The crossroads of public health and technology have produced many innovations, but probably none as simple or powerful as the humble text message, which spans the globe and improves health care in a variety of ways.
Is This Thing On?, or ITTO, is our Wednesday column showing how everyday people use technology in unexpected ways.
Smartphones’ prevalence and portability provide an effective public health vehicle for isolated and impoverished populations to decrease epidemics and promote overall good health. Current estimates reveal there now are over 5 billion mobile phone subscribers and over 70 percent of them reside in low- and middle-income countries, where many text-based health programs are being developed, and are gaining adoption in the U.S.
Text To Change, a non-profit organization in Africa, has been using mobile technology for health education since 2008. TTC uses text messages, or SMS, in its educational programs targeting health issues like HIV and AIDS, malaria, and reproductive health in Uganda, Kenya and Namibia.
TTC runs a six-week SMS-based quiz program, sending participants three questions per week. The quiz participants answer by sending a free text message, after which they receive the correct answer with additional information on the topic.
Detailed information on weekly quiz issues are also put up in a local newspaper and on the TTC website. At the end of the program, participants who answered correctly also have an opportunity to win prizes such as mobile phones and air time. The simple program has led to a 40 percent increase in people seeking free HIV testing.
Kenya’s improved malaria recovery rates also demonstrate the impact of text messages in the successful treatment of disease and chronic conditions.
The country’s six-month malaria program determined that participants who received varied text messages, both inspiring and informative, had a 25 percent improvement rate over programs that did not use texts to help treat the disease.
Being mindful is particularly crucial in treating malaria, since patients must complete a full dose of medication before they are disease-free. Failure to complete the course of treatment not only jeopardizes full recovery, but gives time for malaria parasites to adapt and become resistant to medication.
The Kenyan program highlights how text messages can serve as key, authoritative reminders for healthcare workers to keep treatment at the forefront of the participants’ thoughts when fighting malaria.
In Cambodia, the nation’s largest telecom provider Mobitel gives out free SIM cards and SMS as part of an open-source software program called “FrontlineSMS ,” which allows volunteers to send and receive malaria reports via text.
The SMS data is sent to the Malaria Information and Alert System in the city of Phnom Penh and fed into a national database using Google Earth.
The volunteers’ text-messaged reports identify cases in real-time, which health care providers then monitor in an effort to combat and contain the disease, providing a more effective, coordinated response to the “big picture” view of the ground-level situation.
Before mobile phones were part of the program, it took a month before patient information arrived at the district health level. But the text message system helps volunteers and agencies more quickly and efficiently manage resources and response, aiming to eliminate malaria in the next 15 years.
These programs increasingly find an audience in developed nations like the U.S. as well, where over 85 percent of Americans own a cell phone and 72 percent of cell users send or receive text messages.
The National Healthy Mothers, Healthy Babies Coalition launched text4baby, the first free health text messaging service in the U.S. to help more pregnant women and new moms get information about giving their babies the best possible start in life.
Participants can register online or by typing the word “BABY” for English or “BEBE” for Spanish to 511411, entering the baby’s due date and zip code. Users then receive free messages with pregnancy tips and advice on how to care for a newborn, providing vaccination and other reminders.
Text4baby began nationally in February 2010, and more than 200,000 individuals now receive the regular updates.
The state of Illinois boasts 9,000 participants, and according to Sheila Sanders, project coordinator for the program with Illinois Maternal and Child Health Coalition, who negotiated with several mobile phone companies for free service. The program is available to moms, dad, and grandparents — anyone who expects to care for the baby in an effort to decrease infant and maternal mortality rates.
“Sometimes you don’t get everything you need at every (doctor’s) appointment,” said Saunders. “This information is designed to give you every tidbit of information you need to know.”
The use of text messages to combat health crises has several advantages: cost-effectiveness, scalability, convenience, broad reach, and widespread popularity around the world. In addition, all basic phones are able to receive SMS, and to overcome illiteracy barriers, agencies are currently making use of Interactive Voice Response services as well.
While much news in mobile health focuses on smartphone devices and apps, SMS use in health programs suggests that often a vital tool in any campaign is one that has been there all along — and can be cost-effective, informative, easily accessible, anonymous, and above all, life-saving.