Due to its increasingly widespread adoption, mobile phones have been often been

adopted as a platform for health campaigns to reach out to its audiences. Mobile health
(mHealth) refers to the integration of mobile telecommunication technologies into the health
arena (Gurman, Rubin Roess, 2012; mHealth; Mechael, 2009). The readings provided, by
Gurman, Rubin and Roess (2012), Whittaker, Merry, Dorey and Maddison (2012), and Chib,
Wilkin, Leow, Hoefman and Biejma (2012), evaluated various studies on mhealth campaigns
in both developed and developing countries. One interesting finding that stood out from
amongst the readings is that the audience response rates towards different platforms of
mhealth Short Message Services (SMS) and voice for health campaign differs starkly
between health campaigns in developing countries and developed country.

In developing countries, mhealth campaigns that utilized SMS as a platform to engage

target audiences received a low response rate. For Text to Change, a Short Message Service
(SMS)-based HIV education campaign in Uganda, the audience response rate is low (Chib,
Wilkin, Leow, Hoefman & Biejma, 2012). Findings of this campaign found that only 2.3% of
quiz recipients out of the 10,000 unique mobile numbers who received the text messages
responded (Chib, Wilkin, Leow, Hoefman & Biejma, 2012). On the other hand, findings from
the mhealth campaigns that utilized SMS as the campaign platform in developed countries,
has seen a much higher audience response rate. The findings from the study on STUB IT, a
video messaging intervention in New Zealand, reveal that response rates were high with
simple text message questions (Whittaker, Merry, Dorey & Maddison, 2012).

Furthermore, these studies findings have also revealed that the target audiences in
developing countries preferred voice-based communication as compared to text-based
communication as the platform for engagement. In the mhealth campaign by Mobile Midwife

in Ghana, 99% of the participants chose voice over text messages as a form of engagement
(Gurman, Rubin & Roess, 2012). On the other hand, participants of mHealth campaigns
responded more to text-based platform than voice-based platform for engagement. In New
Zealand, it is harder to get target audience to respond to voice calls on their mobile phones
(Whittaker, Merry, Dorey & Maddison, 2012). In contrast, the campaign STUB IT, in New
Zealand, has received high response rates with simple text message questions (Whittaker,
Merry, Dorey & Maddison, 2012).

This difference in the findings of the analysed mHealth campaigns between both
developed and developing countries has presented an interesting point for further discussion.
It is my opinion that these findings, shows us, on an empirical level, the importance of
aligning the use of different mobile platforms, in this case, voice-based or text-based
platform, according to the purpose and the intended audience of the specific campaign in
order to maximize the impact. The understanding of the important characteristics of
developing and developed countries could potentially affect the success of future mhealth
cmapigns. The characteristics that will be explored are: literacy and health literacy.

Literacy refers to the ability to read and write. Literacy rates will directly affect the
intended audiences ability to understand and respond to text-based messages. The basic
reasonable assumption is that developed countries have a higher literacy rate than developing
countries. Accordingly, mHealth campaigns should take into account this discrepancy and the
platform selected should accommodate the target audiences capacity to comprehend
messages in words and respond accordingly. The low literacy rates limits the effectiveness of
text-based platform for mHealth campaigns in developing countries as complicated
information cannot be conveyed. In addition, literacy has been cited as a factor that

contributed to mobile ownership in developing countries. Mobile ownership rate in subSaharan Africa is highly correlated with income, literacy, and male ownership (Gurman,
Rubin & Roess, 2012).

In week 4s class, we understand that health literacy refers to the extent of which
someone has the ability to obtain, process, and understand basic health information and
services needed to make appropriate health decisions. We further discussed that several
factors correlate with the healthy literacy level of a given individual. These factors include
the individuals education level, income level and social status. Holding all else constant, I
would assume that a developed country, such as New Zealand, will have a higher education
level and average income level as compared to a developing country, such as Uganda. As
such, it can be inferred that individuals in developing countries tend to have significantly
lower health literacy level as compared to individuals in developed countries. On this ground,
the purpose and approach of the mHealth campaigns for a developed country should greatly
differ from the mHealth campaigns for a developing country. It is thus important to select a
mobile platform that can best achieve the purpose of each mHealth campaign.

As the target audiences in a developing country might only have below basic health
literacy level, mHealth campaigns should focus on educating and increasing their health
knowledge level first before proceeding to change their health attitudes or behaviour. This is
in line with the KAB Behavioral Change Model that we have been utilising in several CNM
modules, which states a certain intended behaviour change happens over time. As participants
receive more knowledge, changes in attitude are initiated, and this attitude will result in a
behavioral changes. In this case, the utilization of a text-based platform to reach out and
educate these audiences might not be effective or adequate. This is based on the assumption

that voice-based platform, due to its interactive nature, provides a better platform to facilitate
education. Due to the process of a two-way communication, participants are able to raise
questions and clarify their doubts with regards to the health message being conveyed to them.
Conversely, the person playing the role of the educator can ascertain the level of
understanding of her audience. Hence, the ability to educate participants is assumed to be
higher for voice-based platform, making it a more suitable mobile platform to adopt for
mHealth campaigns in developing countries, where its primary purpose is to educate. An
article from Uganda that sent SMS quizzes to participants noted an error caused by people
responding to SMS in conversational format instead of a quiz.

On the other hand, a text-based platform would be more effective for developed
countries, where the purpose of mHealth campaigns are focused on changing attitudes
towards certain health issues an inculcating or eradicating certain behaviour. Comparatively, I
would assume that the population in a developed country has higher proficiency in health
knolwedge as compared to the population in developing countries. In this situation, the KAB
model suggest that, since knowledge is present, the focus of the mHealth campaigns should
be on changing the attitude to initiate a behavioural change. We should also further consider
that these reinforcements should be subtle and non-intrusive so as to not frustrate these
participants and encourage participation. This is evident from the New Zealand study, as the
researcher found it difficult to get young participants to answer voice calls on their mobile
phones (Whittaker, Merry, Dorey & Maddison, 2012). However, conversely, response rates
were almost perfect, when the text messaging system was used. 96% of students responded to
the text message question on quit day (Whittaker, Merry, Dorey & Maddison, 2012). This is
in contrast with the 24% rate that followed the call procedure (Whittaker, Merry, Dorey &
Maddison, 2012).

My reflection presents a simplistic view of how mHealth can be positioned to align

itself with the different populations. It should be acknowledged, however, that the real
challenge for future mHealth campaigns is to constantly keep up with mobile technology and
population changes in a very dynamic world.
References
Gurman, T., Rubin, S., & Roess, A. (2012). Effectiveness of mhealth behavior change
communication interventions in developing countries: A systematic review of the
literature. Journal of Health Communication: International Perspectives, (17), 82104.
Mechael, P. (2009). The case for mHealth in developing countries. Innovations. 4(1), 103
118.