SMS-based digital health intervention in Rwanda's home-based care program for remote management of COVID-19 cases and contacts: A qualitative study of sustainability and scalability

Abdulaa Babili; Sabin Nsanzimana; Edson Rwagasore; Richard T Lester

doi:10.3389/fdgth.2022.1071790

SMS-based digital health intervention in Rwanda's home-based care program for remote management of COVID-19 cases and contacts: A qualitative study of sustainability and scalability

Front Digit Health. 2023 Jan 9:4:1071790. doi: 10.3389/fdgth.2022.1071790. eCollection 2022.

Authors

Abdulaa Babili¹, Sabin Nsanzimana², Edson Rwagasore³, Richard T Lester⁴

Affiliations

¹ Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
² Central Administration, Rwanda Biomedical Center, Kigali, Rwanda.
³ Department of Public Health Surveillance and Emergency Preparedness and Response, Rwanda Biomedical Center, Kigali, Rwanda.
⁴ Faculty of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada.

Abstract

Background: COVID-19 pandemic resulted in unprecedented global health challenges. Rwanda identified its first COVID-19 case on March 14, 2020 and subsequently introduced Home-Base Care (HBC) Program in August 2020 following community transmission of the virus and to alleviate logistical and financial strain on the healthcare system. Cases and contacts eligible for HBC were remotely supported by WelTel, an SMS-based mHealth intervention that was successfully implemented before for HIV epidemic in Rwanda. Enrolled cases and contacts were supported and monitored daily via their cell and/or mobile phones until they complete isolation/quarantine period. This study explored the rationale, perspectives, and experiences of key informants (KIs) during the implementation WelTel's mHealth tool for HBC in Rwanda.

Methods: Semi-structured one-on-one virtual interviews were conducted with KIs in this qualitative study. The KIs were classified into 2 major categories: (A) Senior staff including policymakers, directors, and senior managers; (B) Technical teams including case managers, and other staff supporting the implementation of WelTel (e.g., IT staff). Interviews were audio-recorded, transcribed, and analyzed in NVivo. Thematic analysis was conducted using a hybrid approach. A topic guide was developed using the Modified Consolidated Framework for Implementation Research and feedback from local stakeholders.

Results: 7 KIs were interviewed. Five themes emerged following thematic analysis including: SMS-Based mHealth for Home-Isolation; Facilitators for Intervention Adoption; Barriers for Intervention Adoption; Infection prevention and control for Home-Isolation; and SMS-Based mHealth for Future Pandemics and Epidemics. Based on interviews, strong political commitment and advanced digital infrastructure were major facilitators for adopting WelTel for HBC. A major barrier to adopting WelTel was identified as technical-based issues. This was followed by local communication culture. All participates agreed on the significance of using WelTel to improve access and adherence to infection prevention and control measures, understand transmission dynamics, and inform public health decision-making regarding HBC.

Conclusions: Rwanda successfully adopted WelTel for supporting and monitoring COVID-19 cases and contacts in home-isolation and the implementation was instrumental to the country's effort to manage the pandemic. Experiences and perspectives of cases and contacts enrolled into WelTel must be explored to understand the appropriateness and effectiveness of the intervention.

Keywords: COVID-19; East Africa; Rwanda; digital health; implementation sceince; mHealth; outbreak management; pandemic preparedness and response.

Grants and funding

The corresponding author received a research scholarship during his time at the London School of Hygiene and Tropical Medicine which was used to support this research (Johnson & Johnson Scholarship Fund Award). Furthermore, the study was funded by the Canadian Institutes of Health Research (CIHR) funding number GR015626.