Mobiles for Health - American Style

Posted by CorinneRamey on Jul 20, 2009

Although nonprofits in the United States has been slower to embrace mobile phones for health purposes than the rest of the world, mobiles are catching on as a way to reach diverse populations across the U.S.

“Mobile provides a fantastic channel for communication,” said Erin Edgerton, senior social media strategist at the Center for Disease Control and Prevention (CDC). “It’s always on, always with you and provides personal access to information.”

Nonprofits and government agencies are using this ubiquitous device for health purposes including monitoring, education and instant alerts and communication.

Mobile monitoring

For diabetes patients in Georgia, mobile phones have facilitated an instant connection to help and education. In several different pilot studies, participants used cell phones to document aspects of diabetes treatment ranging from glucose readings to snapping photos of the meals that they ate. Participants then sent the photos, readings, or other questions to a diabetes education center, where a diabetes educator could instantly respond to questions.

“By being almost always with you, anytime you had a question or concern or surprise, the device was available for capturing those concerns,” said Professor Elizabeth Mynatt, director of the GVU Center of the Georgia Institute of Technology, which does technology research. Currently, funding for the project comes from Georgia Tech, the CDC, and Google.

The researchers found that the data gathered with mobile phones was more accurate than the data recalled during a weekly clinic visit. “You can ask people what they have for breakfast, and it sounds healthy, but then you see the proportions on the plate, and not so much,” said Mynatt. The recorded data also allowed patients to experiment with diet and other issues because they could see how their daily health choices changed their glucose readings and other indicators.

The most significant finding was that the phones allowed people to take control of their own health, said Mynatt. In one study, which lasted for two months and involved 50 participants, patients who participated in the mobile monitoring program learned to manage the disease and control their health better than those in a diabetes education program that didn’t use phones. “Not only did they make progress, but they believed that they were in control,” said Mynatt. Patients in the control group, who didn’t use the mobile phones, actually believed they had less control over the disease than when they started the program.


Internet Sexuality Information Services, Inc (ISIS), a California-based nonprofit focused on sexual health, has been using text messaging since 2006. One of their first programs, SEXINFO, began in response to rising gonorrhea rates among African Americans in San Francisco. People text "SEXINFO" to a short code, and then respond to a multiple options, ranging from "what 2 do if ur condom broke" to "if ur not sure u want to have sex." In the first 25 weeks, the service had 4,500 inquiries, 2,500 of which led to more information and referrals.

A more recent text message campaign, called Hookup, was launched in April 2009 with the State of California and the California Family Health Council, said ISIS executive director Deb Levine. By texting "hookup" to the short code 365247, users receive weekly tips and sexual information. At any time, users can access clinic information as well. "One of the things we found was that while health providers feel that it's important for people to have access to services and know about services, from a patient’s point of view, you only want to know about a service when you're in a crisis or have a problem," said Levine.

Within each tip, there is a prompt to respond with a zip code to find a nearby free or low-cost clinic. For example, a recent tip read, “HookupWeeeklyTIP: Meds cure Chlamydia, gonorrhea, + syph. Herpes and HIV stay w/u 4ever. Txt CLINIC +ur zipcode 4 clinics Txt Stop 2end Stnd rates”

With only $2,000 spent on marketing, ISIS has so far about 1,000 users signed up to receive the weekly tips. "Cost per acquisition is really good," said Levine. "They're sticking with it and not dropping out."

High pollution texting

In Phoenix, Arizona, which the American Lung Association recently listed ninth-most ozone polluted city in America, residents can keep track of air quality by mobile phone. The Arizona Department of Environmental Quality (ADEQ), a government agency, offers a text service that alerts people when a “high pollution advisory” is issued for the Greater Phoenix Area.

The program started a year and a half ago, and so far 900 people have signed up, said Mark Shaffer, communications director at the ADEQ. “We've been targeting people who wouldn't be around freeway signs or looking at the news,” said Shaffer. “We've had a lot of landscaping companies and people in the field sign up.”

The agency sends a message at high-risk times, which, depending on the season, tend to be about once a week, Shaffer said. For example, one common message reads, “ADEQ-PM2.5 High Pollution Advisory Tuesday Do not burn wood in devices or open fires Drive less Cut outdoor activity if sensitive.”

Quick, but not always easy

For many nonprofits, mobile isn’t cheap. In addition to setup and platform fees, there are fees for each text message sent. The toughest part for ADEQ, said Shaffer, was figuring out how to make mobile affordable. “I remember two of our people made bids on this, and they wanted a thousand dollar platform fee a month,” said Shaffer. “It was going to keep us from doing it.” The agency eventually found a more reasonably-priced vendor, but still pays slightly less than 10 cents per message, depending on the quantity sent.

But Levine disagreed, saying that lack of knowledge was a bigger problem than cost. “I think the biggest barrier to entry is ignorance,” she said. “People understand what a text message is. But they really don't understand how to apply that to their work.” She recommends nonprofits interested in mobile think outside the box in terms of creative message content and new ways, like contests or video, of reaching an audience.

For the CDC, the toughest part is providing concrete evidence that mobile works, said Edgerton at the CDC. “The gold standard for us is, can we say definitively it had an impact on health behavior?”

The mobile future

In the future, nonprofits are looking to go beyond texting and find other ways to use mobile phones. “I think that the future is going to be much more visual than textual,” said Levine, of ISIS. “We’re about to do an event-based project using Bluetooth, and we’ll pass out ringtones and wallpaper.” At an upcoming hip-hop concert, people will walk around with Bluetooth vests offering wallpaper and ringtones, and the DJ will encourage fans to text a shortcode for more sexual health information. “The really cool thing about Bluetooth is that we don't have to ask for people's phone numbers,” said Levine. “There’s no charge to the young people for accepting it.”

Shaffer, in Arizona, said that his agency was looking to use Twitter and social networking more than texting.

The CDC, which is currently expanding its mobile program, is not only looking at text-based programs, but is expanding its mobile website and has done programs that involve videos meant to be viewed on mobile phones. “I think there will be a lot more integration with other mediums,” said Edgerton.

Mynatt said that she thought mobiles would be used to give people more individual access to health information. “I’m very interested in how we can provide tools for people to work with their own health data, including data that they provide that they might not share with a whole network of physicians,” she said. “Mobile allows people be able to collect and manage data about their own bodies.”

Image courtesy Center for Disease Control

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