Transforming reproductive healthcare delivery through telemedicine services expansion: evidence from a mixed-methods pilot evaluation in rural Ghana
MSI Reproductive Choices Ghana
How they used Delve
The research team at MSI Reproductive Choices Ghana used Delve to code in-depth interviews with telemedicine clients, with two researchers coding independently in a shared project, in a CFIR-guided thematic analysis of a sexual and reproductive health telemedicine model expanded into rural Ghana.
“Qualitative data were managed and analysed using Delve (Delve Research Ltd, accessed January 2025, www.delvetool.com), a cloud-based qualitative data analysis platform designed to support collaborative coding, thematic analysis and framework-based qualitative approaches. Coding was performed by two independent research team members (MR, EM) with debriefs as needed to resolve discrepancies.”
- Field
- Sexual and reproductive health service delivery; a telemedicine model for early medical abortion, contraception and fertility evaluation expanded into rural Ghana
- Data
- Individual in-depth interviews with telemedicine clients, conducted by two of the authors with three trained local research assistants (all interviewers female), one conducted in Twi and translated with back-translation; part of a mixed-methods evaluation running January 2024 to March 2025 that also drew on routine clinical data, courier and call-centre tracking and client feedback surveys covering 2,721 clients
- Approach
- Deductive thematic analysis structured by the Consolidated Framework for Implementation Research (CFIR). CFIR domains drove the initial codebook; transcripts were coded deductively against CFIR constructs while subcodes were iteratively refined inductively to catch emergent detail (courier communication, digital literacy barriers). Two researchers coded independently, debriefing as needed to resolve discrepancies, and themes were organised across the five CFIR domains. Thematic validity was checked by reflection and validation with selected operational stakeholders; reporting follows COREQ.
- Data types
- Interviews
Abstract
BACKGROUND: In 2021, Ghana’s National Comprehensive Abortion Care Standards and Protocols recognised telemedicine as an approved delivery model for early medical abortion (EMA). Following a successful pilot in Accra, MSI Reproductive Choices Ghana expanded their telemedicine model to more rural areas and broadened their package of sexual and reproductive health (SRH) services to include fertility evaluation. This study evaluates the expanded model. METHODS: A mixed-methods evaluation (January 2024 to March 2025) drew on routine clinical data, courier and call centre tracking, client feedback surveys, and qualitative, individual in-depth interviews with telemedicine clients to assess clinical safety, service utilisation and user experience. Quantitative analysis included descriptive statistics and unadjusted logistic and ordinal regression. Qualitative interviews with clients explored feasibility, acceptability and implementation challenges. A deductive, thematic analysis was conducted with the support of Delve qualitative research software and guided by the Consolidated Framework for Implementation Research. RESULTS: A total of 2721 clients accessed telemedicine services, with 70.0% receiving EMA and 29.5% short-term contraceptive methods. Among EMA clients reached for follow-up, 96.9% reported complete abortion with no further intervention. Satisfaction was high: 89.4% would recommend the service, and 78.2% would use it again. Qualitative findings highlighted that clients valued privacy, convenience and autonomy, particularly in stigmatised or crowded spaces. Barriers to accessing services included unclear eligibility criteria, limited digital access and misperceptions that the service was for abortion only. Most clients contacted the service between 4 and 6 weeks’ gestation. Post-abortion contraception uptake was 24.8%, with no significant variation by age or location. Nearly half of clients reported having no other way to access care. CONCLUSIONS: Telemedicine is a feasible, safe and acceptable model for SRH delivery in Ghana. Findings will inform national scale-up and strategies to strengthen equity, communication and service integration.
Citation
Ernest Afriyie Owusu, Matthea Roemer, Ernestina Monney, Prince Dugbazah, Ellis Nutifafa Attah, George Akanlu, Chris Fofie (2025). Transforming reproductive healthcare delivery through telemedicine services expansion: evidence from a mixed-methods pilot evaluation in rural Ghana. BMJ Global Health. https://doi.org/10.1136/bmjgh-2024-018762