Tracking health seeking behavior during an Ebola outbreak via mobile phones and SMS.
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ABSTRACT:
SUBMITTER: Feng S
PROVIDER: S-EPMC6550280 | biostudies-literature | 2018
REPOSITORIES: biostudies-literature
Publications
Tracking health seeking behavior during an Ebola outbreak via mobile phones and SMS.
Feng Shuo S Grépin Karen A KA Chunara Rumi R
NPJ digital medicine 20181002
The recent Ebola outbreak in West Africa was an exemplar for the need to rapidly measure population-level health-seeking behaviors, in order to understand healthcare utilization during emergency situations. Taking advantage of the high prevalence of mobile phones, we deployed a national SMS-poll and collected data about individual-level health and health-seeking behavior throughout the outbreak from 6694 individuals from March to June 2015 in Liberia. Using propensity score matching to generate ...[more]
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Project description:For billions of people across the globe, mobile phones enable relatively cheap and effective communication, as well as access to information and vital services on health, education, society, and the economy. Drawing on context-specific evidence on the effects of the digital revolution, this study provides empirical support for the idea that mobile phones are a vehicle for sustainable development at the global scale. It does so by assembling a wealth of publicly available macro- and individual-level data, exploring a wide range of demographic and social development outcomes, and leveraging a combination of methodological approaches. Macro-level analyses covering 200+ countries reveal that mobile-phone access is associated with lower gender inequality, higher contraceptive uptake, and lower maternal and child mortality. Individual-level analyses of survey data from sub-Saharan Africa, linked with detailed geospatial information, further show that women who own a mobile phone are better informed about sexual and reproductive health services and empowered to make independent decisions. Payoffs are larger among the least-developed countries and among the most disadvantaged micro-level clusters. Overall, our findings suggest that boosting mobile-phone access and coverage and closing digital divides, particularly among women, can be powerful tools to attain empowerment-related sustainable development goals, in an ultimate effort to enhance population health and well-being and reduce poverty.
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Project description:BackgroundTraditionally, health care-seeking for child illness is assessed through population-based and nationally representative demographic and health surveys (DHS) that are conducted once every five to seven years and are based on maternal recall. These maternal reports are subject to recall bias. Mobile phones (with the use of GPS technology) have the potential to constantly track movements of phone owners and provide high quality and more accurate data at a population level in low and middle income countries (LMICs) to assess the validity of maternal recall. We provided a group of mothers with smartphones installed with a location-aware application and visited them monthly to administer a survey questionnaire on care-seeking for diarrhoea, fever and cough with fever. This paper assesses for any reactivity to smartphones or repeated study contacts for measuring care-seeking and if this resulted in change in health care provider preference.MethodsWe enrolled 749 mothers from rural areas of Pune district in Maharashtra, India and randomly allocated them to one of three groups - a longitudinal phone group, a longitudinal control group and a cross-sectional control group. We collected baseline information from mothers, including individual and household demographic and socio-economic characteristics and care-seeking preferences for child illness. We followed up both longitudinal groups monthly and each cross-sectional sub-group once over a period of 6 months. At each follow up, we administered questions identical to those in the National Family Health Survey (NFHS) questionnaire to determine an episode of diarrhoea, fever or cough within the last 15 days, care seeking for the same, and the type of provider. The data were analysed using the ?2 test or Fisher Exact Test for categorical variables, or with the Kruskall-Wallis non-parametric test for continuous variables (due to the non-normal nature of the data). Multivariable joint models of group and visit time were analysed with logistic regression methods.ResultsAll three groups were similar in their socio-demographic characteristics at baseline. We did not observe any significant difference in care seeking for diarrhoea, fever or cough with fever between groups. Also, we did not observe any significant difference in proportion of children seeking care from the private sector.ConclusionsWe did not observe any reactivity in this study due to the presence of the phone (Hawthorne effect) or repeated study visits. The study also shows the potential of using GPS enabled smartphones to enrich DHS surveys in LMICs like India. However, further studies need to be conducted in other population groups before the findings can be generalised.
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Project description:Signing Deaf South Africans have limited access to health information. As a result, their knowledge about health is limited. Cell phone usage in South Africa is high. This study aimed to assess whether a short message service (SMS)-based health promotion campaign could improve Deaf people's knowledge of hypertension and healthy living. Additionally, the study aimed to assess the acceptability of using SMSs for health promotion targeting Deaf people.A baseline questionnaire assessed participants' knowledge about hypertension before an SMS-based information campaign was conducted. After the campaign, an exit questionnaire was conducted, containing the same questions as the baseline questionnaire with additional questions about general acceptability and communication preferences. Results were compared between baseline and exit, using McNemar's test, paired t-test and Wilcoxon signed-rank test. Focus groups aimed to get further information on the impact and acceptability of SMSs. The focus groups were analysed using inductive thematic analysis.The campaign recruited 82 participants for the baseline survey, but due to significant loss-to-follow-up and exclusions only 41 participants were included in the analysis of the survey. The majority (60%) were men. Eighty percent were employed, while 98% had not finished high school. The campaign showed a statistically significant improvement in overall knowledge about hypertension and healthy living amongst participants. Six individual questions out of 19 also showed a statistically significant improvement. Despite this, participants in focus groups found the medical terminology difficult to understand. Several ways of improving SMS campaigns for the Deaf were identified. These included using using pictures, using 'signed' SMSs, combining SMSs with signed drama and linking SMS-campaigns to an interactive communication service that would enable the Deaf to pose questions for clarification. Focus groups suggested that participants who were hypertensive during the campaign adopted a healthier lifestyle.SMSs were effective in improving Deaf people's knowledge of hypertension and healthy living. However, SMS-campaigns should be cognizant of Deaf people's unique needs and communication preference and explore how to accommodate these.The research was registered with the Pan African Clinical Trial Registry on December 1, 2015. Identification number: PACTR201512001353476 .
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