title: MHEALTH INTERVENTION DEVELOPMENT TO SUPPORT PATIENTS WITH ACTIVE TUBERCULOSIS.
abstract: BACKGROUND
  Mobile Health (mHealth) based interventions have been increasingly used to improve a broad range of health outcomes. However, few researchers have reported on the process or the application of theory to guide the development of mHealth based interventions, or specifically for tuberculosis (TB) treatment management.
  
  
  OBJECTIVE
  To describe the steps, process, and considerations in developing a text messaging-based intervention to promote treatment adherence and provide support to patients with active TB.
  
  
  METHODS
  Traditional qualitative techniques, including semi-structured interviews, field notes, content analysis, iterative coding, and thematic analysis, were used to design and document the intervention development with a multidisciplinary team of researchers, clinicians, administrators, and patients who were in active TB treatment. The Information-Motivation-Behavioral Skills (IMB) model was used to guide the coding scheme for content analysis of patient-directed TB educational material and intervention development.
  
  
  RESULTS
  The development steps included: a) establishing intervention components, including justifications, considerations, timing and frequency of components; b) developing educational messages, including cultural adaption, text or short message service (SMS) formatting, and prioritizing message delivery order; and c) determining implementation protocol. A set of 16 IMB-based messages were developed for the educational component. Final intervention development was achieved in 3 months.
  
  
  CONCLUSIONS
  A collaborative approach and application of a theory to guide the intervention design and development is supported. Although a collaborative approach was more time consuming, it resulted in a more responsive, culturally appropriate, and comprehensive intervention. Considerations for developing a text messaging based intervention are provided and may serve as a guide for similar interventions. Further empirical evidence is needed for applying the IMB model for adherence-promotion in TB efforts.
authors.affiliation: Columbia University School of Nursing, New York, NY, USA ; University of Utah, College of Nursing, Salt Lake City, UT, USA.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Iribarren
authors.affiliation: University of Utah, College of Nursing, Salt Lake City, UT, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Beck
authors.affiliation: School of Nursing, Loyola University, New Orleans, LA, USA.
authors.forename: Patricia F
authors.initials: PF
authors.lastname: Pearce
authors.affiliation: Region V TB Program, Province of Buenos Aires, Argentina.
authors.forename: Cristina
authors.initials: C
authors.lastname: Chirico
authors.affiliation: Region V TB Program, Province of Buenos Aires, Argentina.
authors.forename: Mirta
authors.initials: M
authors.lastname: Etchevarria
authors.affiliation: Institute for Clinical Effectiveness and Healthcare Policy, Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rubinstein