An M-Health Intervention to Improve Clinic Attendance Among Gynae-Oncology Patients: A Pilot Randomized Controlled Trial in Kenyatta National Hospital, Kenya

Gynaecological cancers, including cervical, ovarian, and endometrial malignancies, contribute substantially to morbidity and mortality worldwide. Timely clinic attendance is essential for continuity of care, yet patients in developing countries often face barriers such as financial constraints, forgetfulness, and transport difficulties. Mobile health (mHealth) interventions, particularly short message service (SMS) reminders, have shown promise in chronic disease management, but evidence in oncology care remains limited. The effectiveness, feasibility, acceptability, and financial consequences of two-way SMS reminders in improving timely clinic attendance among gynecology patients at Kenyatta National Hospital (KNH), Kenya, were assessed in this pilot randomized controlled trial (RCT). A two‑arm RCT was conducted with 122 gynae‑oncology patients randomised 1:1 to either the intervention arm (SMS recipients) or the control arm (received usual care). Attendance data were extracted from hospital attendance records and analysed using chi‑square tests and logistic regression. Thematic analysis was used to evaluate the viability and acceptability of four key informant interviews with providers and two recipient focus group discussions. Microcosting was utilized to estimate incremental provider costs. At baseline, timely clinic attendance was low (31.1%) and comparable between arms (control 29.5% vs intervention 32.8%, p=0.696). Financial limitations, forgetfulness, and transport issues were the most common barriers. Following the intervention, timely attendance was significantly higher in the SMS group (67.2%) than controls (26.2%). After adjustment for sociodemographic and clinical covariates, SMS recipients were 12.8 times more likely to attend on time (95%CI=3.9–42.3, p<0.001). There was high acceptability among patients and providers, with SMS reminders perceived as supportive, culturally appropriate, and privacy‑respecting. Providers affirmed feasibility, citing infrastructure readiness and low costs, though barriers such as phone access and network reliability were noted. Incremental costs were modest, suggesting sustainability. KNH gynecological patients’ timely clinic attendance was greatly enhanced by two-way SMS reminders. The intervention was feasible, acceptable, and affordable, supporting its potential as a scalable strategy to strengthen oncology care continuity in resource-constrained settings. In addition to supporting the integration of digital health interventions to promote universal health coverage and Sustainable Development Goals 3 and 5, these findings provide evidence to a crucial gap in oncology practice in LMICs.