Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Cholera | Research article

Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program

Authors: Christine Marie George, Fatema Zohura, Alana Teman, Elizabeth Thomas, Tasdik Hasan, Sohel Rana, Tahmina Parvin, David A. Sack, Sazzadul Islam Bhuyian, Alain Labrique, Jahed Masud, Peter Winch, Elli Leontsini, Kelsey Zeller, Farzana Begum, Abul Hasem Khan, Sanya Tahmina, Farazana Munum, Shirajum Monira, Munirul Alam

Published in: BMC Public Health | Issue 1/2019

Login to get access

Abstract

Background

The Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7) is a handwashing with soap and water treatment intervention program delivered by a health promoter bedside in a health facility and through home visits to diarrhea patients and their household members during the 7 days after admission to a health facility. In a randomized controlled trial among cholera patient households in Bangladesh, the 7-day CHoBI7 program resulted in a significant reduction in cholera among household members of cholera patients and sustained improvements in drinking water quality and handwashing with soap practices 12 months post-intervention. In an effort to take this intervention to scale across Bangladesh in partnership with the Bangladesh Ministry of Health and Family Welfare, this study evaluates the feasibility and acceptability of mobile health (mHealth) programs as a low-cost, scalable approach for CHoBI7 program delivery.

Methods

Formative research for the development of the CHoBI7 mHealth intervention included 40 semi-structured interviews, 4 mHealth workshops, 2 group discussions, and a pilot study of 52 households to assess the feasibility and acceptability of the developed mHealth program. Thematic analysis of the interviews and group discussions was conducted by two individuals separately based on emergent themes, and then themes were compared and discussed.

Results

A theory- and evidence-based approach using qualitative research methods was implemented to design the CHoBI7 mHealth program. Semi-structured interviews with government stakeholders identified perceptions and preferences for scaling the CHoBI7 mHealth program. Group discussions and semi-structured interviews with diarrhea patients and their family members identified beneficiary perceptions of mHealth and preferences for CHoBI7 mHealth program delivery. mHealth workshops were conducted as an interactive approach to draft and refine mobile message content based on stakeholder preferences. The pilot findings indicate that the CHoBI7 mHealth program has high user acceptability and is feasible to deliver to diarrhea patients that present at health facilities for treatment in Bangladesh. Both text and voice messages were recommended for program delivery. Dr. Chobi, the sender of mHealth messages, was viewed as a credible source of information that could be shared with others.

