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Review
. 2019 Oct 14;10(10):CD013447.
doi: 10.1002/14651858.CD013447.

Clients' perceptions and experiences of targeted digital communication accessible via mobile devices for reproductive, maternal, newborn, child, and adolescent health: a qualitative evidence synthesis

Heather Mr Ames  1 , Claire Glenton, Simon Lewin, Tigest Tamrat, Eliud Akama, Natalie Leon
Affiliations
Review

Clients' perceptions and experiences of targeted digital communication accessible via mobile devices for reproductive, maternal, newborn, child, and adolescent health: a qualitative evidence synthesis

Heather Mr Ames et al. Cochrane Database Syst Rev. .

Abstract

Background: Governments and health systems are increasingly using mobile devices to communicate with patients and the public. Targeted digital client communication is when the health system transmits information to particular individuals or groups of people, based on their health or demographic status. Common types of targeted client communication are text messages that remind people to go to appointments or take their medicines. Other types include phone calls, interactive voice response, or multimedia messages that offer healthcare information, advice, monitoring, and support.

Objectives: To explore clients' perceptions and experiences of targeted digital communication via mobile devices on topics related to reproductive, maternal, newborn, child, or adolescent health (RMNCAH).

Search methods: We searched MEDLINE (OvidSP), MEDLINE In-Process & Other Non-Indexed Citations (OvidSP), Embase (Ovid), World Health Organization Global Health Library, and POPLINE databases for eligible studies from inception to 3-6 July 2017 dependant on the database (See appendix 2).

Selection criteria: We included studies that used qualitative methods for data collection and analysis; that explored clinets' perceptions and experiences of targeted digital communication via mobile device in the areas of RMNCAH; and were from any setting globally.

Data collection and analysis: We used maximum variation purposive sampling for data synthesis, employing a three-step sampling frame. We conducted a framework thematic analysis using the Supporting the Use of Research Evidence (SURE) framework as our starting point. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. We used a matrix approach to explore whether potential implementation barriers identified in our synthesis had been addressed in the trials included in the related Cochrane Reviews of effectiveness.

Main results: We included 35 studies, from a wide range of countries on six continents. Nineteen studies were conducted in low- and middle-income settings and sixteen in high-income settings. Some of the studies explored the views of people who had experienced the interventions, whereas others were hypothetical in nature, asking what people felt they would like from a digital health intervention. The studies covered a range of digital targeted client communication, for example medication or appointment reminders, prenatal health information, support for smoking cessation while pregnant, or general sexual health information.Our synthesis showed that clients' experiences of these types of programmes were mixed. Some felt that these programmes provided them with feelings of support and connectedness, as they felt that someone was taking the time to send them messages (moderate confidence in the evidence). They also described sharing the messages with their friends and family (moderate confidence).However, clients also pointed to problems when using these programmes. Some clients had poor access to cell networks and to the internet (high confidence). Others had no phone, had lost or broken their phone, could not afford airtime, or had changed their phone number (moderate confidence). Some clients, particularly women and teenagers, had their access to phones controlled by others (moderate confidence). The cost of messages could also be a problem, and many thought that messages should be free of charge (high confidence). Language issues as well as skills in reading, writing, and using mobile phones could also be a problem (moderate confidence).Clients dealing with stigmatised or personal health conditions such as HIV, family planning, or abortion care were also concerned about privacy and confidentiality (high confidence). Some clients suggested strategies to deal with these issues, such as using neutral language and tailoring the content, timing, and frequency of messages (high confidence).Clients wanted messages at a time and frequency that was convenient for them (moderate confidence). They had preferences for different delivery channels (e.g. short message service (SMS) or interactive voice response) (moderate confidence). They also had preferences about message content, including new knowledge, reminders, solutions, and suggestions about health issues (moderate confidence). Clients' views about who sent the digital health communication could influence their views of the programme (moderate confidence).For an overview of the findings and our confidence in the evidence, please see the 'Summary of qualitative findings' tables.Our matrix shows that many of the trials assessing these types of programmes did not try to address the problems we identified, although this may have been a reporting issue.

Authors' conclusions: Our synthesis identified several factors that can influence the successful implementation of targeted client communication programmes using mobile devices. These include barriers to use that have equity implications. Programme planners should take these factors into account when designing and implementing programmes. Future trial authors also need to actively address these factors and to report their efforts in their trial publications.

