Implementing health care delivery in low resource settings: a qualitative evaluation

Implementing health care delivery in low resource settings: a qualitative evaluation of a text message based programme to enhance adherence to health care and treatment for hypertension.

Delivery of proven treatments for high blood pressure, one of the leading preventable risks to health, remains a challenge in low resource settings where lack of a health care infrastructure limits delivery of effective care. A low-cost mobile phone based system to follow-up patients, deliver targeted health-messages by SMS-text and provide reminders about collecting medicines has been developed by colleagues in the Primary Care Trials Unit, and the intervention tested in a clinical trial with 1,500 patients in a primary care facility in Cape Town, South Africa. 

This follow up qualitative study explored the use of a mobile phone based infrastructure to support health services delivery, including use and interpretation of SMS texts, and how this varies with different population groups, sampling, where possible, for age, literacy, distance from the health facility and other factors. We aimed to explore the way the system is viewed, valued and interpreted by recipients and providers and understand the implications for the current provision of clinical care. The methodology mainly comprised one-to-one interviews and focus groups.

This study not only illuminated trial findings but built on work in progress examining barriers to access to effective and affordable health care for those in poverty in South Africa and fed into discussion with the government of the Western Cape where wider use of text-messaging for health is planned.

DSPI Principal Investigator: Dr Rebecca Surender

Completed: 2014