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Tanzania REaCH - 4 ;

Reflections from the REaCH trial

REaCH is a training programme for the delivery of remote healthcare, currently being trialled in Nigeria and Tanzania. Testimonials from team members working on the project is revealing multiple benefits, both to those working on the project and the patients.

Researchers behind the REaCH trial want to investigate if patient access to healthcare can be increased by developing telephone-based healthcare appointments. The study team want to test whether these remote appointments are as acceptable, safe, and trustworthy as face-to-face appointments.

The REaCH programme enables health workers to deliver trusted and safe care using the phone and limited internet availability to patients with type 2 diabetes, hypertension, Chronic Obstructive Pulmonary Disease (COPD), and/or coronary heart disease.

Changing attitudes to remote care

Feedback from several respondents suggests that attitudes to remote care are indeed changing through the programme.

In a country where people like to mind their business and make ends meet, it was quite challenging getting participants to participate remotely in the study for the first month, as the average time for an interview is about 15 minutes. However, continuous education of the participants about the research project, directly and through the health workers in the various facilities, has increased participation in the remote interviews and remote consultations.– Habeeb Alabi, Research Assistant

“My experience working on the REaCH project as a research assistant has been both educative and enlightening. Educative, in the sense that I now know what kind of drugs are prescribed for hypertensive and diabetic patients, along with their symptoms; and enlightening because I have been able to discover people's attitude and orientation towards their own health and their perception of the attitude of the health workers.” Omolara Popoola, Research Assistant

“l (…) noticed that some patients who still had health challenges did not want to go back to the health facility to consult with the health workers. But after interviewing them, they kept calling back to explain their symptoms and ask for health information or care. After patiently and sympathetically listening to them, I encouraged them to consult their health worker.” Rebecca Ojuade, Research Assistant

One research assistant on the project even noted a change in their own attitude towards health and the option of remote healthcare.

“I have been more conscious of my health since the beginning of this study. I believe remote consultation will go a long way in reducing self-medication, ensure proper follow up and lead to an improvement in the health sector in Nigeria.” Habeeb Alabi, Research Assistant

Tanzania photo 5

In attendance at the Third National Non-Communicable Diseases Scientific Conference 2021 held in Arusha from 11-12 November 2021. From left: Prof Senga Pemba; Dr James Charles Kiologwe, Assistant Director of Non-communicable diseases, Tanzania Ministry of Health; Dr Albino Kalolo; Dr Beatrice Chipwaza and Titus Mashanya.

Developing personal and professional skills

Several individuals highlighted how they are learning new skills or further developing existing ones through their work on the project.

“My experience working on the REaCH Trial has been educative, helping to build my capacity in research and administration. My skills in budgeting and account keeping were strengthened as I am involved in most financial transactions. I have also learnt better ways of writing reports and minutes. As a researcher, daily communication, weekly and monthly meetings with research and statistics experts in Nigeria and around the world, have broadened my knowledge in the areas of research, standard operating procedures, and ethics” – Abiola Oladejo, Administrative Assistant

REaCH Trial Project has wonderfully made me more aware of how detailed research planning ought to be, especially when the target objects are people.– Oluwatoyin Oluyinka, Research Assistant

“Working on the REaCH project has (…) allowed me to develop interview skills, especially when dealing with patients/respondents who may be sceptical about answering some of the questions. I have learnt how to reassure them and put their minds at rest about the confidentiality of their information and the purpose of the research. I have also learnt how to patiently work with patients/respondents who may have some difficulties answering some of the questions.” Omolara Popoola, Research Assistant

REaCH trial Tanzania
A visit to the trial facilities in Ifakara Town Council and Ulanga District by members of the research team and the TSC and DMEC. From left: Prof Senga Pemba, Dr Beatrice Chipwaza, Dr Eric Van Praag (DMEC), Dr. Gabriel Upunda (TSC), Titus Mashanya and the late Secilia Makunja

Working with local government

The REaCH study, which involves 20 health clinics in both Nigeria and Tanzania, also presented opportunities to work with local government.

Abiola Oladejo, an Administrative Assistant on the project, said: “One of my fondest memories was our visits to the Ministry of Health of each local government that was recruited for the study. I gained additional knowledge of how to navigate the bureaucratic corridors of formal organizations.”

Overcoming challenges

The REaCH trial study has not been without its challenges, both in terms of patient participation and configuring the necessary technology. However, as staff reflect on these challenges and how they were overcome, it’s clear that patience and persistence have paid off so far.

During my first contact with record officers for the collection of patients’ diagnoses, half of the patients that were diagnosed as hypertensive, diabetic and having chronic airway obstruction were without phone numbers. I encountered some hostility when I requested the record officers to kindly get the patients’ phone numbers or the number of a live-in relative. This was soon overcome, and the clinic personnel have now been very helpful in getting the phone numbers.– Rebecca Ojuade, Research Assistant

“The usual teething problem of new technologies came up: getting the research assistants, randomizer and the data analyst to all be on the same page, I had to run several online and physical training sessions and use the WhatsApp platform to ensure the availability of 24/7 support. The major challenge was in ensuring that the surveys were set up correctly. A lot of back-and-forth, reconfiguration, redesigning from scratch and so on. It was a whole new experience, but in the end, it has been a success story.” Ahmed Olanrewaju, Database Manager

Nigerian REaCH Team_Group Photo

Members of the Nigerian research team. From left: Dr Emmanuel Adebayo, Prof Akinyinka Omigbodun, Dr Olufunke Fayehun, Prof Eme Owoaje, Dr Motunrayo Ajisola, Abiola Oladejo, Ahmed Olanrewaju and Dr Joshua Akinyemi.

Next steps

As the REaCH trial nears completion, the research team looks forward to disseminating their findings and increasing the impact of their work. Steps are currently being taken to deliver the remote consulting training in a self-directed way, without a training facilitator. This will make the training more widely affordable for health workers, their employers and to policymakers.

The team are also close to delivering REaCH training via Tanzania’s Ministry of Health e-learning platform. They are also exploring similar national learning platforms in Nigeria, Kenya and Uganda to host REaCH training.

For full details on the REaCH trial, please see this page.

For further information on the REaCH training, please visit our Warwick webpage.

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