Key stakeholder perspectives on implementation of mHealth and NCD- related interventions in Kenyan Emergency Departments.

Abstract Background: Emergency Department (ED) populations are a high-risk group that are opportune for interventions targeting NCDs and NCD risk factors, like tobacco use. Mobile health (mHealth)interventions such as Text2Quit, a novel text message-based mHealth tool addressing tobacco cessation in the US, have demonstrated effectiveness for tobacco cessation and for ED-based mHealth interventions in High Income Countries (HIC). To successfully adapt and implement such mHealth interventions in limited resource settings like African EDs, it is essential to examine the implementation climate and engage key stakeholders. These implementers provide invaluable insight to understand healthcare system level factors that affect adoption, implementation and maintenance of the interventions. Methods: We conducted 12 semi-structured key informant interviews (KIIs) with ED administrators and staff including 2 departmental heads, 5 medical doctors, 3 nurses, and 2 clinical officers at a national referral hospital in Kenya. This was guided by RE-AIM framework indicators of Adoption, Implementation, and Maintenance (eg feasibility of intervention integration, and suggestions to improve implementation). Interviews were conducted in English, recorded, professionally transcribed and translated, and analyzed using a constant comparative analysis approach, according to grounded theory principles. Findings: Key informants were positive about the adoption of them Health intervention in Kenyan EDs and across different health facility levels in Kenya due to the perceived need for the program, facility and staff receptiveness and existing healthcare infrastructure to leverage. Recommended implementation strategies included follow-up mechanisms for program participants, inclusion of all healthcare cadres in implementation and increased sensitization and the use of champions. Barriers to Implementation in the ED included competing clinical priorities with emergency cases, limited staffing and shame associated with smoking. Conclusion: Implementing a mobile health tobacco cessation program like Text2Quit is feasible and acceptable in Kenyan EDs when supported by targeted strategies.