Developing a theory-driven contextually relevant mHealth intervention

ABSTRACT

Background: mHealth interventions have huge potential to reach large numbers of people in resource poor settings but have been criticised for lacking theory-driven design and rigorous evaluation. This paper shares the process we developed when developing an awareness raising and behaviour change focused mHealth intervention, through applying behavioural theory to in-depth qualitative research. It addresses an important gap in research regarding the use of theory and formative research to develop an mHealth intervention.

Objectives: To develop a theory-driven contextually relevant mHealth intervention aimed at preventing and managing diabetes among the general population in rural Bangladesh.

Methods: In-depth formative qualitative research (interviews and focus group discussions) were conducted in rural Faridpur. The data were analysed thematically and enablers and barriers to behaviour change related to lifestyle and the prevention of and management of diabetes were identified. In addition to the COM-B (Capability, Opportunity, Motivation-Behaviour) model of behaviour change we selected the Transtheoretical Domains Framework (TDF) to be applied to the formative research in order to guide the development of the intervention.

Results: A six step-process was developed to outline the content of voice messages drawing on in-depth qualitative research and COM-B and TDF models. A table to inform voice messages was developed and acted as a guide to scriptwriters in the production of the messages.

Conclusions: In order to respond to the local needs of a community in Bangladesh, a process of formative research, drawing on behavioural theory helped in the development of awareness-raising and behaviour change mHealth messages through helping us to conceptualise and understand behaviour (for example by categorising behaviour into specific domains) and subsequently identify specific behavioural strategies to target the behaviour.

KEYWORDS:

• mHealth
• behaviour change
• message development
• diabetes
• Bangladesh

Responsible Editor Peter Byass, Umeå University, Sweden

Responsible Editor Peter Byass, Umeå University, Sweden

Acknowledgments

We would like to thank m-World Bangladesh, and particularly Faisal Mahmud, for providing us technical expertise and their assistance in the final delivery of the mHealth messages.

Author contributions

HMJ wrote the first draft of the manuscript, contributed to the design and analysis of the formative research data and led the development of the mHealth intervention. JM was involved in design and analysis of the formative research and contributed to the development of the mHealth intervention. KAk collected the research data, and contributed to the design and analysis of the formative research. AK, NA and SKS contributed to the development of the intervention. AKAK and KAz provided oversight and advice on the intervention development. TN and HBB were part of the trial team and read and commented on the manuscript. EF provided expertise, contributed to the intervention development and contributed significantly to the manuscript. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

The formative research was collected as part of a large cluster randomised control trial. Ethical approval was received for the research from the University College London Research Ethics Committee (4766/002) and the Ethical Review Committee of the Diabetic Association of Bangladesh (BADAS-ERC/EC/t5100246). All research respondents gave either informed written consent or consent by thumbprint to participate in the study.

Paper context

The evidence for the effectiveness of mHealth interventions in low-income countries is somewhat limited, and many lack a theoretical basis and context is not always considered. This paper addresses some of the gaps in research – it reports the process of applying qualitative research to behavioural theory to guide the development of an mHealth intervention in Bangladesh. It is hoped that the principles and process developed will be applied and tested in other contexts.

Additional information

Funding

The research and interventions were funded through the trial, which is funded by the Medical Research Council UK (MR/M016501/1) under the Global Alliance for Chronic Diseases (GACD) Diabetes Programme. The funders had no role in the design of the study and collection, analysis, interpretation of data or in writing the manuscript.