The use, adherence, and evaluation of interactive text-messaging among women admitted to prevention of mother-to-child transmission of HIV care in Kenya (WelTel PMTCT)
Abstract Background To improve future mobile health (mHealth) interventions in resource-limited settings, knowledge of participants’ adherence to interactive interventions is needed, but previous studies are limited. We aimed to investigate how women in prevention of mother-to-child transmission of...
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12884-023-06194-0 |
| _version_ | 1797362811129561088 |
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| author | Björn Nordberg Eunice Kaguiri Katrine J. Chamorro de Angeles Erin E. Gabriel Mia Liisa van der Kop Winfred Mwangi Richard T. Lester Edwin Were Anna Mia Ekström Susanne Rautiainen |
| author_facet | Björn Nordberg Eunice Kaguiri Katrine J. Chamorro de Angeles Erin E. Gabriel Mia Liisa van der Kop Winfred Mwangi Richard T. Lester Edwin Were Anna Mia Ekström Susanne Rautiainen |
| author_sort | Björn Nordberg |
| collection | DOAJ |
| description | Abstract Background To improve future mobile health (mHealth) interventions in resource-limited settings, knowledge of participants’ adherence to interactive interventions is needed, but previous studies are limited. We aimed to investigate how women in prevention of mother-to-child transmission of HIV (PMTCT) care in Kenya used, adhered to, and evaluated an interactive text-messaging intervention. Methods We conducted a cohort study nested within the WelTel PMTCT trial among 299 pregnant women living with HIV aged ≥ 18 years. They received weekly text messages from their first antenatal care visit until 24 months postpartum asking “How are you?”. They were instructed to text within 48 h stating that they were “okay” or had a “problem”. Healthcare workers phoned non-responders and problem-responders to manage any issue. We used multivariable-adjusted logistic and negative binomial regression to estimate adjusted odds ratios (aORs), rate ratios (aRRs) and 95% confidence intervals (CIs) to assess associations between baseline characteristics and text responses. Perceptions of the intervention were evaluated through interviewer-administered follow-up questionnaires at 24 months postpartum. Results The 299 participants sent 15,183 (48%) okay-responses and 438 (1%) problem-responses. There were 16,017 (51%) instances of non-response. The proportion of non-responses increased with time and exceeded 50% around 14 months from enrolment. Most reported problems were health related (84%). Having secondary education was associated with reporting a problem (aOR:1.88; 95%CI: 1.08–3.27) compared to having primary education or less. Younger age (18–24 years) was associated with responding to < 50% of messages (aOR:2.20; 95%CI: 1.03–4.72), compared to being 35–44 years. Women with higher than secondary education were less likely (aOR:0.28; 95%CI: 0.13–0.64), to respond to < 50% of messages compared to women with primary education or less. Women who had disclosed their HIV status had a lower rate of non-response (aRR:0.77; 95%CI: 0.60–0.97). In interviews with 176 women, 167 (95%) agreed or strongly agreed that the intervention had been helpful, mainly by improving access to and communication with their healthcare providers (43%). Conclusion In this observational study, women of younger age, lower education, and who had not disclosed their HIV status were less likely to adhere to interactive text-messaging. The majority of those still enrolled at the end of the intervention reported that text-messaging had been helpful, mainly by improving access to healthcare providers. Future mHealth interventions aiming to improve PMTCT care need to be targeted to attract the attention of women with lower education and younger age. |
| first_indexed | 2024-03-08T16:12:47Z |
| format | Article |
| id | doaj.art-d78dbc7e960748c195b0021a9a097b36 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-03-08T16:12:47Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-d78dbc7e960748c195b0021a9a097b362024-01-07T12:53:10ZengBMCBMC Pregnancy and Childbirth1471-23932024-01-0124111110.1186/s12884-023-06194-0The use, adherence, and evaluation of interactive text-messaging among women admitted to prevention of mother-to-child transmission of HIV care in Kenya (WelTel PMTCT)Björn Nordberg0Eunice Kaguiri1Katrine J. Chamorro de Angeles2Erin E. Gabriel3Mia Liisa van der Kop4Winfred Mwangi5Richard T. Lester6Edwin Were7Anna Mia Ekström8Susanne Rautiainen9Department of Global Public Health, Karolinska InstitutetPartners in Prevention, Moi UniversityDepartment of Global Public Health, Karolinska InstitutetDepartment of Medical Epidemiology and Biostatistics, Karolinska InstitutetDepartment of Global Public Health, Karolinska InstitutetDepartment of Global Public