Browsing by Author "Amanda, J. Meyer"
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Item Anybody out there? A process evaluation of SMS sent to household TB contacts in Kampala, Uganda(ResearchGate, 2018) Amanda, J. Meyer; Babirye, Diana; Armstrong-Hough, Mari; Mark, David; Ayakaka, Irene; Katamba, Achilles; Haberer, Jessica E.; Davis, J. LucianPrevious studies have reported inconsistent effectiveness of SMS (short-messaging services) for improving health outcomes, but few have examined to what degree the quality, or “fidelity”, of implementation may explain study results. Objective: We sought to determine the fidelity of a one-time SMS intervention to promote uptake of TB evaluation services among household contacts of index TB patients. Methods: From February to June 2017, we nested a process evaluation of SMS delivery within the intervention arm of a randomized controlled trial of TB contact investigation in Kampala, Uganda. Because mobile service providers in Uganda do not provide delivery confirmations, we asked household TB contacts to confirm receipt of a one-time TB-related SMS by sending an SMS reply via a toll-free “short code.” Two weeks later, a research officer followed-up by telephone to confirm receipt of the one-time SMS and administer a survey. We considered participants lost-to-follow-up after three unsuccessful call attempts on three separate days over a one-week period. Results: Of 206 consecutive household contacts, 119 had an SMS initiated from the server. Thirty-nine (33%) were children aged 5-14, including 24 (20%) girls and 15 (13%) boys. Twenty-one (18%) were adolescents or young adults, including 14 (12%) young women and seven (6%) young men. Fifty-nine (50%) were adults, including 31 (26%) women and 28 (24%) men. Of 107 (90%) participants for whom we were able to ascertain SMS receipt status, 67% (n=72) confirmed SMS receipt, including 22% (n=24) by reply SMS and 45% (n=48) during the follow-up telephone survey. There were no significant clinical or demographic differences between those who did and did not report receiving the SMS message. 52% (n=56) reported ever reading the SMS. The cumulative likelihood of an SMS reaching its target and being read and retained by a participant was 19%. Conclusions: The fidelity of a one-time SMS intervention to increase uptake of household TB contact investigation and linkage to care was extremely low, a fact only discoverable through a detailed process evaluation. Our findings suggest the need for systematic process monitoring and reporting of implementation fidelity in both research studies and programmatic interventions employing mobile communications to improve health.