Page 181 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 4 of 6 Original Research

TABLE 3: Feasibility of mobile health technology by education level (N = 83). among the youth population in Malawi, Ghana and South
Covariates No Education Primary Secondary Tertiary P Africa showed that 88% of youth owned an MOD. Despite
26
(N = 1) (N = 15) (N = 50) (N = 17)
Phone Ownership the high levels of MOD ownership, there is a possibility that
Yes 0 11 49 15 0.0016* adolescents share their MODs with other family members,
No 1 4 1 2 which increased the risks of accidental disclosures of
16
SMS Message Frequency confidential information regarding their health status.
Every day 0 5 19 4 0.7902* Investing in improving SMS-based mHealth interventions
Every 2-6 days 0 1 6 1 that do not divulge patient information and protecting
Once a week 0 0 2 2 individual privacy is urgently needed. 16,27 While there have
Once every 2 weeks 0 0 4 1 been different mHealth interventions studied in adult
Never 1 8 17 8 populations in developing and developed countries, these
Text Language findings support the exploration of mHealth in adolescents
Zulu 1 11 27 11 0.6543*
English 0 4 19 4 residing in both rural and urban KZN.
Have you ever sent a SMS message to medical provider?
Yes 1 1 3 1 0.2200* Telecommunication technologies are emerging as an important
No 0 13 42 14 means of extending healthcare to patients with limited direct
Do not know 0 1 2 0 access to a healthcare facility, with a Cochrane review
Have you ever received a SMS message from medical provider? showing that there is growing interest in the use of cell phone
Yes 0 2 4 5 0.2252* technology. In this study, 65% of adolescents were willing to
28
No 1 9 39 11 participate in a mHealth intervention. There are different
Do not know 0 2 4 0 communication tools that have been used for delivering
Would you be willing to receive an SMS message from a medical provider in the mHealth, ranging from simple, for example SMS, to more
future?
Yes 0 11 33 9 0.4181* complicated, for example interactive apps. Participants from
No 1 1 7 4 both clinics found that communicating with a healthcare
Maybe 0 2 7 3 provider using SMS text messages was an acceptable tool.
*, p-value reflects results of Fisher’s Exact Test. More than 25% of cells had expected counts One of the major potential benefits of mHealth is in improving
less than 5 making Chi-Square Test inappropriate.
adherence and retention to care. A study conducted in a rural
area of Kenya found that an SMS-based mHealth intervention
almost the same between males and females (88% vs. 83% was associated with 90% improvement in adherence over 48
p = 0.19). There was a high frequency of SMS messages use in weeks. Additional benefits include decreased need for
29
the rural site as compared to urban (40% vs. 26%, p = 0.08). regular follow-up appointments resulting in a positive
Despite high MOD ownership, 48% of participants in the financial effect for patients as most clinics are far from the
urban site had never sent an SMS text message. The majority community. Several studies have found a correlation
18
of the study population at both sites had not sent or received between high usage of mHealth and improvement of
any form of text message from a medical provider; however, adherence. 22,30,31 The high MOD ownership and willingness to
adolescents at both the rural and urban sites were willing to access mHealth at both sites indicate that there is a space for
use mobile technology to access healthcare (Table 2). mHealth interventions among these communities.

Feasibility of mHealth interventions was stratified by The higher usage of SMS text messaging in the participants
participant level of education (Table 3). Fifty per cent of the from the rural clinic compared to the urban clinic
study population was attending secondary school with a likely highlights the influence of different access to
statistically significant increase in MOD ownership with telecommunication technologies between the settings.
higher level of education (p = 0.0016). Only 38% of participants The ready availability of Internet-based messaging (e.g.
reported that they use SMS every day; however, 34 % reported WhatsApp) in urban centres may account for the lower use
that they never sent an SMS text message. Use of mHealth of SMS text messaging. This finding highlights the need
was feasible particularly in adolescents who attend secondary for the use of simple technologies that can be accessed
school with high levels of MOD ownership and 67% willing by both urban and rural communities when designing
to receive SMS regarding their health. mHealth interventions. Implementation of telecommunication
technologies requires adequate infrastructure, sustained
Discussion budget for operational costs and this will need involvement
of public and private sector support for it to be sustainable.
32
In this exploratory pilot study evaluating the acceptability of
text messaging support for adolescents in an urban and rural The frequency of preferred messages differs by country,
clinic, we found no significant difference in MOD ownership with patients in developing countries preferring to receive
and acceptability of mHealth between the two sites. messages once a week, 20,29,30 compared to daily text messaging
Participants in both sites had high MOD ownership, with that was preferred by patients in some developed countries.
33
more than 90% of adolescents in this cohort owning a MOD. This preference may be related to socio-economic status with
There are similar trends in MOD ownership that have been adolescents in developing countries being more likely to
noted in other studies from Africa. A study of MOD ownership share MODs and less frequent messages would decrease the

http://www.sajhivmed.org.za 174 Open Access