Intervention fidelity and factors affecting the process of a mobile phone text messaging intervention among adolescents living with HIV: A convergent mixed methods study in southern Ethiopia

Objective: To assess the intervention fidelity and explore contextual factors affecting the process of a mobile phone text messaging intervention in improving adherence to and retention in care among adolescents living with HIV, their families, and their healthcare providers in southern Ethiopia. Design: A convergent mixed-methods design guided by the process evaluation theoretical framework and the RE-AIM framework was used alongside a randomised controlled trial to examine the fidelity and explore the experiences of participants in the intervention. Setting: Six hospitals and five health centres providing HIV treatment and care to adolescents in five zones in southern Ethiopia. Participants: adolescents (aged 10–19), their families and their healthcare providers. Intervention: Mobile phone text messages daily for 6 months or standard care (control). Results: 306 participants were enrolled in the process evaluation. Among the intervention participants (N =153), 171 (55.9%) of whom were men, most resided in an urban area 225 (73.5%), and participants had a mean age of 15 (2.62). The overall experiences of implementing the text messages reminder intervention were described as helpful in terms of treatment support for adherence but had room for improvement. During the study, 30,700 text messages were sent, and fidelity was high, with 99.4% successfully receiving text messages during the intervention. Barriers such as failed text messages delivery, limitations in phone ownership, and technical limitations affected fidelity. Technical challenges can hinder maintenance, but a belief in the future of digital communication permeates the experiences of the text messages reminders. Conclusions: Overall fidelity was high, and participants' overall experiences of mobile phone text messages were expressed as helpful. Contextual factors, such as local telecommunications networks and local electric power, as well as technical and individual factors must be considered when planning future interventions.研究目的：评估埃塞俄比亚南部地区针对艾滋病病毒感染者青少年、其家属及医护人员开展的手机短信干预项目的干预保真度（intervention fidelity），并探索影响该干预流程的情境因素，该干预旨在提升艾滋病病毒感染者青少年的治疗依从性与随访留存率。 研究设计：本研究采用收敛性混合研究设计（convergent mixed-methods design），以过程评估理论框架（process evaluation theoretical framework）及RE-AIM框架为指导，并结合随机对照试验（randomised controlled trial），以考察干预保真度并探究干预参与者的实践体验。 研究场景：埃塞俄比亚南部五个区域的6家医院及5家卫生中心，上述机构均为青少年艾滋病患者提供治疗与护理服务。 研究对象：10至19岁的艾滋病病毒感染青少年、其家属及医护人员。 干预措施：干预组接受为期6个月的每日手机短信干预，对照组则接受标准护理。 研究结果：本过程评估共纳入306名参与者。其中干预组（N=153）内，男性占比55.9%（171名）；73.5%（225名）的参与者居住于城市地区，参与者平均年龄为15岁（标准差2.62）。研究人员认为，短信提醒干预的整体实施体验在为治疗依从性提供支持方面颇具益处，但仍存在改进空间。研究期间，共发送30700条短信，干预保真度较高，99.4%的干预组参与者成功接收了干预期间的短信。研究发现，短信投递失败、手机持有受限及技术局限性等障碍因素会影响干预保真度。尽管技术难题可能阻碍干预的持续开展，但参与者普遍认可数字通信的未来价值，这一观点贯穿于其对短信提醒服务的体验之中。 研究结论：整体干预保真度较高，参与者普遍认为手机短信干预具有实用价值。在规划未来同类干预项目时，需考量当地电信网络、电力供应等情境因素，以及技术层面与个体层面的相关影响因素。