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Conflict of interest statement

Heather Ames: no declaration of interest

Claire Glenton: no declaration of interest

Simon Lewin: no declaration of interest

Tigest Tamrat: no declaration of interest

Eliud Akama: no declaration of interest

Natalie Leon: no declaration of interest

Figures

1
1
PRISMA flow diagram.
See this image and copyright information in PMC

References

References to studies included in this review

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Lau 2014 {published data only}
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Mbuagbaw 2012 {published data only}
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Mbuagbaw 2014 {published data only}
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Naughton 2013 {published data only}
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References to studies excluded from this review

Abbass‐Dick 2017 {published data only}
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Abramson 2015 {published data only}
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Blas 2013 {published data only}
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Brinkel 2017 {published data only}
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Broom 2015 {published data only}
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Brüll 2016 {published data only}
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Bull 2010 {published data only}
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Campbell 2015 {published data only}
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Chang 2013 {published data only}
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Chib 2013 {published data only}
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Cordova 2015 {published data only}
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Cormick 2012 {published data only}
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Cormick 2015 {published data only}
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Curioso 2007 {published data only}
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Dean 2012 {published data only}
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Devine 2014 {published data only}
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Fletcher 2016 {published data only}
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Fornos 2014 {published data only}
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Gatwood 2014 {published data only}
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Goldenberg 2014 {published data only}
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Hearn 2014 {published data only}
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Herbec 2014 {published data only}
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Hmone 2016 {published data only}
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Holloway 2017 {published data only}
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Horvath 2016 {published data only}
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Huberty 2015 {published data only}
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Huq 2014 {published data only}
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Irons 2015 {published data only}
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Jamison 2013 {published data only}
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Kharbanda 2009 {published data only}
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Kharbanda 2011 {published data only}
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Labacher 2013 {published data only}
    1. Labacher L, Mitchell C. Talk or text to tell? How young adults in Canada and South Africa prefer to receive STI results, counseling, and treatment updates in a wireless world. Journal of Health Communication 2013;18(12):1465‐76. - PubMed
Lee 2014 {published data only}
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Levine 2008 {published data only}
    1. Levine D, McCright J, Dobkin L, Woodruff AJ, Klausner JD. SEXINFO: a sexual health text messaging service for San Francisco youth. American Journal of Public Health 2008;98(3):393‐5. - PMC - PubMed
Lewis 2013 {published data only}
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Maar 2016 {published data only}
    1. Maar MA, Yeates K, Toth Z, Barron M, Boesch L, Hua‐Stewart D, et al. Unpacking the black box: a formative research approach to the development of theory‐driven, evidence‐based, and culturally safe text messages in mobile health interventions. JMIR mHealth and uHealth 2016;4(1):e10. - PMC - PubMed
Marsh 2014 {published data only}
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Mbuagbaw 2013 {published data only}
    1. Mbuagbaw L, Ongolo‐Zogo P, Thabane L. Investigating community ownership of a text message programme to improve adherence to antiretroviral therapy and provider‐client communication: a mixed methods research protocol. BMJ Open 2013;3(6):e002816. - PMC - PubMed
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    1. Michell C, Oakeshott P. Text messaging to promote health. British Journal of General Practice 2014;64(619):72‐3. - PMC - PubMed
Moskowitz 2009 {published data only}
    1. Moskowitz DA, Melton D, Owczarzak J. PowerON: the use of instant message counseling and the Internet to facilitate HIV/STD education and prevention. Patient Education and Counseling 2009;77(1):20‐6. - PMC - PubMed
Muessig 2013 {published data only}
    1. Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, et al. Putting prevention in their pockets: developing mobile phone‐based HIV interventions for black men who have sex with men. AIDS Patient Care and STDs 2013;27(4):211‐22. - PMC - PubMed
O'donnell 2016 {published data only}
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Pérez 2015 {published data only}
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Price 2009 {published data only}
