What is the aim of this synthesis?
The aim of this Cochrane qualitative evidence synthesis was to explore clients' views and experiences of being communicated with by the health system through their mobile phone. Our synthesis looked at communication about pregnancy, newborn, and child health, sexual health, and family planning. By synthesis we mean the bringing together and synthesising of results from primary qualitative studies into a larger whole. We collected all relevant studies and included 35 studies in the synthesis.
This synthesis links to other Cochrane Reviews that assess the effectiveness of this type of targeted digital health communication.
Key messages
Many clients like receiving messages from the health services by mobile phone. However, some clients have problems receiving messages due to lack of network access, internet, or phone, or language, reading, or privacy issues. Clients' experiences are also influenced by message timing, frequency, content, and sender.
What did we study in the synthesis?
Governments and health systems are starting to use mobile phones to communicate with clients. When the information is targeted at particular people or groups of people, and when the health system decides when and what to communicate, this is called 'digital targeted client communication.' Common types of digital targeted client communication are text messages that remind people to go to appointments or to take their medicines. Other types include phone calls or video messages that offer healthcare information, advice, monitoring, and support.
We looked for studies of clients' views and experiences of targeted communication by mobile phone. We focused on communication with pregnant women and parents of young children, and with adults and teenagers about sexual health and family planning.
What are the main findings of the synthesis?
We included 35 studies from around the world. These studies 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). Others 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). Languages issues as well as clients' 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 concerned about privacy and confidentiality (high confidence). Some 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, and many people wanted a sender that they knew and trusted (moderate confidence).
How up-to-date is the synthesis?
We searched for studies published before July 2017.
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.
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.
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).
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).
We included studies that used qualitative methods for data collection and analysis; that explored clients' perceptions and experiences of targeted digital communication via mobile device in the areas of RMNCAH; and were from any setting globally.
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.
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.