A qualitative study to inform the design, content and structure of an interactive SMS messaging service in Chikwawa, Malawi

Laidlaw, Rebecca and Morse, Tracy and Beattie, Tara (2016) A qualitative study to inform the design, content and structure of an interactive SMS messaging service in Chikwawa, Malawi. In: 2nd Behaviour Change Conference, 2016-02-24 - 2016-02-25. (https://doi.org/10.3389/conf.FPUBH.2016.01.00017/e...)

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Background mHealth, the use of mobile communication in the health sector, has become increasingly popular, particularly in Sub-Saharan Africa. Primarily due to the wider accessibility of mobile technology which has increased in recent years. In Malawi, approximately 30% of the population own a mobile phone, including both contract and pre-paid devices (ITU, 2013). This number has risen dramatically with a 70% increase in subscribers in the last six years, and it is still on the rise (ITU, 2013). Mobile phone ownership has increased in line with advancements in cellular coverage; with rates currently standing at 94% of the population having access to adequate mobile coverage, reaching 79% of the geographical area of Malawi (GSMA, 2014). In addition, Malawians spend on average 56% of their monthly income paying for and maintaining a mobile phone (ITU, 2014). This figure is staggering and depicts the high priority which is placed on this technology. Therefore in light of the technological advancements and the wide accessibility of mobile devices in Malawi, the potential for mobile communication to aid the health sector in terms of health education delivery is promising. The Scotland Chikwawa Health Initiative (SCHI), a consortium led by the University of Strathclyde, working in the Chikwawa District of Malawi conducted extensive baseline analysis before the implementation of the WHO ‘Health Settings’ approach in the area. From these 144 focus group discussions at village level it has been highlighted that local residents require health education on areas such as family planning, HIV/AIDS, malaria, cholera and nutrition. Youth were particularly vocal about their need for health education and the lack of youth friendly services for family planning and HIV. These are issues which have the potential to be overcome with the introduction of mhealth resources. As designing and developing mobile based health education programmes through SMS messaging can increase health education reach (Cole-Lewis & Kershaw, 2010) and also increase youth engagement through specifically targeted programmes (Wohl et al.,2011; Yukari et al., 2014; Rana et al., 2015) Aim The aim of this research is to examine the feasibility of using mHealth tools to implement health education programme in Chikwawa, Malawi. Qualitative analysis will be conducted within 2 of the project villages to inform the design, content and structure of the SMS Messaging Service and ensure tailoring of the service to the residents of Chikwawa. Method Seventy-five residents from two SCHI supported villages, Chimoto and Sikenala, took part in 8 focus groups discussing health education needs and the potential for mhealth service introduction. Four focus groups occurred in Chimoto; Male Youth (8 participants), Female Youth (11 participants), Male Adults (7 participants) and Female Adults (9 participants). Four focus groups occurred in Sikenala; Male Youth (10 participants), Female Adults (14 participants), Male Adults (7 participants) and Female Adults (14 participant). The focus groups were conducted in Chichewa, the local language, using a semi-structured question guide and lasted between 45 and 60 minutes. Discussions were recorded, transcribed verbatim and then translated into English by the facilitators. Thematic analysis was then used to analyse the data, using the Braun & Clark (2006) step by step guide to thematic analysis. Results Five themes were identified encapsulating the opinions and beliefs of the residents in Chimoto and Sikenala; Current Health Education Practices, Message Content, Mobile Phone Access, Trust in the SCHI and Sustainability. Current Health Education Practices refers to the current availability of health education, the access to such information and self-reported need for further information in more accessible means. Message Content depicts participants’ need for practical application of the messages they receive and adequate information for the participant to make an informed choice about their own health. In terms of the SMS Messaging Service, participants had no preference as to frequency or volume of messages but stated they would prefer to receive messages out with school hours. Mobile Phone Access represents the participants’ fears around accessibility of the service to those without mobile devices. The sharing of messages and mobile phones with friends and family was discussed as a potential method to overcome this barrier. Trust in the SCHI depicts the residents’ positive views of the project and that they would believe the content of the messages because they trust the SCHI as the source, especially if they recognised a designated project mobile number. This was affirmed by their declaration to share messages with those without phone access. Weariness of the service was identified only in terms of cost because of negative experiences with other subscription services. Finally Sustainability encapsulates the participants’ views on the long term aims of the messaging service and their request for the project to follow up with visits and services in addition to the messages. They particularly emphasising a need for face-to-face communication. Conclusions From this analysis it appears that the sampled participants are on board with the messaging service, and have provided in depth detailed examples of the type of information they require, specifically regarding reproductive health. All focus groups reported a willingness to use the service, to encourage others to use the service and to share the information they receive. Efforts now need to be focused on identifying ways to ensure the service can be provided equally to all, both in terms of mobile phone access and confidence in user ability. In addition, as well as creating health messages based on best practice, complimentary services such as facilitated peer discussions and other mhealth based educational resources need to be identified and incorporated into the intervention. It is the intention of SCHI to implement an interactive SMS Messaging Service, working closely with the local health centre, to make the requested health information more widely accessible and personally tailored to the residents of the Chikwawa District.


Laidlaw, Rebecca ORCID logoORCID: https://orcid.org/0000-0001-5132-2374, Morse, Tracy ORCID logoORCID: https://orcid.org/0000-0003-4185-9471 and Beattie, Tara ORCID logoORCID: https://orcid.org/0000-0002-5593-8368;