtukunda, I., Semulimi, A. W., Bwambale, F., Mumbere, J., Twinamasiko, N., Nakabuye, M., Mukisa, J., Mukunya, D., & Batte, C. (2022) · PLoS ONE · doi:10.1371/journal.pone.0266858 · Cited by 1
Pharmacoeconomic perspectives on HIV: integrating data for long-term treatment and prevention
Mursal, M., Fatima, G., & Gushchina, Y. S. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2025.1716965 · Cited by 1
Khan, M. S., Almas, A., Samad, Z. Z., Zimmerman, K. O., & Ali, T. S. (2025) · Journal of Health Population and Nutrition · doi:10.1186/s41043-025-01097-6 · Cited by 1
Pankomera, R., & van Greunen, D. (2016) · doi:10.2316/p.2016.837-009 · Cited by 2
“3 Community-based peer health workers (PHW) used mobile phones to text higher level providers with patient-specific clinical AIDS information [52].”
BackgroundPredicting Participant Consent in mHealth Trials – A Caregiver’s Perspective
O’Connor, Y., Heavin, C., Gallagher, J., & O’Donoghue, J. (2017) · AJIS. Australasian journal of information systems/AJIS. Australian journal of information systems/Australian journal of information systems · doi:10.3127/ajis.v21i0.1470 · Cited by 1
Feminist power and its implications on Uganda’s malaria communication campaign
Nakiwala, A. S., & Semujju, B. (2018) · Feminist Media Studies · doi:10.1080/14680777.2018.1465442 · Cited by 1
Laar, A. S., Harris, M. L., Shifti, D. M., & Loxton, D. J. (2022) · Research Square · doi:10.21203/rs.3.rs-1212113/v1 · Cited by 1
Schnall, R. (2016) · CIN Computers Informatics Nursing · doi:10.1097/cin.0000000000000246
“6,7 Thus, the purpose of this work was to design two mobile phone apps for HIV prevention in high-risk men who have sex with men and for self-management of persons living with HIV (PLWH).”
Demand Side Interventions for the Prevention of Mother to Child Transmission of HIV
Meese, H. (2011) · Berkeley Undergraduate Journal · doi:10.5070/b3242011669
Social Business and It's Sustainability: A Case Study on 'Aponjon' of D.Net, Bangladesh.Preprint
Mahtab, N., Islam, M. N., Ahmed, S. P., & Ahmed, S. U. (2017) · SSRN Electronic Journal · doi:10.2139/ssrn.2857783
Improving Global Health With Smartphone Technology
Nimkar, S., & Gilles, E. E. (2018) · International Journal of E-Health and Medical Communications · doi:10.4018/ijehmc.2018070101
“Some of the many applications of mHealth in global projects include: the FoodSwitch app for nutrition information in Australia (Dunford et al., 2014); a communication tool between AIDS patients and peer health workers in rural Uganda (Chang et al., 2011); a Cambodian program to increase contraceptive use among post-ab…”
BackgroundEze, E. (2018) · Cork Open Research Archive (University College Cork, Ireland)
Addotey-Delove, M., Scott, R. E., & Mars, M. (2020) · doi:10.21203/rs.2.17194/v3
Kalinga, A. K., Munga, M. A., Ngenya, A., John, W., Kisoka, W. J., Oriyo, N. M., Mutalemwa, P. P., Mandara, W., Masagati, L., Ogondiek, J. W., et al. (2021) · Research Square · doi:10.21203/rs.3.rs-1074243/v1
Naggirinya, A. B., Meya, D. B., Rujumba, J., Waiswa, P., & Parkes-Ratanshi, R. M. (2021) · Research Square · doi:10.21203/rs.3.rs-892587/v1
Ojagbemi, A., Daley, S., Kola, L., Salisbury, T. T., Feeney, Y., Makhmud, A., Lempp, H. K., Thornicroft, G., & Gureje, O. (2022) · Research Square · doi:10.21203/rs.3.rs-1395529/v1
Improving Global Health With Smartphone Technology
Nimkar, S., & Gilles, E. E. (2019) · IGI Global eBooks · doi:10.4018/978-1-5225-7909-0.ch004
Aker, J. C., & Cariolle, J. (2023) · Palgrave studies in agricultural economics and food policy · doi:10.1007/978-3-031-41885-3_5
Disconnected data: mHealth data systems and challenges for primary health care workers in India
Nongrum, M. S., Dhaliwal, B. K., Na, Y., Jamir, T., Shekhawat, S., Rao, K., Ramani, S., Albert, S., & Closser, S. (2025) · SSM - Health Systems · doi:10.1016/j.ssmhs.2025.100124
Bhardwaj, A., Subba, P., Rai, S., Bhat, C., Ghimire, R., Jordans, M. J. D., Green, E. P., Vasudevan, L., & Kohrt, B. A. (2020) · Figshare · doi:10.6084/m9.figshare.12599371
Bhardwaj, A., Subba, P., Rai, S., Bhat, C., Ghimire, R., Jordans, M. J. D., Green, E. P., Vasudevan, L., & Kohrt, B. A. (2020) · Figshare · doi:10.6084/m9.figshare.12599377
Bhardwaj, A., Subba, P., Rai, S., Bhat, C., Ghimire, R., Jordans, M. J. D., Green, E. P., Vasudevan, L., & Kohrt, B. A. (2020) · Figshare · doi:10.6084/m9.figshare.12599374
Bhardwaj, A., Subba, P., Rai, S., Bhat, C., Ghimire, R., Jordans, M. J. D., Green, E. P., Vasudevan, L., & Kohrt, B. A. (2020) · Figshare · doi:10.6084/m9.figshare.12599380
Hailemariam, T., Atnafu, A., Gezie, L. D., Kaasbøll, J., Klein, J., & Tilahun, B. (2024) · Figshare · doi:10.6084/m9.figshare.26597672
Laar, A. S., Harris, M. L., Shifti, D. M., & Loxton, D. J. (2022) · Figshare · doi:10.6084/m9.figshare.21077171
Hailemariam, T., Atnafu, A., Gezie, L. D., Kaasbøll, J., Klein, J., & Tilahun, B. C. (2024) · Figshare · doi:10.6084/m9.figshare.26597666
Hailemariam, T., Atnafu, A., Gezie, L. D., Kaasbøll, J., Klein, J., & Tilahun, B. (2024) · Figshare · doi:10.6084/m9.figshare.26597669
Role of digital media campaigns in improving TB health literacy at the community level
Prajapati, Y. N., Gupta, A., Mathew, B., Cherian, M., P, V. G. S., & Balamuralitharan (2026) · Indian Journal of Tuberculosis · doi:10.1016/j.ijtb.2026.02.014
Yirsaw, A. N., Lakew, G., & Nigusie, A. (2026) · PLoS ONE · doi:10.1371/journal.pone.0347576 · Cited by 1
Choo, E. M., Lara-Árevalo, J., Achieng, C., Odhiambo, M., Okello, M. A., Masheti, M., Tickell, K. D., Diakhate, M. M., Singa, B. O., McGrath, C. J., et al. (2026) · PLoS ONE · doi:10.1371/journal.pone.0358775
“Similar barriers have been identified in other mHealth studies [18,20,35,36], where limited device ownership and concerns about privacy when using shared phones hinder participant engagement [36,37].”
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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