Design Research to Embed mHealth into a Community-Led Blood Pressure Management System in Uganda: Protocol for a Mixed Methods Study
Authors: Schwab Josephine , Wachinger Jonas , Munana Richard , Nabiryo Maxencia , Sekitoleko Isaac , Cazier Juliette , Ingenhoff Rebecca , Favaretti Caterina , Subramonia Pillai Vasanthi , Weswa Ivan , Wafula John , Emmrich Julius Valentin , Bärnighausen Till , Knauf Felix , Knauss Samuel , Nalwadda Christine K , Sudharsanan Nikkil , Kalyesubula Robert , McMahon Shannon A 
Published: November 2023

Background
Uncontrolled hypertension is a 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 the hypertensive cases are uncontrolled). Although basic health care in the country is available free of cost at government facilities, regularly accessing medication to control hypertension is difficult because supply chain challenges impede availability. Clients therefore frequently suspend treatment or buy medication individually at private facilities or pharmacies (incurring significant costs). In recent years, mobile health (mHealth) interventions have shown increasing potential in addressing health system challenges in sub-Saharan Africa, but the acceptability, feasibility, and uptake conditions of mobile money approaches to chronic disease management remain understudied.

Objective
This study aims to design and pilot-test a mobile money–based intervention to increase the availability of antihypertensive medication and lower clients’ out-of-pocket payments. We will build on existing local approaches and assess the acceptability, feasibility, and uptake of the designed intervention. Furthermore, rather than entering the study setting with a ready-made intervention, this research will place emphasis on gathering applied ethnographic insights early, which can then inform the parameters of the intervention prototype and concurrent trial.

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 policy makers at district and national levels) on their perceptions of hypertension management, money-saving systems, and mobile money in the context of health care. Our results will inform the design, iterative adaptation, and implementation of an mHealth-facilitated pooled financing intervention prototype. At study conclusion, the finalized prototype will be evaluated quantitatively via a randomized controlled trial.

Results
As of August 2023, qualitative data collection, which started in November 2022, is ongoing, with data analysis of the first qualitative interviews underway to inform platform and implementation design. Recruitment for the quantitative part of this study began in August 2023.

Conclusions
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.

Trial Registration
German registry of clinical trials DRKS00030922; https://drks.de/search/en/trial/DRKS00030922

International Registered Report Identifier (IRRID)
DERR1-10.2196/46614