Development of a customized m-Health-based intervention to reduce loss to follow-up among patients undergoing treatment for cervical lesions at a rural Referral Hospital, South Western Uganda

Abstract

Abstract Background Loss to follow-up (LTFU) in individuals undergoing cervical cancer treatment is a major challenge in many low resource settings. Mhealth interventions via text messaging have potential to improve health outcomes in such settings. We describe development of a customized and tailored user-centered mHealth intervention for reducing LTFU among patients undergoing cervical cancer treatment at Mbarara Regional Referral Hospital (MRRH). Methods We interviewed all health care providers (HCPs) at the cervical cancer clinic of MRRH, and owned a phone for at least one year between April and May 2023 to understand challenges/facilitators of LTFU, identify and develop an appropriate mHealth intervention that can re-engage patients in care. Transcripts were subsequently derived, reviewed and coded to generate themes and categories using inductive content analytic approach. Four medical experts used this data to develop relevant SMS content, which was incorporated into an app designed through partnership with Ucatch Technologies Limited, a local application development company in South Western Uganda. Results Interviewed HCPs had owned a phone for 13.8 ≤ years, had worked at the clinic for 5 ≤ years, and used text messages regularly. Qualitative data revealed that the main challenge to re-engagement was absence a reminder mechanism between HCPs and patients. HCPs preferred text and or audio mode of messaging to improve health care responsiveness to LTFUs, awareness, continuity of care, and health service uptake among the majority illiterate population; though with potential constraints of costs and workload. HCPs identified key messaging content to include; the importance of attending scheduled follow-ups, follow up visit date and clinic customization and tailoring the message to the intended recipient. Developed SMS content considering themes was uploaded onto the cc-follow-up app platform and customized according to preferred language, day, frequency and time of delivery. Conclusion Tailoring an mHealth messaging intervention could be an important strategy to re-engage and reduce LTFU through improved information sharing, awareness, responsiveness, care engagement and medical compliance. Our app additionally supports improved clinical and behavioural data collection for low resource settings. More work is required to evaluate our intervention’s feasibility and acceptability among individuals undergoing cervical cancer treatment in South Western Uganda.