Abstract
Despite documented health benefits of household water treatment and storage (HWTS), achieving sustained use remains challenging. In prior evaluations of a long-term HWTS program in Haiti, multiple marketing interventions failed to increase use or had prohibitively high costs. Using mobile phones is a potentially cost-effective way to change HWTS behavior. We conducted a randomized experiment to evaluate the impact of sending short-message service (SMS) messages to promote household chlorination in this program in Haiti. Households (n = 1327) were randomly assigned to: One of four SMS frequencies; one of ten behavioral constructs; “cholera” or “disease” framing; and one or zero household visits from a sales agent. During the three-month campaign, there were no statistically significant relationships between the four outcomes related to chlorine purchases and any SMS frequency, any behavioral construct, or either “cholera” or “disease” framing. Receiving one visit increased the probability of purchasing a bottle of chlorine by 17.1 percentage points (p < 0.001) but did not affect subsequent purchase behavior. Costs of managing the SMS campaign were higher than expected. SMS campaigns may not be cost-effective behavior change interventions in certain contexts. If pursued, we recommend simple interventions, timed with the target behavior, and tailored to mobile phone usage patterns of the target population.
Highlights
Worldwide, approximately 844 million people lack access to a basic drinking water service, and an estimated 1.8 billion rely on contaminated water [1]
Some behavior change communication (BCC) strategies have been shown to increase demand for Household water treatment and storage (HWTS) products, but there is no clear consensus on a single best approach [12]
We hypothesized that an short-message service (SMS) campaign would be a cost-effective way to increase chlorine purchase and use in a population with prior exposure to information campaigns, even if the magnitude of impact was relatively low
Summary
Approximately 844 million people lack access to a basic drinking water service, and an estimated 1.8 billion rely on contaminated water [1]. Household water treatment and storage (HWTS), which includes consumables such as chlorine and durables such as filters, can be a cost-effective means of improving drinking water quality [2] and reducing diarrheal disease [3,4,5,6,7,8,9]. Despite the health benefits of HWTS products, demand remains low. Some behavior change communication (BCC) strategies have been shown to increase demand for HWTS products, but there is no clear consensus on a single best approach [12]. Implementers must often decide between mass media campaigns (such as radio spots and billboards) and interpersonal
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