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Abstract
Objective To assess the intervention fidelity and explore contextual factors affecting the process of implementing a mobile phone text messaging intervention in improving adherence to and retention in care among adolescents living with HIV, their families and their healthcare providers in southern Ethiopia.
Design A convergent mixed-methods design guided by the process evaluation theoretical framework and the Reach, Effectiveness, Adoption, Implementation and Maintenance framework was used alongside a randomised controlled trial to examine the fidelity and explore the experiences of participants in the intervention.
Setting Six hospitals and five health centres provide HIV treatment and care to adolescents in five zones in southern Ethiopia.
Participants Adolescents (aged 10–19), their families and their healthcare providers.
Intervention Mobile phone text messages daily for 6 months or standard care (control).
Results 153 participants were enrolled in the process evaluation. Among the 153 enrolled in the intervention arm, 78 (49.02%) were male and 75 (43.8%) were female, respectively. The mean and SD age of the participants is 15 (0.21). The overall experiences of implementing the text messages reminder intervention were described as helpful in terms of treatment support for adherence but had room for improvement. During the study, 30 700 text messages were sent, and fidelity was high, with 99.4% successfully delivered text messages during the intervention. Barriers such as failed text messages delivery, limitations in phone ownership and technical limitations affected fidelity. Technical challenges can hinder maintenance, but a belief in the future of digital communication permeates the experiences of the text message reminders.
Conclusions Overall fidelity was high, and participants’ overall experiences of mobile phone text messages were expressed as helpful. Contextual factors, such as local telecommunications networks and local electric power, as well as technical and individual factors must be considered when planning future interventions.
Trial registration number PACTR202107638293593.
- Adolescent
- HIV & AIDS
- Information technology
Data availability statement
Data are available on reasonable request. Extra data can be accessed via the Dryad data repository at https://doi.org/10.5061/dryad.n8pk0p31s.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Data availability statement
Data are available on reasonable request. Extra data can be accessed via the Dryad data repository at https://doi.org/10.5061/dryad.n8pk0p31s.
Footnotes
Contributors AT, DJ and IH conceptualised and developed the study design. AT collected the data and transcribed verbatim and translated from Amharic to English. DJ and IH supervised data collection and study implementation. All authors read the transcripts, extracted meaning units, codes and data analysis. Subthemes were created from the code frame by the first and last authors. AT, HÅP, DJ, and IH are guarantor. AT and HÅP drafted the manuscript, and all authors contributed to critical revision and approved the final manuscript.
Funding The project was externally funded by FORTE: Swedish Research Council for Health, Working Life and Welfare Life (FORTE) (https://forte.se/en/) program support 2018-01399 and the Swedish Research Council(https://www.vr.se/english.html) programme support VR 2016-05706. The study protocol has undergone a peer review by the funding body.
Disclaimer The funders had no role in study design, writing of the study protocol, the decision to publish the study protocol, or preparation of the manuscript.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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