Doctor of Philosophy

dissertationTreatment adherence remains a major challenge in tuberculosis (TB) control. Mobile phone text messaging is a promising tool to support TB treatment adherence. The purpose of this study was to develop a text messaging intervention to promote TB treatment adherence, assess feasibility and acceptability, and to explore initial efficacy. A collaborative team of clinicians, administrators and patients in treatment developed the intervention. Content analysis, based on the Information-Motivation-Behavioral Skills (IMB) model, guided educational message selection. To identify considerations for a larger trial a socio-technical evaluation model adapted from Conford, and Barber and associates was applied. The intervention was implemented as a mixed-method, randomized controlled pilot-study at a public pulmonary-specialized hospital in Argentina. Patients newly diagnosed with TB who were18 or older, without drug resistance or HIV, and had access to a mobile phone were recruited. Participants were randomized to usual care plus either medication calendar (n=19) or text messaging intervention (n=18) for the first 2 months of treatment. Data were obtained through interviews, field notes, self-reported adherence, sputum microscopy, and treatment outcomes. Most potential participants had access to mobile phones and knew how to send a text, supporting feasibility of the intervention. The majority of the participants (60%) indicated not being adequately informed about disease or treatment. Participants identified themes of feeling cared for, responsible for their treatment and valued the option to ask questions and receive quick answers. Texting group participants reported adherence 77% of the days (SD 23.5, range 22-100), whereas only 53% in the control group returned calendars. Sputum conversion and treatment outcomes were similar in both groups. Considerations for conducting a larger trial included reducing cost, improving the automated features, and strengthening capacity to return patients to treatment. A collaborative approach and application of the IMB model to guide development was supported. Overall the texting intervention was well accepted and feasible, daily reporting was superior, and adherence was monitored in real time. Although there was not clear evidence that the texting intervention was more efficacious, feasibility and acceptability results suggest that there is value in assessing this interactive intervention in a larger-scale study

A framework for guiding the interdisciplinary design of mHealth intervention apps for physical activity behaviour change

The global pandemic of noncommunicable diseases and its associated premature mortality rates and socioeconomic burden have led to increasingly intensified efforts towards designing and delivering health promotion interventions aimed at addressing the leading modifiable health risk behaviours, such as physical inactivity. Developing physical activity behaviour change interventions that target individuals at the dual intra-interpersonal socioecological levels of health promotion has become a key objective worldwide. Digital and mobile technology is revolutionising the ways in which health behaviour change interventions are delivered to individuals across the world, with mobile health applications (mHealth apps) increasingly recognised as a powerful means of promoting physical activity behaviour change. However, with the growth and opportunities of mHealth apps, come several design challenges. Key design challenges concern the integration of theory, the incorporation of evidence-based behaviour change techniques, the application of persuasive systems design principles, and the importance of multi- and interdisciplinary collaborative design, development and evaluation approaches. These key challenges influence the output product design and effectiveness of mHealth physical activity behaviour change intervention apps. There exists a paucity of approaches for guiding and supporting the multi- and interdisciplinary collaborative design, development and evaluation of mHealth physical activity behaviour change intervention apps. To address this gap, this research study proposes an Interdisciplinary mHealth App Design Framework, framed by a novel boundary object view. This view considers the diverse communities of practice, boundary objects and supporting artefacts, process activities, and knowledge sharing practices necessary and relevant to the design of effective mHealth physical activity behaviour change intervention apps. The framework’s development is guided by a Design Science Research (DSR) approach. Its core components are based on the findings of a critical theoretical analysis of twenty existing multi- and interdisciplinary digital health development approaches. Once developed, the framework is evaluated using a qualitative DSR linguistic interpretivist approach, with semi-structured interviews as the research instrument. The thematic analysis findings from interviews with thirty-one international academic researchers and industry practitioners informs the iterative modification and revision of an enhanced Interdisciplinary mHealth App Design Framework, constituting the main DSR artefact contribution of the research study. In addition, four theoretical contributions are made to the mHealth intervention app design body of knowledge, and a practical contribution is made through the provision of guideline recommendations for academics and industry practitioners. Methodological contributions are also made in terms of applying DSR, adopting a hybrid cognitive reasoning strategy, and employing a qualitative linguistic interpretivist approach to evaluation within a DSR project.Thesis (PhD) -- Faculty of Commerce, Information Systems, 202