JMIR Publications

ABSTRACT

Background:

A growing body of evidence shows that mHealth interventions may improve treatment and care for the rapidly rising number of patients with non-communicable diseases (NCD) in sub-Saharan Africa (SSA). A recent realist review developed a framework highlighting the influence of context factors, including predisposing characteristics, need, and enabling resources (PNE), for the long-term success of mHealth interventions. The views of policy-makers will ultimately determine implementation and scale-up of mHealth interventions in SSA. However, their views about necessary conditions for sustainability and scale-up remain unexplored.

Objective:

This study aimed to understand the views of policy-makers in Ghana with regard to the most important factors for successful implementation, sustainability and scale-up of mHealth NCD interventions.

Methods:

Members of the technical working group responsible for Ghana’s national NCD policy were interviewed about their knowledge of and attitude towards mHealth, and about the most important factors contributing to long-term intervention success. Using qualitative methods and applying a Qualitative Content Analysis (QCA) approach, answers were categorized according to the PNE framework into predisposing characteristics, need and enabling resources.

Results:

19 policy-makers were contacted and 13 were interviewed. Interviewees had long-standing work experience of an average of 26 years and were actively involved in health policy-making in Ghana. They were well informed about the potential of mHealth, and they strongly supported mHealth expansion in the country. The PNE framework’s categories were useful for structuring the thinking of policy-makers about factors supporting the implementation of mHealth interventions. Policy-makers mentioned many factors described in the literature as important for mHealth implementation, sustainability and scale-up – but they focussed more on enabling resources than on predisposing characteristics and needs. Furthermore, they mentioned several factors that have been rather unexplored in the literature.

Conclusions:

The study shows that the PNE framework is useful to guide policy-makers towards a more systematic assessment of context factors that support intervention implementation, sustainability and scale-up. Furthermore, the framework was refined by adding additional factors. Policy-makers may benefit from using the PNE framework at the various stages of mhealth implementation. Researchers may (and should) use the framework when investigating reasons for success (or failure) of interventions.