Apr 22, 2020
Rapid evidence summary: SMS & mobile interventions
How can SMS & mobile interventions inform our work during the COVID-19 era?
With people physically distancing around the world due to COVID-19, we are exploring mobile interventions in order to continue delivering services for our clients. In our latest rapid evidence summary, we looked at literature on the impact SMS and mobile interventions have on health outcomes. This included delving into systematic reviews and impact evaluations.
Our rapid summary suggests that mobile interventions, particularly via SMS, have mixed effects on a range of clinical outcomes and health behaviors. Most reviews and studies suggest that SMS interventions are more cost-effective than standard, in-person interventions. Yet, all studies mention that stand-alone SMS programming is likely to have smaller effects than more complex, multi-component interventions. We must also take timing, content, framing, frequency and recipient/care-giver characteristics into account when designing such interventions.
While high quality systematic reviews on SMS interventions contain few studies, most of which have been conducted in developed or upper-middle income countries, some impact evaluations have been conducted in relatively more stable developing contexts such as Kenya, Uganda and Nigeria. Most of these studies showed a positive impact of SMS programming on outcomes like clinic attendance and adherence to antimalarial treatments, as well as on full immunization and medication rate.
One systematic review looked at seven countries and found that in all attendance rate studies, SMS and mobile phone appointment reminders significantly improved attendance rates. Moreover, SMS reminders were more cost-effective than telephone interventions and were equally efficacious.
In one study in rural Uganda, SMS messages notified households when a doctor and/or vaccinations were available at the local clinic. The messages led to an increase in attendance at the clinic for children six years old or younger, and also resulted in a decrease in the duration and severity of illness for these same children. These effects only occurred among children in households where an adult of the same sex received the SMS from the clinic. This suggests the significance of mother-daughter and father-son relationships in this community.
Another study in Coastal Kenya found that among outpatients screened for acute HIV, appointment reminders through SMS, phone calls, and in-person reminders increased the uptake of repeat HIV tests two to four weeks after the initial test by 40%.
All positive effects in our summary were limited to certain subgroups of the studied populations or resulted from a variation of the SMS intervention (like with an extended message or when SMS was combined with a small financial incentive).
For in-depth information on results and limitations, read the full rapid evidence summary.
