Feasibility, acceptability and challenges of phone reminder system implementation for tuberculosis pill refilling and medication in Northwest Ethiopia

Abstract Background: Mobile health (mHealth) technologies showed a promising effect on improving adherence to Tuberculosis (TB) treatment. However, its implementation was not well studied specifically in low-income settings. This study aimed to fill this evidence gap by exploring the feasibility, acceptability and challenges of phone-based TB medication and pill refilling reminder system implementation during continuation phase. Methods: The study used phenomenological study design to explore participants’ lived experiences on feasibility, acceptability and implementation challenges of the reminder system. This study was part of the Randomised Controlled Trial (RCT) that deployed the reminder system in Northwest Ethiopia. We purposively selected 15 TB patients from eight districts in Central Gondar Zone and Gondar Town Administration who were enrolled in the interventional group of the RCT. The study was guided by the simplified Consolidated Framework for Implementation Research (CFIR). Data was collected using an in-depth interview and also captured events by observation throughout the intervention period. Message delivery reports generated from Ethio-telecom database. Interpretation and analysis were conducted using thematic analysis. Results: This study has shown that the local telecommunication infrastructure has supported the deployment of the new intervention and more than eight of ten reminder messages were delivered to the participants. All participants that received the reminder messages replied as the system was useful and many of them suggested for wider scale-up. We identified challenges related to the inner and outer setting, implementation process and characteristics of the intervention. Conclusion: Phone-based reminder systems could have promising feasibility and acceptability to support TB treatment and care in low-income settings with modifiable challenges throughout the implementation process. More implementation science studies are required to improve its effectiveness in more complex contexts.