What's in it for me? A process evaluation of the implementation of a mobile phone-supported intervention after stroke in Uganda

Abstract

Background: The prevalence of stroke in Uganda is increasing. In stroke rehabilitation, information and communication technology has been shown to have potential in improving service delivery in high-income countries but there is limited knowledge of its use and impact in low-income countries. The aim of the study was to evaluate the implementation process of a mobile phone-supported family-centred rehabilitation intervention and to gain knowledge on the mechanisms of impact as well as the contextual factors that might have affected the implementation process and its outcome.

Method: This was a single-case study design using the integrated Promoting Action on Research Implementation in Health Services framework and the Medical Research Council guidance as frameworks. Quantitative process data was derived from 14 log books used by occupational therapists during the implementation. Qualitative semi-structured interviews were conducted with 12 implementers in different professions, 12 months into the implementation, in order to obtain the primary data. Secondary data was derived from six semi-structured interviews conducted directly after pre-intervention workshops and 6 months later. The framework method was used in the data analysis.

Results: In 11 out of 14 cases, the clients were compliant with the intervention. Yet, challenges such as technical problems were reported. The target of conducting 16 phone calls for each client was achieved to 74%. Eight categories emerged from the qualitative analysis of the interviews including: 1) perceptions on facilitation, 2) using scientific and experience-based knowledge, 3) tailoring the intervention, 4) supportive working culture, 5) barriers to the service delivery, 6) implementers' interaction with the intervention, 7) perceptions on motivations and values, and 8) improving the model and enabling sustainability. Mechanisms contributing to the implementation of the intervention included engaged facilitators and motivated participants. Challenges in the client recruitment and poor information dissemination were some of the mechanisms impeding the implementation.

Conclusions: The intervention was partially delivered in accordance with the logic model for the project, where the implementation process was influenced by several barriers in the context such as technical setbacks. However, there were also several mediators in the process driving the project forward, including strong facilitation and motivated participants.

Keywords: Africa; ICT; Low-income; Occupational therapy; Process evaluation; SMS; Stroke; Tele medicine; Tele-rehabilitation.

Fig. 1

The key components in a process evaluation. Key components of a process evaluation and constructs of i- PARIHS in a combined framework. Adapted from: Moore et al. [21] and Harvey G, Kitson A [24]

Fig. 2

The data collection timeline. Data collection timeline and data sources

Fig. 3

Information gathered from the logbooks written by the OTs. Eleven cases showed the clients were adherent to the intervention. Problems reported

Fig. 4

The emerging categories related to the main constructs in the combined theoretical framework. The relationships between the eight categories that were identified in the qualitative interviews