Conclusion

This study presents a theory- and evidence-based approach that can be implemented for the development of future water, sanitation, and hygiene mHealth programs in low-resource settings.
Appendix
Available only for authorised users
Literature
1.
Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases. a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis. 2017;17(9):909–48.CrossRef
2.
Esrey SA. Water, waste, and well-being: a multicountry study. Am J Epidemiol. 1996;143(6):608–23.PubMedCrossRef
3.
Saha D. Acute diarrhoea in children in rural Gambia: Knowledge, attitude and practice, aetiology, risk factors and consequences among children less than five years of age. Dunedin: The University of Otago; 2013.
4.
George CM, Perin J, Neiswender de Calani KJ, Norman WR, Perry H, Davis TP Jr, Lindquist ED. Risk factors for diarrhea in children under five years of age residing in peri-urban communities in Cochabamba, Bolivia. Am J Trop Med Hyg. 2014;91(6):1190–6.PubMedPubMedCentralCrossRef
5.
6.
Halder A, Tronchet C, Akhter S, Bhuiya A, Johnston R, Luby S. Observed hand cleanliness and other measures of handwashing behavior in rural Bangladesh. BMC public health. 2010;10(1):545.PubMedPubMedCentralCrossRef
7.
Wolf J, Hunter PR, Freeman MC, Cumming O, Clasen T, Bartram J, Higgins JPT, Johnston R, Medlicott K, Boisson S, et al. Impact of drinking water, sanitation and handwashing with soap on childhood diarrhoeal disease: updated meta-analysis and meta-regression. Trop Med Int Health. 2018;23(5):508–25.CrossRef
8.
Luby SP, Agboatwalla M, Bowen A, Kenah E, Sharker Y, Hoekstra RM. Difficulties in maintaining improved handwashing behavior, Karachi, Pakistan. Am J Trop Med Hyg. 2009;81(1):140–5.PubMedCrossRef
9.
Zwane AP, Kremer M. What works in fighting diarrheal diseases in developing countries? A critical review. World Bank Res Obs. 2007;22(1):1–24.CrossRef
10.
Qadri F, Ali M, Chowdhury F, Khan AI, Saha A, Khan IA, Begum YA, Bhuiyan TR, Chowdhury MI, Uddin MJ, et al. Feasibility and effectiveness of oral cholera vaccine in an urban endemic setting in Bangladesh: a cluster randomised open-label trial. Lancet. 2015;386(10001):1362–71.PubMedCrossRef
11.
Zurovac D, Sudoi RK, Akhwale WS, Ndiritu M, Hamer DH, Rowe AK, Snow RW. The effect of mobile phone text-message reminders on Kenyan health workers' adherence to malaria treatment guidelines: a cluster randomised trial. Lancet. 2011;378(9793):795–803.PubMedPubMedCentralCrossRef
12.
Cole-Lewis H, Kershaw T. Text messaging as a tool for behavior change in disease prevention and management. Epidemiol Rev. 2010;32:56–69.PubMedCrossRef
13.
Free C, Phillips G, Galli L, Watson L, Felix L, Edwards P, Patel V, Haines A. The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS Med. 2013;10(1):e1001362.PubMedPubMedCentralCrossRef
14.
Higgs ES, Goldberg AB, Labrique AB, Cook SH, Schmid C, Cole CF, Obregon RA. Understanding the role of mHealth and other media interventions for behavior change to enhance child survival and development in low- and middle-income countries: an evidence review. J Health Commun. 2014;19(Suppl 1):164–89.PubMedPubMedCentralCrossRef
15.
Gibson DG, Ochieng B, Kagucia EW, Were J, Hayford K, Moulton LH, Levine OS, Odhiambo F, O'Brien KL, Feikin DR. Mobile phone-delivered reminders and incentives to improve childhood immunisation coverage and timeliness in Kenya (M-SIMU): a cluster randomised controlled trial. Lancet Glob Health. 2017;5(4):e428–38.PubMedPubMedCentralCrossRef
16.
17.
GSMA: Mobile industry driving growth and enabling digital inclusion. 2018.
18.
19.
Michie S, Prestwich A. Are interventions theory-based? Development of a theory coding scheme. Health Psychol. 2010;29(1):1.PubMedCrossRef
20.
