Digital Health

© 2016 Pritha Chakraborty, Courtesy of Photoshare

Digital health is the use of mobile phones and other wireless technology to promote health objectives. Digital health approaches have been used to improve quality of service delivery, monitor stockouts, manage logistics, provide supportive supervision to community health workers, improve clinical knowledge, and more. Digital health approaches as part of evidence-based multichannel social and behavior change (SBC) strategy can also create demand and facilitate access to sexual and reproductive health (SRH) services for urban young people.


What Are the Benefits?

  • Young people’s access to mobile phones is increasing. Mobile phones have changed the way that young people communicate and get information (PSI, 2016). The evidence shows that digital health interventions are being used to increase youth’s access to SRH information and services in low- and middle-income countries (LMICs) (Ippoliti & L’Engle, 2017).
  • Evidence is emerging that mobile phones are an effective tool in reaching young people, increasing their knowledge, and changing their behaviors (Ippoliti & L’Engle, 2017).
  • Young people can often access digital health initiatives anonymously, which can be important to young people living in environments that consider SRH information and services taboo (Dasra, 2017) and young people who may feel fear or embarrassment talking about SRH issues publicly (Glik et al., 2014).
  • Mobile phones can help reach populations with limited mobility, visibility, and agency, like girls who are married, out-of-school youth, or migrant girls (GAGE, 2017).

How to Implement?

Research target audience’s access to and use of mobile technology
While digital health interventions have the potential to reach a wide audience (Bajoga et al., 2015), access to the required technology can vary greatly across a variety of determinants, including age, gender, socioeconomic status, geographical location, and urbanicity. Implementers must take into account the target audiences’ access to and use of the technology required to participate in the intervention activities. Furthermore, project implementers must also consider the target area’s capacity to support the digital health activities. A poor cellular network can compromise the continuity, reach, and quality of the intervention (Ippoliti & L’Engle, 2017).
Use appropriate language
Content development for digital health initiatives must use the appropriate language for the target audience, paying special attention to young people’s vernacular. Ensuring that complete and accurate information is provided within the character restrictions of SMS is equally important (Ippoliti & L’Engle, 2017). Tips for delivering appropriate content via digital technologies:

  • Consider the local language, common slang among youth, local expressions, traditions, taboos, and laws.
  • Be mindful of the relevance and appropriateness of metaphors.
  • Keep language simple.
  • Consider brief stories or examples that the audience can relate to.
Supplement digital health activities with other initiatives
Some young people may need additional support beyond the intervention’s technological activities, for example participating in small group or one-on-one discussions in their community.

Programmatic Example: ‘Hello Mama’

In Nigeria, USAID’s Maternal and Child Survival Program (MCSP) initiated “HelloMama” with the goal of improving health outcomes of pregnant women, newborns, children and families in Nigeria. The locally-led initiative uses age- and stage-based mobile messaging to complement the efforts of frontline health workers, in alignment with the national health system’s priorities and policies. HelloMama delivers vital health information to pregnant women, new mothers, and their families through their mobile phones with messages specifically designed for behavior change. The messages correspond to what a woman is experiencing in her pregnancy or in her child’s development. HelloMama uses both text and interactive voice messaging from 10 weeks of pregnancy to 1 year after birth to increase demand for antenatal care, immunization services, childcare and other associated services, including postpartum family planning. Operational research on this promising digital health intervention is ongoing, and the results should be available by early 2019.

Explore opportunities to partner with other initiatives
Implementers should consider how digital health interventions can partner with and integrate with other initiatives—for example, thinking through how mobile technology may enable a young person to also access a mobile savings product (GAGE, 2017) that helps them save and protect their financial assets.
Ensure safety of user’s privacy
As technology advances, issues related to client security need to be prioritized by digital health initiatives, especially those dealing with confidential health information.
Monitor, evaluate and learn
Digital media is constantly changing and evolving, meaning that the infrastructure and functionality of digital health initiatives will need to adapt as needed to make sure project activities are still successful (Ippoliti & L’Engle, 2017). Two-way platforms, such as SMS or WhatsApp, could also be used for service delivery points to collect feedback on quality from young people once they have accessed a service.

 

What Is the Evidence?

  • In Kenya, The SRHR Alliance supports the Youth for Life website, which provides SRHR information and links young people to facilities that offers youth-friendly services. The platform also features an SMS service to disseminate information and promote discussion about topical issues. A five-month study of the platform showed that digital platforms are effective in reaching adolescents and young people with information and referring them to appropriate services (96% of the study’s sample). The platform’s ease of use, variety of content, convenience, confidentiality, and interactive nature were credited for its success (1st Adolescent Health Symposium, 2015).
  • In Madagascar, UNFPA partnered with Marie Stopes and Sisal to use mobile phones to provide free information and payment vouchers through SMS. During the project, peer educators reached out to young people with SRHR information, distributed e-vouchers, and made referrals to clinics. Peer educators even reached young people who did not have access to a mobile phone, by using their own phones to redeem an e-voucher. Over 18 months, approximately 2,000 of the 2,714 young women who were given e-vouchers for free services used them, and an estimated 1,900 pregnancies were avoided (Yinger, 2016).
  • Started in Nigeria, Learning about Living provides a question-and-answer service via SMS. The project allows young people to text questions they have about SRHR to trained counselors. The counselors aim to respond within 24 hours, but often reply within six hours. With the project’s expansion to Senegal, Morocco, Egypt, and Cambodia, the communication channels have expanded as well to include email and Facebook. In Cambodia, the project supplemented its activities with a podcast developed by young people. The podcast consists of short episodes that clients can receive either through a direct call to their phone or through an on-demand Interactive Voice Response call-in service. During the first three years of activities in Senegal, the project answered approximately 250,000 SMS sent by more than 67,000 individual users (Ippoliti & L’Engle, 2017).
  • In Kenya, LVCT Health’s One2One Integrated Digital Platform (OIDP) seeks to increase young people’s knowledge of SRHR, HIV, and gender-based violence, and to provide space for sharing among adolescents and youth. The project includes a hotline; a SMS service; and online platforms, including Facebook, Twitter, Website, Instagram, WhatsApp, and YouTube. The platform also gives users an opportunity to chat with a professional counselor; links adolescents to services; and reminds patients of upcoming appointments. As of 2015, the platform has reached 2.8 million adolescents in Kenya.

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Helpful Tips

Youth Participation

  • Engage young people as researchers to find out more about their peers’ usage of mobile phones and other media sources, as well as in the content development for digital health interventions.

Data Management

  • Record user data to build evidence on the kinds of queries young people have. This can be used for advocacy as well as enhancing programming.
  • Age and gender disaggregated data on users will help tailor messages and service delivery.

Multisectoral Collaboration

  • Find partners also working on initiatives using mobile phones to reach young people with a more complete set of services (i.e., financial or education services).

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Challenges

References

See a listing of all AYSRH references.