A very famous man once said that a mobile phone could not save a life. That man was Bill Gates. He said it a long time ago and he has changed his mind since!
In a way he was right. It’s not the phone that saves lives. It’s the knowledge that the phone delivers that is the lifesaver. So what entails for healthcare messaging and mobile health?
We tend to think of health care as the care delivered by health professionals; doctors, nurses, community healthcare workers. But ‘self-care’ is just as important. And for that, you need knowledge and support.
Mobile phone messaging programmes have been used in a wide range of conditions:
- to help people give up smoking
- support people who are suffering depression
- improve eating habits
- encourage men to return for a check-up after circumcision
- to improve the care of children with malaria
- to help people with diabetes manage their condition and more.
Here in India the mMitra programme has been using mobile phone messages to encourage pregnant women and new mothers to make healthy decisions about their care. mMitra delivers messages in Hindi and Marathi to 500,000 women in urban slums.
The aim is to help women have a healthy pregnancy, an attended birth and to care for their baby in a way that maximises his or her life chances.
The programme has been running for about two years and improvements have been observed on 17 key issues. The first report will be published later this year. Meanwhile here are some of the very important lessons learnt along the way.
Make sure you know what changes you are trying to create.
Only by identifying the key changes needed can you craft the right messages. And just establishing the key issues helps ensure that the care delivered by the health care system is right as well. If the messages are reminding women to take iron tablets, is this being reinforced at clinic visits?
Break the changes down into the smallest possible steps.
Changing any behaviour is difficult and we all need support. How often have you planned to go to the gym regularly or improve your diet, and found by the end of the week that you have not managed to do that? We all tend to slip back to the status quo. Regular messages that help you take small steps towards a health goal really can help. If someone actually asks ‘did you manage to eat five portions of fruit and vegetables today, you are more likely to do that tomorrow.
Listen to the consumer.
Health professionals may see things very differently to how the patient sees them. mMitra team of medical advisors was asked why women did not take iron pills during pregnancy. After all, they are available free at many hospitals and clinics. The doctors said it was because the women tended to get constipated when taking iron tablets. Then we asked the mothers. They said, yes the tablets made them constipated, but that wasn’t the real reason they stopped taking them. The tablets are black, they make the stools black and the women thought that they would make their baby’s skin black. So we crafted messages about dealing with constipation, but also added a message to explain that taking iron tablets will not affect the baby’s skin colour.
Be on their side.
The message programme has to help and support, not nag or belittle. We try to ‘walk the journey’ with the mother and reflect what happens in her life. It’s important to make the emotional connection first, so she trusts you, and then feed in the health message or behavioural change. Hence messages that say joyful things like ’your baby is just the size of a poppy seed, but its heart is already beating’ or ‘inside you, your baby can suck its thumb now. This helps develop the sucking muscles in the cheeks, so your little one will be able to suckle as soon as they are born’ engage the mother. So then, when ‘it’s time for your vaccination’, or ‘take your iron pills every day’, she will listen.
Lots of little messages achieve more than occasional long messages. Our messages are age and stage based. We register the woman’s due date or the baby’s birthdate so can send her messages that are time specific. That could be reminders…it’s time for your baby’s immunisation, or it could simply be …about now your baby will smile.
Knowledge saves time, and lives
Using technology to increase knowledge among mothers saves time for health professionals. If a mother arrives at the clinic knowing she will have her TT vaccination or her blood taken the visit can go more smoothly. It can also save money. Every mother who reports a possible danger sign quickly represents a possible saving of the costs associated with a complication. And of course, avoids the trauma and distress associated with complications.
Keep it personal
Using mobile messages to deliver the information just when people need it makes the programme personalised. A woman in early pregnancy really wants to know how to cope with sickness, or what will happen at the antenatal clinic. She won’t be ready for much about the birth or to make decisions about feeding her baby yet. So we try to give her just the right information at just the right time.
And that idea is relevant whatever condition you are dealing with. Someone with an appointment for surgery in a few weeks’ time may be thinking about what the doctor said at the last visit and what they can do to get fit enough for the operation. Someone having the op next week will be worrying about what to pack to take to the hospital and how much it might hurt.
We are likely to see much wider use of mobile technology in the future. Not just to send reminders, but also to inform, support and assist patients and save time and money for healthcare systems. Technology will not replace health professionals, but it can make their job easier and improve how patients feel about their care.
That’s a win for both caregivers and patients.
Daphne Metland is a medical journalist, specialising in maternal and child health. She creates healthcare messages that are delivered by mobile phone direct to patients.