Perceived barriers and facilitators in using text and voice messaging for improving HIV and sexual and reproductive health of female entertainment workers in Cambodia: a qualitative study.

Background: Female entertainment workers (FEWs) in Cambodia are one of the hard-to-reach populations at risk of human immunodeficiency virus (HIV) and poor sexual and reproductive health (SRH). Due to the stigmatizing nature of their work, it is difficult to reach them with prevention and treatment services. The Mobile Link project is a mobile health (mHealth) intervention that aims to deliver health messages to FEWs and link them up to health services. This study aims to explore the perspectives of stakeholders on the Mobile Link and identify barriers and facilitators to the project implementation, in order to determine areas for improvement of future mHealth interventions.

Methods: This study was conducted between November to December 2018 in the capital city and other three provinces where the Mobile Link was implemented. We employed a qualitative research design using an interpretative approach. A purposive sampling method was used to recruit participants across four project sites. All participants were stakeholders involved directly or indirectly with the Mobile Link. Nine different groups of stakeholders at the national, non-governmental organizations, community, and individual levels were recruited. Seventeen semi-structured in-depth interviews (IDIs) and five focus group discussions (FGDs) were conducted and transcribed. Data were managed using NVivo 12 and analysed using thematic analysis with an inductive approach.

Results: We derived four major themes: (I) perceived benefits, (II) attitudes, (III) access, and (IV) enabling environment. Different levels of stakeholders reported on the perceived benefits of the Mobile Link, including ease of use, knowledge gained, link to services, and cost-effectiveness. Perceived benefits and enabling environment were identified as facilitators to implementation of the project. Barriers included technological issues, operational challenges, poor rapport with entertainment establishment owners, and low motivation to participate in the Mobile Link among FEWs.

Conclusions: The Mobile Link has many advantages and is well-accepted by stakeholders from the national and community levels. We discussed the implications of the perceived facilitators and barriers identified on the project and mHealth interventions. Implications discussed should be taken into consideration by organizations implementing mHealth interventions for HIV key populations in Cambodia as well as in other resource-limited settings.