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Background: DREAM-GLOBAL (Diagnosing hypertension-Engaging Action and Management in Getting Lower Blood Pressure in Indigenous and low- and middle-income countries) studied a SMS text messaging-based system for blood pressure measurement and hypertension management in Canadian Aboriginal and Tanzanian communities. The use of SMS text messages is an emerging point of interest in global health care initiatives because of their scalability, customizability, transferability, and cost-effectiveness., Objective: The study aim was to assess the effect on the difference in blood pressure reduction of active hypertension management messages or passive health behavior messages. The system was designed to be implemented in remote areas with wireless availability. This study described the implementation and evaluation of technical components, including quantitative data from the transmission of blood pressure measurements and qualitative data collected on the operational aspects of the system from participants, health care providers, and community leadership., Methods: The study was implemented in six remote Indigenous Canadian and two rural Tanzanian communities. Blood pressure readings were taken by a community health worker and transmitted to a mobile phone via Bluetooth, then by wireless to a programmed central server. From the server, the readings were sent to the participant's own phone as well. Participants also received biweekly tailored SMS text messages on their phones. Quantitative data on blood pressure reading transmissions were collected from the study central server. Qualitative data were collected by surveys, focus groups, and key informant interviews of participants, health care providers, and health leadership., Results: In Canada, between February 2014 and February 2017, 2818 blood pressure readings from 243 patients were transmitted to the central server. In Tanzania, between October 2014 and August 2015, 1165 readings from 130 patients were transmitted to the central server. The use of Bluetooth technology enabled the secure, reliable transmission of information from participants to their health care provider. The timing and frequency were satisfactory to 137 of 187 (73.2%) of participants, supporting the process of sending weekly messages twice on Mondays and Thursdays at 11 am. A total of 97.0% (164/169) of the participants surveyed said they would recommend participation in the DREAM-GLOBAL program to a friend or relative with hypertension., Conclusions: In remote communities, the DREAM-GLOBAL study helped local health care providers deliver a blood pressure management program that enabled patients and community workers to feel connected. The technical components of the study were implemented as planned, and patients felt supported in their management through the SMS text messaging and mobile health program. Technological issues were solved with troubleshooting. Overall, the technical aspects of this research program enhanced clinical care and study evaluation and were well received by participants, health care workers, and community leadership., Trial Registration: Clinicaltrials.gov NCT02111226; https://clinicaltrials.gov/ct2/show/NCT02111226., (©Jordan Andrea Barsky, Rebekah Hunter, Colin McAllister, Karen Yeates, Norm Campbell, Peter Liu, Nancy Perkins, Diane Hua-Stewart, Marion A Maar, Sheldon W Tobe. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 09.12.2019.)

Growing evidence points to the potential value of mobile phone-based technologies ('mHealth') to help strengthen community health systems in low- and middle-income countries, but mHealth approaches also carry considerable risks with respect to data security, individual privacy, and confidentiality. We examined the perspectives of frontline community health workers and their female clients regarding data security and privacy within the context of an mHealth intervention to improve women's uptake of maternal health services from October 2013 to July 2014 in rural Tanzania. Qualitative findings demonstrate that the use of new technologies to capture health service user data during pregnancy and childbirth has both positive and negative impacts on perceptions of personal privacy and confidentiality. Women's concerns regarding privacy aligned closely with a belief that pregnancies and expected delivery dates must be kept secret, reflecting fears that pregnancy renders women vulnerable to witchcraft by jealous neighbors. Women also shared concerns that health workers' male partners could access their private information. Strong community-based engagement is recommended from the outset when developing a mHealth intervention to integrate beliefs and gender dynamics that may influence acceptability and implementation of new technologies., (Copyright © 2018 Elsevier Ltd. All rights reserved.)