Formative research for the design of a scalable mobile health program water, sanitation, and hygiene: CHoBI7 mobile health program

Christine Marie George, Fatema Zohura, Alana Teman, Elizabeth Thomas, Tasdik Hasan, Sohel Rana, Tahmina Parvin, David A. Sack, Sazzadul Islam Bhuyian, Alain Labrique, Jahed Masud, Peter Winch, Elli Leontsini, Kelsey Zeller, Farzana Begum, Abul Hasem Khan, Sanya Tahmina, Farazana Munum, Shirajum Monira, Munirul Alam

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: The Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7) is a handwashing with soap and water treatment intervention program delivered by a health promoter bedside in a health facility and through home visits to diarrhea patients and their household members during the 7 days after admission to a health facility. In a randomized controlled trial among cholera patient households in Bangladesh, the 7-day CHoBI7 program resulted in a significant reduction in cholera among household members of cholera patients and sustained improvements in drinking water quality and handwashing with soap practices 12 months post-intervention. In an effort to take this intervention to scale across Bangladesh in partnership with the Bangladesh Ministry of Health and Family Welfare, this study evaluates the feasibility and acceptability of mobile health (mHealth) programs as a low-cost, scalable approach for CHoBI7 program delivery. Methods: Formative research for the development of the CHoBI7 mHealth intervention included 40 semi-structured interviews, 4 mHealth workshops, 2 group discussions, and a pilot study of 52 households to assess the feasibility and acceptability of the developed mHealth program. Thematic analysis of the interviews and group discussions was conducted by two individuals separately based on emergent themes, and then themes were compared and discussed. Results: A theory- and evidence-based approach using qualitative research methods was implemented to design the CHoBI7 mHealth program. Semi-structured interviews with government stakeholders identified perceptions and preferences for scaling the CHoBI7 mHealth program. Group discussions and semi-structured interviews with diarrhea patients and their family members identified beneficiary perceptions of mHealth and preferences for CHoBI7 mHealth program delivery. mHealth workshops were conducted as an interactive approach to draft and refine mobile message content based on stakeholder preferences. The pilot findings indicate that the CHoBI7 mHealth program has high user acceptability and is feasible to deliver to diarrhea patients that present at health facilities for treatment in Bangladesh. Both text and voice messages were recommended for program delivery. Dr. Chobi, the sender of mHealth messages, was viewed as a credible source of information that could be shared with others. Conclusion: This study presents a theory- and evidence-based approach that can be implemented for the development of future water, sanitation, and hygiene mHealth programs in low-resource settings.

Original languageEnglish (US)
Article number1028
JournalBMC public health
Issue number1
StatePublished - Jul 31 2019


  • Bangladesh
  • Cholera
  • Diarrhea
  • Formative research
  • Mobile health
  • Qualitative research methods
  • Water, sanitation, and hygiene

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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