Inauen J, Mosler H-J. Developing and testing theory-based and evidence-based interventions to promote switching to arsenic-safe wells in Bangladesh. J Health Psychol. 2014;19(12):1483–98.PubMedCrossRef
21.
Contzen N, Meili IH, Mosler HJ. Changing handwashing behaviour in southern Ethiopia: a longitudinal study on infrastructural and commitment interventions. Soc Sci Med. 2015;124:103–14.PubMedCrossRef
22.
Taylor N, Conner M, Lawton R. The impact of theory on the effectiveness of worksite physical activity interventions: a meta-analysis and meta-regression. Health Psychol Rev. 2012;6(1):33–73.CrossRef
23.
Webb TL, Joseph J, Yardley L, Michie S. Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res. 2010;12(1):e4.PubMedPubMedCentralCrossRef
24.
Dreibelbis R, Kroeger A, Hossain K, Venkatesh M, Ram PK. Behavior change without behavior change communication: nudging handwashing among primary school students in Bangladesh. Int J Environ Res Public Health. 2016;13(1):129.PubMedCentralCrossRef
25.
Dreibelbis R, Winch PJ, Leontsini E, Hulland KR, Ram PK, Unicomb L, Luby SP. The integrated behavioural model for water, sanitation, and hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings. BMC public health. 2013;13(1):1015.PubMedPubMedCentralCrossRef
26.
Carpenter CJ. A meta-analysis of the effectiveness of health belief model variables in predicting behavior. Health Commun. 2010;25(8):661–9.PubMedCrossRef
27.
Mosler H-J. A systematic approach to behavior change interventions for the water and sanitation sector in developing countries: a conceptual model, a review, and a guideline. Int J Environ Health Res. 2012;22(5):431–49.PubMedCrossRef
28.
Ajzen I. From intentions to actions: A theory of planned behavior: Springer; 1985.
29.
Rogers RW. A protection motivation theory of fear appeals and attitude change1. J Psychol. 1975;91(1):93–114.PubMedCrossRef
30.
Contzen N, Mosler HJ. Identifying the psychological determinants of handwashing: Results from two cross-sectional questionnaire studies in Haiti and Ethiopia. Am J Infect Control. 2015;43(8):826–32.PubMedCrossRef
31.
32.
Weil AA, Khan AI, Chowdhury F, LaRocque RC, Faruque A, Ryan ET, Calderwood SB, Qadri F, Harris JB. Clinical outcomes in household contacts of patients with cholera in Bangladesh. Clin Infect Dis. 2009;49(10):1473–9.PubMedCrossRef
33.
George CM, Ahmed S, Talukder KA, Azmi IJ, Perin J, Sack RB, Sack DA, Stine OC, Oldja L, Shahnaij M, et al. Shigella Infections in Household Contacts of Pediatric Shigellosis Patients in Rural Bangladesh. Emerg Infect Dis. 2015;21(11):2006–13.PubMedPubMedCentralCrossRef
34.
Black RE, Merson MH, Rowe B, Taylor PR, Abdul Alim AR, Gross RJ, Sack DA. Enterotoxigenic Escherichia coli diarrhoea: acquired immunity and transmission in an endemic area. Bull World Health Organ. 1981;59(2):263–8.PubMedPubMedCentral
35.
Burrowes V, Perin J, Monira S, Sack DA, Rashid MU, Mahamud T, Rahman Z, Mustafiz M, Bhuyian SI, Begum F, et al. Risk Factors for Household Transmission of Vibrio cholerae in Dhaka, Bangladesh (CHoBI7 Trial). Am J Trop Med Hyg. 2017;96(6):1382–7.PubMedPubMedCentralCrossRef
36.
Figueroa ME, Kincaid DL, Sobsey N, Clasen T. Social, cultural and behavioral correlates of household water treatment and storage. Household water treatment and safe storage; 2007.
37.
Amin N, Pickering AJ, Ram PK, Unicomb L, Najnin N, Homaira N, Ashraf S, Abedin J, Islam MS, Luby SP. Microbiological evaluation of the efficacy of soapy water to clean hands: a randomized, non-inferiority field trial. Am J Trop Med Hyg. 2014;91(2):415–23.PubMedPubMedCentralCrossRef
38.
George CM, Monira S, Sack DA, Rashid MU, Saif-Ur-Rahman KM, Mahmud T, Rahman Z, Mustafiz M, Bhuyian SI, Winch PJ, et al. Randomized Controlled Trial of Hospital-Based Hygiene and Water Treatment Intervention (CHoBI7) to Reduce Cholera. Emerg Infect Dis. 2016;22(2):233–41.PubMedPubMedCentralCrossRef
