Research Article
Community-Level Text Messaging for 2009 H1N1 Prevention in China

https://doi.org/10.1016/j.amepre.2013.03.014Get rights and content

Background

Although patients worldwide increasingly are using mobile phone text messaging (SMS) for clinical care, quality data are sparse on the community-level effectiveness of SMS to prevent and control disease.

Purpose

To determine SMS effectiveness in improving 2009 H1N1 knowledge, attitudes, behaviors, and self-reported outcomes and to assess community SMS acceptability.

Methods

A program evaluation of Shanghai, China's SMS system using a single-blinded, randomized-controlled method was conducted in 2010 and results were analyzed in 2010–2011. Randomly selected community residents who agreed to participate were assigned to receive 3 weeks of either 2009 H1N1 prevention and control or tobacco-cessation messages. Assessments were made of 2009 H1N1 knowledge, attitudes, behaviors, and self-reported influenza-like illness before and after sending messages to participants. Acceptability of SMS also was assessed.

Results

Of 1992 respondents, those receiving 2009 H1N1 messages had higher scores measuring 2009 H1N1 knowledge (4.2% higher) and desired attitudes (9.4% higher) (p<0.001); 1.77 times greater odds of new 2009 H1N1 vaccination (p<0.001); and 0.12 times smaller odds of reporting influenza-like illness (p<0.001) than those receiving tobacco messages. More than 95% of participants found the SMS program useful and trustworthy; nearly 90% would use it again.

Conclusions

SMS can improve self-reported uptake of short-term behaviors, such as vaccination, that can result in long-term prevention and control of disease. SMS can improve knowledge and influence attitudes about infection prevention and control and self-reported health outcomes. In Shanghai, health-based SMS is acceptable to users.

Section snippets

Background

In 2011, an estimated 5.9 billion mobile phones were in use worldwide.1 Short message service (SMS), which allows users to send short text messages between mobile phones, has become equally widespread; an estimated 7 trillion SMS messages were sent in 2011.2 Sending and receiving SMS messages is cheap, even when used frequently.3

Messaging of this type has been used to manage specific health conditions, such as diabetes or tobacco use, in high- and low-income settings.4, 5, 6 Studies of SMS

Methods

Shanghai, China's 12320 health-based SMS program (hereafter called SMS program) was evaluated in 2010, and results were analyzed in 2010–2011. The 12320 National Hotline and SMHB staff (hereafter called stakeholders) helped set the level of rigor for data collection (single-blinded, randomized controlled method) and a priori metrics for an effective (≥5% difference in knowledge, attitudes, and behaviors between intervention and control groups) and acceptable (>70% positive response to

Results

Participants in the H1N1 versus tobacco groups did not differ by demographic characteristics (Table 1). Between the pre-SMS and post-SMS survey, the average individual knowledge score increased significantly within the H1N1 group (by 24.3%, p<0.001; Table 2) and within the tobacco group (by 20.1%, p<0.001). The 4.2% greater change in average individual knowledge score in the H1N1 group versus the tobacco group also was significant (95% CI=2.9%, 5.6%).

The average individual attitudes score

Discussion

Short message service messaging increased respondents’ self-reported uptake of 2009 H1N1 vaccination, reduced reports of influenza-like illness, and improved knowledge and attitudes about 2009 H1N1 prevention and control. To our knowledge, this is the first community-based study using a randomized controlled method to demonstrate that SMS disease prevention and control messages can influence both respondents’ self-reported health behaviors and outcomes.

The SMS messaging regarding 2009 H1N1

Acknowledgments

The authors acknowledge Robert W. Pinner for his scientific and moral support for this project.

All funding for the study was provided by the China–U.S. Collaborative Program on Emerging and Re-Emerging Infectious Diseases in Beijing, China (a cooperative agreement between the Ministry of Health of the People’s Republic of China and the DHHS).

No financial disclosures were reported by the authors of this paper.

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