Mobile Technology for Health

"Global mobile phone use is rapidly increasing and a large percentage of mobile phone subscribers are young people. Many programs are capitalizing on their ubiquity as a novel way to reach young people with important health information, and research is beginning to demonstrate that mobile phones are a feasible means of mass communication for this population."

From the Interagency Youth Working Group (IYWG), this YouthLens briefing shares results from recent research and lessons learned from programmes using short message service (SMS), also known as text messaging, to address the health of adolescents, especially in the developing world. There is high use of this technology amongst this age group; one study found that 87% of 441 high school students from low-income areas of South Africa reported sending a text message or making a call on a mobile phone during a typical day. In this context, the report shows that mobile health, also known as mHealth, has advantages when used in health programmes for youth. For instance, in addition to being relatively inexpensive, portable, and accessible, mobile phones offer perceived privacy when compared with face-to-face meetings with health care providers and counselors.

The briefing describes various ways that mHealth can improve young people's access to sexual and reproductive health information and services:

• One-way communication - For example, in one study from the United States, young women ages 13-24 who wanted to use oral contraceptives were randomised to receive either standard care alone or standard care plus daily text messages for 180 days. The text messages provided educational information and reminded the young women to take their next pill. Six-month contraceptive continuation rates were 9% percent higher for women in the intervention group than for women in the control group. The women who received text messages were also more likely to have used their pills consistently. One-way communication can also be used to let subscribers know where they can look for more information on a given topic, as well as related services.
• Two-way communication - In this type of communication, the conversation can be initiated either by a health care provider or by a young person who has questions or concerns about his or her health. For example, Learning about Living, available in schools across Nigeria, uses a variety of e-learning methods to provide information and advice about adolescent sexual and reproductive health, maternal morbidity, and gender equality. As one of two mobile services offered through the project, MyQuestion allows youth to use text messaging, the internet, or a telephone hotline to submit their personal questions about health. Trained counselors from the nongovernmental organisation (NGO) Education as a Vaccine Against AIDS answer the questions. Five years into the programme, MyQuestion had responded to more than 398,000 questions from users of the service.
• Educational games and incentives - For example, in 2005, PATH and its partners launched an SMS-based contest called eQuest to increase knowledge about HIV/AIDS among youth in Kenya. Youth competed in the national contest by finding answers to questions about HIV prevention, living with HIV, HIV counseling and testing, and other issues relevant to HIV/AIDS. More than 260,000 youth ages 15-24 participated.
• New communication approaches - In Tanzania and Kenya, FHI 360 and many local and international partners piloted a service called m4RH that allows mobile phone users to access tailored information about family planning at their convenience. The free service includes a searchable database of contraceptive options, ranging from injectables and implants to condoms and natural methods. Each menu item in the database comes with a code that users can text to a main number if they want to receive automated, evidence-based text messages about that method. The menu also includes a clinic locator to help users find the nearest clinic that offers the family planning services they need. During interviews conducted as part of an evaluation of the pilot project, users reported that the service improved their knowledge and behaviours. Its content is being expanded to include weekly text messages that support positive family planning behaviours, timely reminders alerting users to renew their method or make a follow-up appointment, and interactive stories to help dispel myths and misperceptions about contraception. The project is also expanding to Rwanda, where it will specifically address youth and cover a broader spectrum of sexual and reproductive health issues for young people, including puberty, sex and pregnancy, HIV, and sexually transmitted infections (STIs). In 2013, all of the messages developed for the m4RH project will be made available to the global health community for use in other mHealth programmes.

In addition to outlining why text messaging makes sense as a tool for facilitating mHealth for adolescents, the briefing explores challenges, such as the fact that, in spite of the low cost and high availability of mobile phones, financial barriers can still limit access to this communication tool. Also: messages may not be received; phone sharing, which is common in many developing countries, can reduce confidentiality; language barriers and low literacy rates may limit understanding of text messages; response times to messages can vary; and fluctuations in mobile networks may reduce the ability to send and receive messages.