MobileActive.org

Mobile phone text messaging is a potentially powerful tool for behavior change because it is widely available, inexpensive, and instant.

This systematic review provides an overview of behavior change interventions for disease management and prevention delivered through text messaging. Evidence on behavior change and clinical outcomes was compiled from randomized or quasi-experimental controlled trials of text message interventions published in peer-reviewed journals by June 2009. Only those interventions using text message as the primary mode of communication were included. Study quality was assessed by using a standardized measure. Seventeen articles representing 12 studies (5 disease prevention and 7 disease management) were included. Intervention length ranged from 3 months to 12 months, none had long-term follow-up, and message frequency varied.

Of 9 sufficiently powered studies, 8 found evidence to support text messaging as a tool for behavior change. Effects exist across age, minority status, and nationality. Nine countries are represented in this review, but it is problematic that only one is a developing country, given potential benefits of such a widely accessible, relatively inexpensive tool for health behavior change.

Methodological issues and gaps in the literature are highlighted, and recommendations for future studies are provided. 

For millions of people in less resourced regions of the world, text messages (SMS) provide the only regular contact with their doctor. Classifying messages by medical labels supports rapid responses to emergencies, the early identification of epidemics and everyday administration, but challenges include text-brevity, rich morphology, phonological variation, and limited training data. We present a novel system that addresses these, working with a clinic in rural Malawi and texts in the Chichewa language. We show that modeling morphological and phonological variation leads to a substantial average gain of F=0.206 and an error reduction of up to 63.8% for specific labels, relative to a baseline system optimized over word-sequences. By comparison, there is no significant gain when applying the same system to the English translations of the same texts/labels, emphasizing the need for subword modeling in many languages. Language independent morphological models perform as accurately as language specific models, indicating a broad deployment potential.

Can text messages help stop the spread of HIV/AIDS? Text to Change (TTC), a Ugandan NGO, thinks the

answer is yes. To prove it they have teamed up with Zain to launch an innovative project that utilizes a technology that has been rapidly expanding to make sure that HIV/AIDS does not do the same.

Through a pilot partnership with the Text to Change (TTC) initiative, HIPS is using an innovative tool to support companies in providing key prevention messages and education on HIV/AIDS to their employees and community networks – text messages. Early results are promising: the launch of the program resulted in a 40% increase in demand for sexual and reproductive health services from participant company clinics.

The aim of this paper is to present the main findings of the interviews and observation undertaken in health locations in rural areas of Peru, aimed at exploring the application of mobile technology for health in isolated areas, and thereby to provide wider reflections about the use of mobile phones to improve health delivery in isolated areas in developing countries. It also reflects on methodological complexities, particularly those related to the application of online research methods, through the experience gained during the research.

The great growth of the penetration of mobile phones in developing countries has attracted the attention of the ICT4D community and numerous publications reflect about their impact for development (see for example Donner, 2005; Vodafone, 2004; Sullivan, 2007 or Scott et al., 2004). A part of this literature is focused on the application of mobile phones for health delivery (bridges.org, 2005; Katz, 2005 or Voxiva, 2005). Nevertheless, publications about the application of mobile phones for health focused in rural areas of developing countries are still scarce. This paper focuses on this gap of the literature, focusing on rural areas of Peru and wider reflecting about the behavior of mobile phones in this specific context. 

Given the evolution and forecasts of penetration of mobile phones in developing countries (see Gartner, 2006 or Donner, 2005) as well as the appealing of these devices for the population (Castells et al.,2007), it is important to remark that Health Ministries in developing countries and development agencies have not paid enough attention to the possibilities that mobile technology brings for health delivery. 

This paper reports on the interviews to healthcare workers undertaken in rural areas of Peru, aimed at exploring their perception about how mobile phones can contribute to the resolution of their information and communication needs, as well as provide wider reflections about the general debate about the benefits of mobile phones for health for development. The workers were chosen as participants in two innovative and contrasting ICT4D projects: CellPREVEN and EHAS, seeking at obtaining valuable feedback about their experience on one side, and their opinion as healthcare workers with no previous experience on the use of mobile telephony within an ICT4D initiative, on the other. Additionally, the paper aims at exploring the complexities involved in the methodology, particularly the difficulties in the appliance of online research methods during the research.  

