The Need for Implementation Science Research in mHealth: a vehicle from pilot to scale-up

Billions of dollars are spent on global health research projects each year, but only a limited number of proven interventions are translated into practice and policy (Grimshaw et al., 2012, Bajunirwe et al., 2016). Technology is providing unprecedented opportunities to improve patient engagement in care for better adherence, yet a significant knowledge-action gap remains. Many evidence-based innovations are not adequately scaled up to meet the full challenges of the global Sustainable Development Goals (SDGs) (Grimshaw et al., 2012, Glasgow et al., 2013, Arora et al., 2017, Damschroder at al., 2009)

  • Mobile health (mHealth) is an emerging area of disease management that can assist patients to adhere to prolonged treatment regimens and improve their quality of care – an area where improvement can have more impact than the discovery of new treatments.
    Globally, mobile phones are now the most pervasive and accessible form of two-way communication technology. In 2014, the number of mobile phone subscriptions surpassed the number of people, and uptake in vulnerable and marginalized groups has, in many cases, bridged the socioeconomic ‘digital divide’ (WHO, 2010).Text messages via short message service (SMS) are one of the most popular forms of mobile communication, and has become the most used data transfer system in the world; over 24 billion text messages are sent and received each day (Chen et al., 2015).

    In a landmark randomized controlled trial (WelTel Kenya1), Lester et. al. showed that two-way, weekly text messaging significantly improved Anti Retrovirus Treatment (ART) adherence and Viral (VL) Suppression in an HIV-positive Kenyan population initiating ART, over a one-year period(Lester et al., 2010).As noted by a recent Cochrane review, this RCT study (and many others) have built a strong assemblage of high-quality evidence supporting the utilization of weekly text-messaging to enhance ART adherence and viral suppression, in comparison to current standards of HIV/AIDS care (Horvath et al., 2010). The implementation of such interventions, however, is an important aspect that requires investigation in addition to the development of the intervention itself.

    Implementation science is the study of methods to promote the adoption and integration of evidence-based practices into routine health care and public health settings. Implementation research plays an important role in identifying barriers to, and enablers of, effective global health programming and policymaking, and leveraging that knowledge to develop evidence-based innovations in effective delivery approaches (Olson et al., 2017). Undertaking a comprehensive implementation science study is particularly important when studying mHealth interventions, as the healthcare system itself is complex, includes multiple interacting components, and interventions must be adapted to fit the needs of a practice setting and patients with different views and expectations (Varsi et al., 2015, Battle et al., 2015). In acknowledgment of this, the UBC mHealth team is currently working on a five year comprehensive implementation science research project.

    The overarching aim of the UBC mHealth implementation project is to create and test an implementation research tool which can be used to inform mHealth for impact at scale. In order to achieve this aim, the mHealth team will analyze the process of scaling-up the WelTel intervention within fourteen implementation sites: Canada, the US, Kenya, Ethiopia, South Africa, and Rwanda. Using the Consolidated Framework for Implementation Research, the resultant tool will fill a major void by creating an mHealth tailored tool which can be used for any digital health study, globally.


    • Arora, P. G., Connors, E. H., Blizzard, A., Coble, K., Gloff, N., & Pruitt, D. (2017). Dissemination and implementation science in program evaluation: A telemental health clinical consultation case example. Evaluation and program planning60, 56-63.
    • Battle, J. D., Farrow, L., Tibaijuka, J., & Mitchell, M. (2015). mHealth for Safer Deliveries: A mixed methods evaluation of the effect of an integrated mobile health intervention on maternal care utilization. In Healthcare (Vol. 4, No. 3, pp. 180-184).
    • Bajunirwe, F., Tumwebaze, F., Abongomera, G., Akakimpa, D., Kityo, C., & Mugyenyi, P. N. (2016). Identification of gaps for implementation science in the HIV prevention, care and treatment cascade; a qualitative study in 19 districts in Uganda. BMC research notes9(1), 217.
    • Chen, S., Pan, Y., Qu, Y., Liu, Z., Yao, L., & Xiang, L. (2015). Mobile phone based interventions for promoting adherence to tuberculosis treatment: a systematic review and meta-analysis. The Lancet386, S29.
    • Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation science4(1), 50.
    • Glasgow, R. E., Eckstein, E. T., & ElZarrad, M. K. (2013). Implementation science perspectives and opportunities for HIV/AIDS research: integrating science, practice, and policy. JAIDS Journal of Acquired Immune Deficiency Syndromes63, S26-S31.
    • Grimshaw, J. M., Eccles, M. P., Lavis, J. N., Hill, S. J., & Squires, J. E. (2012). Knowledge translation of research findings. Implementation science7(1), 50.
    • Horvath, T., Azman, H., Kennedy, G. E., & Rutherford, G. W. (2012). Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection. The Cochrane Library.
    • Kay, M., Santos, J., & Takane, M. (2011). mHealth: New horizons for health through mobile technologies. World Health Organization64(7), 66-71.
    • Lester, R. T., Ritvo, P., Mills, E. J., Kariri, A., Karanja, S., Chung, M. H., … & Marra, C. A. (2010). Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. The Lancet376(9755), 1838-1845.
    • National Academies of Sciences, Engineering, and Medicine. (2016). Applying an implementation science approach to genomic medicine: workshop summary. National Academies Press.
    • Varsi, C., Ekstedt, M., Gammon, D., & Ruland, C. M. (2015). Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. Journal of medical Internet research17(11).

    By Binyam Tilahun