JMIR Publications

ABSTRACT

Background:

Uncontrolled hypertension is the leading risk factor for cardiovascular diseases. In Uganda, such diseases account for approximately 10% of all deaths, with 1 in 5 adults having hypertension (> 90% of hypertensive cases are uncontrolled). Although basic healthcare in the country is available free of cost at government facilities, regularly accessing medication to control hypertension is difficult as supply chain challenges impede availability. Clients therefore frequently suspend treatment, or buy medication individually at private facilities or pharmacies (incurring significant costs).

Objective:

This study seeks to investigate affordable, local solutions to address unmet needs for blood pressure management, and to expand and evaluate promising, locally devised approaches to facilitate medication availability with an emphasis on digital interventions (e.g., nesting mobile money or mHealth solutions within existing efforts).

Methods:

We will conduct a mixed methods study following a Human Centered Design approach. We will begin by conducting extensive qualitative research with a range of stakeholders (clients, health care providers, religious, cultural, and community leaders, academics, and policymakers on district and national level) on their perceptions of hypertension management, saving systems, and mobile money in the context of health care. Results will inform design, iterative adaptation and implementation of an mHealth-facilitated pooled financing intervention prototype. This prototype will enable clients to save money for their health care expenditures and contribute to a health facility money pool which will allow bulk purchases to cover antihypertensive medication. Concluding this study, the finalized prototype will be evaluated quantitatively via a randomized controlled trial.

Results:

As of February 2023, qualitative data collection, having started in November 2022, is ongoing with data analysis for first qualitative interviews under way to inform platform and implementation design. Recruitment for the quantitative part of this study is expected to begin in June 2023.

Conclusions:

Local populations often devise solutions to existing problems in ways that are more easily scaled and readily adopted. Rather than entering a setting with a ready-made intervention, this research will place emphasis on gathering applied ethnographic insights early, which can then inform the parameters of an intervention and concurrent trial. Our results aim to inform the ongoing discourse on novel and sustainable pathways to facilitate access to medication for the management of hypertension in resource constrained settings. Clinical Trial: The trial component has been registered in the German registry of clinical trials (DRKS). Registration number: DRKS00030922; Date of Trial Registration: 17.12.2022; URL Registration Record: https://www.drks.de/DRKS00030922.