The article is structured as follows: first, the context of the research is presented; after that, some methodological issues about the field work in Peru are discussed. Next, the most remarkable findings of the interviews are presented, linked to wider reflections about the benefits of mobile phones in rural areas of developing countries. These results highlight three important advantages provided by mobile phones: the value of the immediacy in the communication for emergencies, the potential of multimedia capabilities of mobile phones and the improved reliability comparing to other technologies, but they also reflect on the recent limitations for their adoption and use in isolated communities. The article ends concluding that the application of mobile phones for health delivery is clear and of great impact in isolated areas of developing countries, but limited at this moment, with great potential in the short term.

Mobile phones are becoming prolific in society, both in industrialized and non-industrialized countries. Of all of the developments in new media, mobile is the only one that seems to be narrowing the digital divide rather than widening it, making it a crucial tool in improving the health of poor and hard-to-reach populations. Organizations around the world are beginning to implement mobile technology into their health behavior interventions and are seeing rising success. In diabetes and other chronic disease management, mobile phones are being used for medication alerts and health reporting. The technology is being used to send sexual health and HIV/AIDS information in places like downtown San Francisco and rural Africa, as part of ongoing testing, counseling and prevention services. In the US, applications involving GPS technology, video games, and persuasive technology are all being tested for their effectiveness in influencing health behavior and applicability on mobile phones.

Through published research and interviews with key leaders in the mobile health field, this paper outlines the benefits of mobile technology and the barriers to integrating mobile fully into public health campaigns. Despite the enormous work already being done and a host of new technologies on the rise, most experts will agree that mobile phones on their own will not serve as primary tools for influencing health behavior.  A comprehensive and integrated campaign that incorporates mobile will be most effective, but mobile alone faces too many barriers to fostering social norms on the wide-scale. In fact, many argue that the ways in which public health advocates are able to place health messages in broadcast media cannot be applied on cell phones because of society’s growing resistance to mobile marketing.

The paper asks: What are some examples of how organizations around the world have harnessed mobile technology to improve the health behavior of disease-specific and target populations? What lies in the future for mobile technology and health? Is mobile the answer we have been looking for?

This document aims to help readers understand the current challenges of deploying development-oriented services on mobile phones, evaluate existing technologies, and identify the most promising directions to lower the barriers of developing, deploying and accessing services on mobile phones and thereby creating an enabling environment for more social-oriented services to appear.

This document is divided into two major parts. The first part presents the major challenges today for both developing and accessing mobile services, potential ways to bridge them with existing tools, technologies and infrastructure, and potential research directions to follow to provide a more comprehensive resolution or solution. The second part focuses on presenting the major technologies and the major options existing today to deploy content and applications on mobile phones. For each of these technologies, the document presents a short analysis of the technology's potential and the requirements in terms of infrastructure, devices, targeted end-users, and costs associated with implementation and delivery.

Mobile phones are revolutionising the lives of millions of people in East Africa and will continue to be the primary means for the great majority to access voice, data and Internet services. But mobile consumers in East Africa are taxed at some of the highest levels world-wide. In addition to VAT, an excise duty, or luxury tax, is levied on mobile services.

Recognizing that this tax hits the poor hardest, the GSM Association, the global trade association representing the interests of over 850 GSM mobile phone operators and over 180 manufacturers and suppliers worldwide, in collaboration with GSM Africa, commissioned Deloitte to analyze the effect that lowering excise duties would have on the industry and total government receipts.

The findings are very encouraging. By lowering the excise duty on mobile services, governments can expect higher level of tax and extend the essential mobile franchise to poorer sections of society. Today mobile phones are a basic need and not a luxury. All stakeholders will benefit if mobile services are taxed accordingly. As the governments in East Africa go into their budgeting rounds, we call for an urgent review of mobile taxation policies. Restructuring mobile taxes can be a win win-win solution for government, business and consumers.

