Page 182 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 5 of 6 Original Research

chances of accidental disclosure. Other suggestions by youth (such as mHealth) to support a sustainable ART programme
36
to improve confidentiality of mHealth include the use of especially in vulnerable groups. However, as many African
MODs with access codes to increase security. In addition, countries struggle with poverty, high unemployment rate and
22
daily SMS might be intrusive, produce habituation and weak economic growth, it will be challenging to channel
response fatigue. There is suggestion that a two-way text resources for implementation of such projects.
24
34
messaging may be better than a simple text message reminder.
More evidence is warranted regarding the optimal frequency Conclusion
of messaging. The majority of adolescents attending school
35
may have restriction placed on the use of MOD both at school This study has demonstrated that adolescents in this study
and at home during the school terms; this is important for the population were willing to use simple SMS technology to
timing of SMS. communicate their health status with the health system both
in urban and rural areas. This demonstrates the acceptability
of potential of mHealth interventions that might have
While the frequency of messaging is high among adolescents,
only 12% of adolescents use cell phones for health-related positive impact in supporting adherence and retention in
26
information ; this is lower than previously thought. A study care. Further studies are required to identify the most
conducted in Malawi, Ghana and South Africa showed that effective types of messaging, cost-effectiveness and
29% use cell phone technology for health-related issues. The sustainability especially in developing countries. This will
26
possible reasons that can be extrapolated for the low usage require partnership with the private sector cellular phone
include that people struggle to differentiate between good networks while tailoring the intervention to the needs and
and bad information from the Internet about health and the information required by adolescents.
prohibitively high cost of using data. Text messaging and
26
phone calls maybe unaffordable in certain very low resource Acknowledgements
24
settings. These challenges will need to be addressed to The authors would like to thank Sister Sibongiseni
achieve adherence and retention. Our study indicates that Ngubelanga from Umbumbulu Clinic and Dr Chirjeev
mHealth interventions hold promise, as 65% of adolescents Kindra from KEH Philani Clinic for their assistance in
are willing to use cell phone technology for health-related collecting the questionnaires and the adolescents for their
information. participation in the study.

Providing healthcare-related messages in a language that the
recipient is comfortable with is very important. There are Competing interests
differences in languages used at home between participants The authors have declared that no competing interests
in the urban and rural clinic, highlighting the need for the exist.
language to be customised to accommodate different ethnic
and linguistic groups. Authors’ contributions

The average age of the participants in this survey is 15 years, M.A.C. did the literature review, summarised and interpreted
with the majority in secondary school. However, if mHealth data collection, and wrote the summary. M.A. assisted with
interventions are to be implemented, then content of corrections and did overall supervision of the project.
messages might need to be different to accommodate
different age groups. These messages need to be Funding
individualised and free of abbreviations like HIV/AIDS to
decrease risk of accidental disclosure. 35 This research received no specific grant from any funding
agency in the public, commercial or not for profit sectors.
A limitation of this study was the small sample size, which
limited the power of the study to detect smaller differences Data availability statement
between the two populations. However, this analysis was Data can be shared upon permission from the authors.
aimed at exploring mHealth in rural and urban areas in KZN
and provides a rationale for further research in this area. Bias
may arise as caregivers consented for enrolment into this Disclaimer
survey, which may influence the responses, but assent was The views and opinions expressed in this article are those of
obtained and those adolescents who refused participation the authors and do not necessarily reflect the official policy or
were not included. Further participants may have shared position of any affiliated agency of the authors.
information while waiting outside the consultation room,
which can lead to contamination of the data. References

Strategies like mHealth are in line with the Fourth Industrial 1. UNICEF. For Every Child, End AIDS: Seventh Stocktaking Report, 2016. Seventh
Stocktaking Report 2016. 2016. [cited n.d.]. Available from: https://www.unicef.
Revolution, as technology has become the focus. With org/publications/index_93427.html
dwindling international funding for provision of ART globally, 2. Slogrove AL, Mahy M, Armstrong A, Davies MA. Living and dying to be counted:
this is a key opportunity to use innovative technologies What we know about the epidemiology of the global adolescent HIV epidemic.
J Int AIDS Soc. 2017;20(Suppl 3):4–15. https://doi.org/10.7448/IAS.20.4.21520
http://www.sajhivmed.org.za 175 Open Access