39.
40.
George CM, Jung DS, Saif-Ur-Rahman KM, Monira S, Sack DA, Rashid MU, Mahmud T, Mustafiz M, Rahman Z, Bhuyian SI, et al. Sustained Uptake of a Hospital-Based Handwashing with Soap and Water Treatment Intervention (Cholera-Hospital-Based Intervention for 7 Days [CHoBI7]): A Randomized Controlled Trial. Am J Trop Med Hyg. 2016;94(2):428–36.PubMedPubMedCentralCrossRef
41.
Devine J, Karver J, Coombes Y, Chase C, Hernandez O. Behavioral determinants of handwashing with soap among mothers and caretakers: emergent learning from Senegal and Peru. Washington, DC: Learning note, Water and Sanitation Program; 2012.
42.
Porzig-Drummond R, Stevenson R, Case T, Oaten M. Can the emotion of disgust be harnessed to promote hand hygiene? Experimental and field-based tests. Soc Sci Med. 2009;68(6):1006–12.PubMedCrossRef
43.
Aunger R, Schmidt W-P, Ranpura A, Coombes Y, Maina PM, Matiko CN, Curtis V. Three kinds of psychological determinants for hand-washing behaviour in Kenya. Soc Sci Med. 2010;70(3):383–91.PubMedCrossRef
44.
George CM, Biswas S, Jung D, Perin J, Parvin T, Monira S, Saif-Ur-Rahman KM, Rashid MU, Bhuyian SI, Thomas ED, et al. Psychosocial factors mediating the effect of the CHoBI7 intervention on handwashing with soap: A randomized controlled trial. Health Educ Behav. 2017;4(4):613–25.CrossRef
45.
Etikan I, Musa SA, Alkassim RS. Comparison of convenience sampling and purposive sampling. Am J Theor Appl Stat. 2016;5(1):1–4.CrossRef
46.
47.
48.
Anis F, White J. The Meena Communicative Initiative in Bangladesh. In: Inclusive Education: Springer; 2017. p. 61–76.CrossRef
49.
50.
Kabeer N. Between affiliation and autonomy: navigating pathways of women's empowerment and gender justice in rural Bangladesh. Dev Chang. 2011;42(2):499–528.CrossRef
51.
Rajan R, Raihan A, Alam M, Agarwal S, Ahsan A, Bashir R, Lefevre A, Kennedy C, Labrique A. MAMA ‘Aponjon’formative research report; 2013.
52.
Aranda-Jan CB, Mohutsiwa-Dibe N, Loukanova S. Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa. BMC Public Health. 2014;14:188.PubMedPubMedCentralCrossRef
53.
54.
Wald DS, Butt S, Bestwick JP. One-way versus two-way text messaging on improving medication adherence: meta-analysis of randomized trials. Am J Med. 2015;128(10):1139.e1131–5.CrossRef
Metadata
Title
Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program
Authors
Christine Marie George
Fatema Zohura
Alana Teman
Elizabeth Thomas
Tasdik Hasan
Sohel Rana
Tahmina Parvin
David A. Sack
Sazzadul Islam Bhuyian
Alain Labrique
Jahed Masud
Peter Winch
Elli Leontsini
Kelsey Zeller
Farzana Begum
Abul Hasem Khan
Sanya Tahmina
Farazana Munum
Shirajum Monira
Munirul Alam
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-7144-z

Other articles of this Issue 1/2019

BMC Public Health 1/2019 Go to the issue

Research article

Measuring 8 to 12 year old children’s self-report of power imbalance in relation to bullying: development of the Scale of Perceived Power Imbalance

Research article

Community-and proximate-level factors associated with perinatal mortality in Nigeria: evidence from a nationwide household survey

Research article

‘Working to stay healthy’, health-seeking behaviour in Bangladesh’s urban slums: a qualitative study

Research article

Beliefs, attitudes and perceptions to sun-tanning behaviour in the Norwegian population: a cross-sectional study using the health belief model

Research article

Air pollutants and outpatient visits for cardiovascular disease in a severe haze-fog city: Shijiazhuang, China

Research article

Development of interventions for an intelligent and individualized mobile health care system to promote healthy diet and physical activity: using an intervention mapping framework