Anybody out there? A process evaluation of SMS sent to household TB contacts in Kampala, Uganda

Previous 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.

Keywords

Process evaluation, SMS, Household TB contacts

Citation

Meyer, A. J., Babirye, D., Armstrong-Hough, M., Mark, D., Ayakaka, I., Katamba, A., ... & Davis, J. L. Anybody out there? A process evaluation of SMS sent to household TB contacts in Kampala, Uganda. https://www.researchgate.net/profile/Diana-Babirye/publication/327577834_Anybody_out_there_A_process_evaluation_of_SMS_sent_to_household_TB_contacts_in_Kampala_Uganda_Preprint/links/5f38c90b299bf13404c8574b/Anybody-out-there-A-process-evaluation-of-SMS-sent-to-household-TB-contacts-in-Kampala-Uganda-Preprint.pdf

URI

https://www.researchgate.net/profile/Diana-Babirye/publication/327577834_Anybody_out_there_A_process_evaluation_of_SMS_sent_to_household_TB_contacts_in_Kampala_Uganda_Preprint/links/5f38c90b299bf13404c8574b/Anybody-out-there-A-process-evaluation-of-SMS-sent-to-household-TB-contacts-in-Kampala-Uganda-Preprint.pdf
https://nru.uncst.go.ug/handle/123456789/6989

Collections

Medical and Health Sciences

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