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Prieto 2016 {published data only}
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Ramanathan 2013 {published data only}
    1. Ramanathan N, Swendeman D, Comulada WS, Estrin D, Rotheram‐Borus MJ. Identifying preferences for mobile health applications for self‐monitoring and self‐management: focus group findings from HIV‐positive persons and young mothers. International Journal of Medical Informatics 2013;82(4):e38‐46. - PMC - PubMed
Ranney 2014 {published data only}
    1. Ranney ML, Choo EK, Cunningham RM, Spirito A, Thorsen M, Mello MJ, et al. Acceptability, language, and structure of text message‐based behavioral interventions for high‐risk adolescent females: a qualitative study. Journal of Adolescent Health 2014;55(1):33‐40. - PMC - PubMed
Redfern 2016 {published data only}
    1. Redfern J, Santo K, Coorey G, Thakkar J, Hackett M, Thiagalingam A, et al. Factors influencing engagement, perceived usefulness and behavioral mechanisms associated with a text message support program. PLOS ONE 2016;11(10):e0163929. - PMC - PubMed
Saranto 2009 {published data only}
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Schnall 2016 {published data only}
    1. Schnall R, Rojas M, Bakken S, Brown W 3rd, Carballo‐Dieguez A, Carry M, et al. A user‐centered model for designing consumer mobile health (mHealth) applications (apps). Journal of Biomedical Informatics 2016;60:243‐51. - PMC - PubMed
Senn 2017 {published data only}
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Senn 2017a {published data only}
    1. Senn TE, Braksmajer A, Coury‐Doniger P, Urban MA, Rossi A, Carey MP. Development and preliminary pilot testing of a peer support text messaging intervention for HIV‐infected black men who have sex with men. Journal of Acquired Immune Deficiency Syndromes 2017;74(Suppl 2):S121. - PMC - PubMed
Shet 2010 {published data only}
    1. Shet A, Arumugam K, Rodrigues R, Rajagopalan N, Shubha K, Raj T, et al. Designing a mobile phone‐based intervention to promote adherence to antiretroviral therapy in South India. AIDS and Behavior 2010;14(3):716‐20. - PubMed
Sidney 2012 {published data only}
    1. Sidney K, Antony J, Rodrigues R, Arumugam K, Krishnamurthy S, D'souza G, et al. Supporting patient adherence to antiretrovirals using mobile phone reminders: patient responses from South India. AIDS Care 2012;24(5):612‐7. - PubMed
Siedner 2012 {published data only}
    1. Siedner MJ, Haberer JE, Bwana MB, Ware NC, Bangsberg DR. High acceptability for cell phone text messages to improve communication of laboratory results with HIV‐infected patients in rural Uganda: a cross‐sectional survey study. BMC Medical Informatics and Decision Making 2012;12(1):56. - PMC - PubMed
Skeels 2006 {published data only}
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Smith 2015 {published data only}
    1. Smith C, Vannak U, Sokhey L, Ngo TD, Gold J, Free C. Mobile technology for improved family planning (MOTIF): the development of a mobile phone‐based (mHealth) intervention to support post‐abortion family planning (PAFP) in Cambodia. Reproductive Health 2015;13(1):1. - PMC - PubMed
Soltani 2012 {published data only}
    1. Soltani H, Furness PJ, Arden MA, McSeveny K, Garland C, Sustar H, et al. Women's and midwives' perspectives on the design of a text messaging support for maternal obesity services: an exploratory study. Journal of Obesity 2012;2012:Article ID 835464. - PMC - PubMed
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Suwamaru 2012 {published data only}
    1. Suwamaru JK. An SMS‐based HIV/AIDS education and awareness model for rural areas in Papua New Guinea. Studies in Health Technology and Informatics 2012;182:161‐9. - PubMed
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Thompson 2016 {published data only}
    1. Thompson S, Mercer MA. Mobile Moms/Liga Inan: improving quality and access to maternal care in Timor‐Leste. United States Agency for International Development [USAID] 2016; Vol. Sep 30. 2016:182.
Toefy 2016 {published data only}
    1. Toefy Y, Skinner D, Thomsen S. “Please don’t send us spam!” A participative, theory‐based methodology for developing an mHealth intervention. JMIR mHealth and uHealth 2016;4(3):e100. - PMC - PubMed
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    1. Tran BX, Houston S. Mobile phone‐based antiretroviral adherence support in Vietnam: feasibility, patient’s preference, and willingness‐to‐pay. AIDS and Behavior 2012;16(7):1988‐92. - PubMed
Uhrig 2012 {published data only}
    1. Uhrig JD, Lewis MA, Bann CM, Harris JL, Furberg RD, Coomes CM, et al. Addressing HIV knowledge, risk reduction, social support, and patient involvement using SMS: results of a proof‐of‐concept study. Journal of Health Communication 2012;17(Suppl 1):128‐45. - PubMed
Vahdat 2013 {published data only}
    1. Vahdat HL, L'Engle KL, Plourde KF, Magaria L, Olawo A. There are some questions you may not ask in a clinic: providing contraception information to young people in Kenya using SMS. International Journal of Gynecology & Obstetrics 2013;123(S1):e2‐6. - PubMed
Vyas 2012 {published data only}
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WHO 2014 {published data only}
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Wilkinson 2017 {published data only}
    1. Wilkinson TA, Berardi MR, Crocker EA, Nordt C, Silverstein M. Feasibility of using text message reminders to increase fulfilment of emergency contraception prescriptions by adolescents. Journal of Family Planning and Reproductive Health Care 2017;43(1):79‐80. - PubMed
Ybarra 2016 {published data only}
    1. Ybarra ML, Prescott TL, Philips GL, Bull SS, Parsons JT, Mustanski B. Iteratively developing an mHealth HIV prevention program for sexual minority adolescent men. AIDS and Behavior 2016;20(6):1157‐72. - PMC - PubMed

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