The premise of this paper is that the explosive growth of mobile communications can be a powerful tool for addressing some of the most critical challenges of the 21st century, such as promoting vibrant democracies, fostering inclusive economic growth, and reducing the huge inequities in life expectancy between rich and poor nations.

The benefits of mobile communications are particularly profound for developing countries, many of which are “leapfrogging” the traditional fixed telecommunications infrastructure. As a result, billions of people in developing countries are gaining access to modern communications of any sort for the first time. There is no doubt that mobile communications are having a significant impact on the way Americans live, work and communicate with each other.

But the impact is no doubt more keenly felt by the African mother who can call ahead to determine whether a doctor is available to treat her sick child before traveling for hours. Obviously, mobile communications are not a panacea for the daunting challenges faced by the 2.7 billion people who live on less than $2 a day. Like any new technology, it has costs and risks as well as benefits, and some of the promised benefits will undoubtedly fail to materialize. It’s worth remembering that 19th century pundits thought the telegraph would inevitably lead to world peace, or that in 1922 Thomas Edison predicted the motion picture would “revolutionize our educational system … and supplant largely, if not entirely, the use of textbooks.”

But Columbia University’s Jeffrey Sachs may well be right when he concludes that “the cell phone is the single most transformative technology for development. With a few exceptions, the U.S. government is largely oblivious to the ways in which the rapid diffusion of mobile services (and other new technologies) could be used to improve the human condition. I believe that the next Administration should launch a major new initiative to harness the confluence of new technologies and innovative business models as a key component of its global development agenda. This initiative would be designed to serve as a catalyst for policy reforms in developing countries, promote an increased capacity for innovation by developing country entrepreneurs to meet local needs, and stimulate additional investments by philanthropists, foundations and companies. Such an initiative could reduce poverty, strengthen democratic institutions, and improve global health outcomes. It could also help restore some of the damage to America’s international reputation, boost America’s “soft power,” and position American businesses and workers to benefit from the growth of emerging markets in Africa, Asia, and Latin America.

This initiative would not be limited to mobile services, and might also include decentralized approaches to providing safe drinking water, new vaccines, therapies, point-of-care diagnostics, clean energy, and improved crops that are more productive, nutritious, and drought-resistant. Obviously, private sector investment in mobile communications for developing country markets will continue to grow. Even in the absence of enlightened U.S. government leadership, mobile services will become more ubiquitous, affordable, and versatile.  But the missed opportunity will be the failure to leverage this large and growing private sector investment for public purposes, such as ensuring fair elections, helping a community health worker save the life of a mother or young child, or giving a farmer or small business owner access to the credit they need to build a path out of poverty.

The number of mobile subscribers globally is estimated to have reached four billion in 2008 (ITU, 2008), with mobile penetration reaching 61%. Around 58% of subscribers are in developing countries, and subscriber growth in Africa – more than 50% per year – is the highest in the world. Studies have shown that this rapid increase in mobile penetration has contributed significantly to economic growth. Fuss, Meschi and Waverman (2005) looked at 92 countries, both developed and developing, to estimate the impact of mobile phones on economic growth for the period 1980 to 2003. They found that a 10% difference in mobile penetration levels over the entire sample period implies a 0.6% difference in growth rates between otherwise identical developing nations. The effect of mobiles was twice as large in developing countries as in developed ones (Waverman, 2005).

Mobile phones have brought three kinds of benefits (id21, 2007). First, incremental benefits, improving what people already do – offering them faster and cheaper communication, often substituting for costly and risky journeys. Fishermen in India, for example, can earn more money and waste less fish by phoning coastal markets to see which market has a shortage of supply. Second, transformational benefits that offer something new. Innovative applications, such as m-banking and m-commerce, are bringing banking services to millions for the first time, and enabling people to use mobile phones to pay for goods and services. Third, production benefits that result from the creation of new livelihoods, not only through professional telecommunications jobs but also through activities like re-selling air-time or phone cards. Since the liberalisation of Nigeria’s telecommunications sector in 2000, the industry has become a key source of new jobs in the economy, employing about 5,500 professionals, and responsible, indirectly, for another 450,000 jobs.