Hypertension Health Promotion via Text Messaging at a Community Health Center in South Africa: A Mixed Methods Study.

Damian Hacking,Kirsty Brittain,Tali Cassidy,Hanne J Haricharan,Marion Heap,Yan Kwan Lau

doi:10.2196/mhealth.4569

Abstract

BackgroundThe use of mobile phones to deliver health care (mHealth) is increasing in popularity due to the high prevalence of mobile phone penetration. This is seen in developing countries, where mHealth may be particularly useful in overcoming traditional access barriers. Non-communicable diseases may be particularly amenable to mHealth interventions, and hypertension is one with an escalating burden in the developing world.ObjectiveThe objective of this study was to test whether the dissemination of health information via a short message service (SMS) led to improvements in health knowledge and self-reported health-related behaviors.MethodsA mixed methods study was carried out among a cohort of 223 hypertension clinic patients, in a resource-poor setting in Cape Town, South Africa, in 2012. Hypertensive outpatients were recruited at the clinic and administered a baseline questionnaire to establish existing knowledge of hypertension. Participants were then randomly assigned to intervention or control groups. The intervention group received 90 SMSes over a period of 17 weeks. Thereafter, the baseline questionnaire was readministered to both groups to gauge if any improvements in health knowledge had occurred. Those who received SMSes were asked additional questions about health-related behavior changes. A focus group was then conducted to obtain in-depth feedback about participants’ experience with, and response to, the SMS campaign.ResultsNo statistically significant changes in overall health knowledge were observed between the control and intervention groups. The intervention group had positive increases in self-reported behavior changes. These were reaffirmed by the focus groups, which also revealed a strong preference for the SMS campaign and the belief that the SMSes acted as a reminder to change, as opposed to providing new information.ConclusionsAlthough the content of the SMSes was not new, and did not improve health knowledge, SMSes were effective in motivating positive self-reported behavior change among hypertensive patients.Trial RegistrationPan African Clinical Trials Registry Number: PACTR201412000968462. Registered 18 December 2014 (Archived by WebCite at http://www.webcitation.org/6fhtyLRcO).

Highlights

Introduction mobile phones to deliver health care (mHealth), the use of mobile phones to support health care, is often seen to have great potential, as mobile technology has a high prevalence, with 6.8 billion subscriptions worldwide [1]. This extends to the developing world, with Africa having the fastest growing market for cell phone technology, and over 75% of the low-income South African population already owning, or having access to, a cell phone number [2]. mHealth can be implemented for a variety of health-related functions: to provide information, act as reminders of clinic visits, encourage behavior changes, and be actively used in symptom diagnoses and drug adherence checking [3][4][5]
The SMSes were viewed not as a source of new information, but rather as a motivation for change, which was felt to be extremely useful: Ok, for me since I hear this thing time and again, wherever I go, I go to Groote Schuur [hospital], I go to Victoria hospital, even here and see dieticians, http://mhealth.jmir.org/2016/1/e22/
Self-reported behavior change in the intervention group showed significant trends toward healthier lifestyles. This observation was confirmed by focus groups, which emphasized the utility of the SMSes as a reminder, and a source of motivation to change, rather than a source of new knowledge

Summary

Introduction

MHealth, the use of mobile phones to support health care, is often seen to have great potential, as mobile technology has a high prevalence, with 6.8 billion subscriptions worldwide [1] This extends to the developing world, with Africa having the fastest growing market for cell phone technology, and over 75% of the low-income South African population already owning, or having access to, a cell phone number [2]. The intervention group had positive increases in self-reported behavior changes These were reaffirmed by the focus groups, which revealed a strong preference for the SMS campaign and the belief that the SMSes acted as a reminder to change, as opposed to providing new information. Registered 18 December 2014 (Archived by WebCite at http://www.webcitation.org/6fhtyLRcO)

Objectives

Results

Conclusion