M-health in harm reduction strategies for people who use drugs

Introduction: the harm reduction strategy is a health program for people who use drugs (PWUD) with the primary aim to reduce adverse health consequences of the use of drugs. It has been found that especially in low-and middle-income countries, the access to harm reduction services and adherence to treatment form a problem for PWUD. Several studies show the contribution of the use of technology to access and adherence in health care. Especially M-health, the use of mobile technology in health care, is recommended to improve communication and information provision between health care programs and patients. This research aims to find out how the implementation of M-health technology could contribute to improving access to harm reduction services and adherence to treatment for people who use drugs in low- and middle-income countries. Methods: in this explorative, qualitative research, the data was collected through semi-structured one-person interviews with a total of thirteen participants. The interview participants consisted of mobile technology experts or harm reduction experts, which were recruited via purposive sampling. Out of the thirteen participants seven were based in low-and middle-income countries and six of them in the Netherlands. The interview topic guides were developed according to the three central concepts of this research: ‘implementation of M-health’, ‘Access’ and ‘Adherence’ to care. The transcribed interviews were processed using the Theme Analyzing method, thereafter a detailed analysis is described in the results section according to the conceptual model of the study and the new themes that have been raised during the interviews. Results: all interview participants recognized the added value of M-health to the harm reduction program. The interviews showed that the use of smartphones was preferred for the implementation of M-health as it provides a variety of information updates, language options and communication services that could all be presented to the PWUD in one smartphone application. The M-health functions of text and voice messages to remind and inform PWUD on harm reduction treatment as well as phone calls from service providers, were considered most valuable by participants. The implementation of M-health in harm reduction programs was highly influenced by the contextual characteristics according to the participants, specifically the insecure lifestyle of PWUD and the lack of technological development conditions in low- and middle-income countries. According to the participants, the most beneficial contribution of M-health for interventions should be designed to improve therapy adherence among PWUD. The function of monitoring & evaluation through M-health in the harm reduction programs could become a valuable data collection method to evaluate the program and to measure the contribution of M-health to harm reduction services. The implementation of M-health in harm reduction programs would lead to more accessible information and more frequent and individual harm reduction services through mobile phones for PWUD. If M-health is included in a context appropriate manner, it is expected to be an added value to harm reduction programs in low-and middle-income countries. For further research, the inclusion of the PWUD perspective and the focus on one specific country context before the implementation of M-health is recommended.