Evaluating the Impact of SMS on Behavior Change

The purpose of PeaceTXT is to use mobile messaging (SMS) to catalyze behavior change vis-a-vis peace and conflict issues for the purposes of violence prevention. You can read more about our pilot project in Kenya here and here. We’re hoping to go live next month with some initial trials. In the meantime, we’ve been busy doing research to develop an appropriate monitoring and evaluation strategy. As is often the case in this new innovative initiatives, we have to look to other fields for insights, which is why my colleague Peter van der Windt recently shared this peer-reviewed study entitled: “Mobile Phone Technologies Improve Adherence to Antiretroviral Treatment in a Resource-Limited Setting: A Randomized Con-trolled Trial of Text Message Reminders.”

The objective of the study was to test the “efficacy of short message service (SMS) reminders on adherence to Antiretroviral Treatment (ART) among patients attending a rural clinic in Kenya.” The authors used a Randomized Control Trial (RCT) of “four SMS reminders interventions with 48 weeks of follow-up.” Over four hundred patients were enrolled in the trial and “randomly assigned to a control group or one of the four intervention groups. Participants in the intervention groups received SMS reminders that were either short or long and sent at a daily or weekly frequency.”

The four different text message interventions were “chosen to address different barriers to adherence such as forgetful- ness and lack of social support. Short messages were meant to serve as a simple reminder to take medications, whereas long messages were meant to provide additional support. Daily messages were close to the frequency of medication usage, whereas weekly messages were meant to avoid the possibility that very frequent text messages would be habituating.” The SMS content was developed after extensive consultation with clinic staff and the messages were “sent at 12 p.m., rather than twice daily (during dosing times) to avoid excess reliance on the accuracy of the SMS  software.”

The results of the subsequent statistical analysis reveal that “53% of participants receiving weekly SMS reminders achieved adherence of at least 90% during the 48 weeks of the study, compared with 40% of participants in the control group. Participants in groups receiving weekly reminders were also significantly less likely to experience treatment interruptions exceeding 48 hours during the 48-week follow-up period than participants in the control group.” Interestingly, “adding words of encouragement in the longer text message reminders was not more effective than either a short reminder or no reminder.” Furthermore, it is worth noting that “weekly reminders improved adherence, whereas daily remin-ders did not. Habituation, or the diminishing of a response to a frequently repeated stimulus, may explain this finding. Daily messages might also have been considered intrusive.”

In sum, “despite SMS outages, phone loss, and a rural population, these results suggest that simple SMS interventions could be an important strategy to sustaining optimal ART response.” In other words, SMS reminders can serve as an important tool to catalyze positive behavior change in resource-limited settings. Several insights from this study are going to be important for us to consider in our PeaceTXT project. So if you know of any other relevant studies we should be paying attention to, then please let us know. Thank you!

7 responses to “Evaluating the Impact of SMS on Behavior Change

  1. Very interesting! Our friends at the Red Cross would probably like to see this as they’ve implemented their own SMS reminder/notification system. I’ll send it via Twitter to Wendy Harmen.

  2. Yep! It’s primarily for fighting cholera in Haiti: http://redcrosschat.org/2010/10/25/text-messages-to-fight-cholera/

  3. just asked. will let you know

  4. Pingback: Evaluating the Impact of SMS on Behavior Change | Digital Health Journal

  5. Pingback: PeaceTXT Kenya: Since Wars Begin in Minds of Men | iRevolution

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