Health, Karolinska InstitutetDepartment of Medicine, Division of Infectious Diseases, University of British ColumbiaDepartment of Reproductive Health, Moi UniversityDepartment of Global Public Health, Karolinska InstitutetDepartment of Global Public Health, Karolinska InstitutetAbstract Background To improve future mobile health (mHealth) interventions in resource-limited settings, knowledge of participants’ adherence to interactive interventions is needed, but previous studies are limited. We aimed to investigate how women in prevention of mother-to-child transmission of HIV (PMTCT) care in Kenya used, adhered to, and evaluated an interactive text-messaging intervention. Methods We conducted a cohort study nested within the WelTel PMTCT trial among 299 pregnant women living with HIV aged ≥ 18 years. They received weekly text messages from their first antenatal care visit until 24 months postpartum asking “How are you?”. They were instructed to text within 48 h stating that they were “okay” or had a “problem”. Healthcare workers phoned non-responders and problem-responders to manage any issue. We used multivariable-adjusted logistic and negative binomial regression to estimate adjusted odds ratios (aORs), rate ratios (aRRs) and 95% confidence intervals (CIs) to assess associations between baseline characteristics and text responses. Perceptions of the intervention were evaluated through interviewer-administered follow-up questionnaires at 24 months postpartum. Results The 299 participants sent 15,183 (48%) okay-responses and 438 (1%) problem-responses. There were 16,017 (51%) instances of non-response. The proportion of non-responses increased with time and exceeded 50% around 14 months from enrolment. Most reported problems were health related (84%). Having secondary education was associated with reporting a problem (aOR:1.88; 95%CI: 1.08–3.27) compared to having primary education or less. Younger age (18–24 years) was associated with responding to < 50% of messages (aOR:2.20; 95%CI: 1.03–4.72), compared to being 35–44 years. Women with higher than secondary education were less likely (aOR:0.28; 95%CI: 0.13–0.64), to respond to < 50% of messages compared to women with primary education or less. Women who had disclosed their HIV status had a lower rate of non-response (aRR:0.77; 95%CI: 0.60–0.97). In interviews with 176 women, 167 (95%) agreed or strongly agreed that the intervention had been helpful, mainly by improving access to and communication with their healthcare providers (43%). Conclusion In this observational study, women of younger age, lower education, and who had not disclosed their HIV status were less likely to adhere to interactive text-messaging. The majority of those still enrolled at the end of the intervention reported that text-messaging had been helpful, mainly by improving access to healthcare providers. Future mHealth interventions aiming to improve PMTCT care need to be targeted to attract the attention of women with lower education and younger age.https://doi.org/10.1186/s12884-023-06194-0HIVPregnant womenPMTCTWHO Option B +Text-messagingMHealth |
| spellingShingle | Björn Nordberg Eunice Kaguiri Katrine J. Chamorro de Angeles Erin E. Gabriel Mia Liisa van der Kop Winfred Mwangi Richard T. Lester Edwin Were Anna Mia Ekström Susanne Rautiainen The use, adherence, and evaluation of interactive text-messaging among women admitted to prevention of mother-to-child transmission of HIV care in Kenya (WelTel PMTCT) BMC Pregnancy and Childbirth HIV Pregnant women PMTCT WHO Option B + Text-messaging MHealth |
| title | The use, adherence, and evaluation of interactive text-messaging among women admitted to prevention of mother-to-child transmission of HIV care in Kenya (WelTel PMTCT) |
| title_full | The use, adherence, and evaluation of interactive text-messaging among women admitted to prevention of mother-to-child transmission of HIV care in Kenya (WelTel PMTCT) |
| title_fullStr | The use, adherence, and evaluation of interactive text-messaging among women admitted to prevention of mother-to-child transmission of HIV care in Kenya (WelTel PMTCT) |
| title_full_unstemmed | The use, adherence, and evaluation of interactive text-messaging among women admitted to prevention of mother-to-child transmission of HIV care in Kenya (WelTel PMTCT) |
| title_short | The use, adherence, and evaluation of interactive text-messaging among women admitted to prevention of mother-to-child transmission of HIV care in Kenya (WelTel PMTCT) |
| title_sort | use adherence and evaluation of interactive text messaging among women admitted to prevention of mother to child transmission of hiv care in kenya weltel pmtct |
| topic | HIV Pregnant women PMTCT WHO Option B + Text-messaging MHealth |
| url | https://doi.org/10.1186/s12884-023-06194-0 |
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