Assessing the Interoperability of mLab and Ushauri mHealth Systems to Enhance Care for HIV/AIDS Patients in Kenya

The core thesis of this study is to explore the legal and technological feasibility to interoperate two mobile health-based solutions in Kenya: Ushauri-Text for Adherence (T4A), and Mobile Laboratory (mLab), to enhance HIV/AIDS care and treatment. This paper focuses on two aspects namely data interoperability by analysing secondary data abstracted from the mLab and the Ushauri databases from June 2017 to June 2018 and doctrinal analysis of the legal and policy environment to support the interoperability. This paper is a case study of the mLab and the Ushauri systems in terms of the technological stack for interoperability which has some legal implications. It includes a pilot study that employed a multistage sampling method in which thirty-nine health facilities in Siaya, Homa bay, Nyeri, and Muranga were selected. Findings show a satisfactory legal environment to augment the interoperability of the two mHealth systems. It is also evident that the two systems were considerably interoperable in terms of technology, semantics, data, and processes. However, interoperating them could largely be compromised by language semantics leading to a discrepancy of characters and numbering in unique identifiers in data entry. Though data in the systems were for the same individuals, it is critical to note that there was a low level of concordance in patient identification numbers in the same facilities where the same patients were receiving clinical services. Additionally, healthcare workers across the various facilities did not follow the NASCOP (2010) eleven-digit unique identifier system. Standardizing human activities while using systems such as the allocation of patient identifiers and following laid down standards while developing systems are critical ways of ensuring interoperability. This paper highlights the need to achieve full-scale implementation of laid down policies and legal requirements such as the systems’ interoperability certification process to standardise the systems and make them interoperable

A Mobile Phone–Based Sexual and Reproductive Health Intervention for Female Sex Workers in Kenya: Development and Qualitative Study

Background: Female sex workers (FSWs) have high rates of both unintended pregnancy and HIV, but few health promotion interventions address their contraceptive needs or other sexual and reproductive health and rights (SRHR) concerns. A broader approach integrates contraceptive promotion with HIV and sexually transmitted infection (STI) prevention and management, alcohol awareness, gender-based violence and rights, and health care utilization. The Women\u27s Health Intervention using SMS for Preventing Pregnancy (WHISPER) mobile phone intervention uses a participatory development approach and behavior change theory to address these high-priority concerns of FSWs in Mombasa, Kenya. Objective: This paper aimed to (1) describe the process of development of the WHISPER intervention, its theoretical framework, key content domains and strategies and (2) explore workshop participants\u27 responses to the proposed intervention, particularly with regard to message content, behavior change constructs, and feasibility and acceptability. Methods: The research team worked closely with FSWs in two phases of intervention development. First, we drafted content for three different types of messages based on a review of the literature and behavior change theories. Second, we piloted the intervention by conducting six workshops with 42 FSWs to test and refine message content and 12 interviews to assess the technical performance of the intervention. Workshop data were thematically analyzed using a mixed deductive and inductive approach. Results: The intervention framework specified six SRHR domains that were viewed as highly relevant by FSWs. Reactions to intervention content revealed that social cognitive strategies to improve knowledge, outcome expectations, skills, and self-efficacy resonated well with workshop participants. Participants found the content empowering, and most said they would share the messages with others. The refined intervention was a 12-month SMS program consisting of informational and motivational messages, role model stories portraying behavior change among FSWs, and on-demand contraceptive information. Conclusions: Our results highlight the need for health promotion interventions that incorporate broader components of SRHR, not only HIV prevention. Using a theory-based, participatory approach, we developed a digital health intervention that reflects the complex reality of FSWs\u27 lives and provides a feasible, acceptable approach for addressing SRHR concerns and needs. FSWs may benefit from health promotion interventions that provide relevant, actionable, and engaging content to support behavior change

“I now know I’m the boss”: Development of mobile phone-based sexual and reproductive health intervention for female sex workers in Kenya

Background: Female sex workers (FSWs) have high rates of both unintended pregnancy and HIV, but few health promotion interventions address their contraceptive needs or other sexual and reproductive health and rights (SRHR) concerns. A broader approach integrates contraceptive promotion with HIV and STI prevention and management, alcohol awareness, gender-based violence and rights, and healthcare utilization. The WHISPER mobile phone intervention uses a participatory development approach and behaviour change theory to address these high-priority concerns of FSWs in Mombasa, Kenya. Objective: This paper aims to describe the development and content of the WHISPER intervention, its theoretical framework and key content domains, and; explore workshop participants’ responses to the proposed intervention, particularly with regards to message content and behavior change constructs. Methods: The research team worked closely with FSWs in two phases of intervention development. First, we drafted content based on review of the literature and behavior change theories. Second, we conducted six workshops with 42 FSWs to test and refine message content, and 12 interviews to assess the technical performance of the intervention. Workshop data were thematically analyzed using a mixed deductive and inductive approach. Results: The intervention framework specified six SRHR domains that were viewed as highly relevant by FSWs. Reactions to content in these domains revealed that social cognitive strategies to improve knowledge, outcome expectations, skills, and self-efficacy resonated well with workshop participants. Participants found the messages empowering to themselves and their communities, and most said they would share the messages with others. The final intervention was a 12-month SMS program consisting of informational and motivational messages, role model stories portraying behavior change among FSWs, and on-demand contraceptive information. Conclusions: Our results highlight the need for health promotion interventions that incorporate both HIV/STI prevention and management and broader components of SRHR. Using a theory-based, participatory approach, we developed a digital health intervention that reflects the complex reality of FSWs’ lives and provides a feasible approach for addressing their SRHR concerns and needs. FSW may benefit from health promotion interventions that provide relevant, actionable, and engaging content to support behaviour change