Care from distance ,yet closer together: how an SMS intervention enhanced care engagement for prevention of mother-to-child transmission care in western Kenya

Abstract

Short messaging services (SMS) for prevention of mother-to-child transmission of HIV (PMTCT) are growing in popularity, yet with little qualitative understanding of how such socio-technological mobile health (mHealth) interventions are experienced and shape continuity of care. In this qualitative study, we explore how WelTel, an SMS intervention for improved PMTCT retention in western Kenya, influenced women's engagement with PMTCT care. We conducted in-depth interviews with women (n ¼ 14) enrolled in PMTCT care and PMTCT care providers (n ¼ 14), across six health facilities between July 2016–June 2017. Interviews were transcribed and imported into NVivo for coding and thematic analysis. In our analysis, we approached WelTel as a socio-technological inter vention and found it to neatly interface with pre-existing PMTCT care and engagement practices. Our findings revealed fitting interactions between existing PMTCT care and engagement practices, women and healthcare providers, and the intervention. We found that the WelTel intervention formalized and strengthened (in)formal phone communications already taking place between some women and their healthcare providers, enhancing phones as caring devices, with positive implications for care engagement. Despite workload and privacy concerns, this resulted in improved client recognition, with women feeling more ‘seen’ and ‘cared for’ by their providers. Health-enhancing client-provider relations were strengthened, and care provision experienced as faster. Our findings demonstrate hitherto unexplored pathways through which SMS interventions can improve PMTCT care engagement, underlining that the success of this type of mHealth interventions may be contingent on their ‘goodness of fit’ with, and contributions to, pre-existing care practices and resources