Table 2.

Short message service (SMS) interventions for disease prevention with an evaluation

Intervention	Disease	Aims	Methods	Results	Limitations/challenges
Learning About Living [36]	HIV/AIDSa and SRHb	To document and distribute lessons learned during the process of initiating, planning, implementing, and monitoring the project.	Project evaluation; duration: 14 months after implementation; N = 9000 youth. Outcomes: objective and subjective.	User description: median age 24 years, 93% from urban and suburban settings, 79% male, 60,000 questions received by SMS, multiple use of service 49%. User satisfaction: 76%, 24% free, 12% prompt response, 7% easy access and availability, 24% educative HIV and SRH. Reason for dissatisfaction: >50% no answer due to bad network, 25% question partially answered, 18% response time too long, 7% question misunderstood.	Limitations: methods not described, results not comparable from state to state due to partner variation in evaluation methods. Challenges: network fluctuations, spam messages, girls and rural outreach.
Cell Phone for Life [41]	HIV/AIDS	To evaluate how the pilot service is perceived by the organizations running the service, those receiving the messages and those close to the recipients who may be affected: (1) baseline study of expectations of the pilot service, current access to information and service usage, and behavior, (2) process evaluation to assess how the pilot service is received, (3) review outcomes and results from the pilot service.	Baseline survey; N = 210. Outcomes: objective and subjective.	Participant characteristics: mean age 26.32 years, 71% female, 66.2% own a mobile phone, 79.5% comfortable using mobile phone, 64.3% use SMS. Qualitative information: Important: two-way communications important, messages may be consulted at any point, save time and money. Concerns: maintenance cost to members, the poor have no access to phones with required technology to perform Cell-Life functions technology, people change mobile phone regularly, potential for misuse or private use of SMS allocated by Cell-Life.	Challenges: maintenance and SMS costs, limited access for poor people, high mobile phone turnover, potential misuse or private use of SMS by Cell-Life.
Text Me! Flash Me! [27]	HIV/AIDS	To understand the main reasons for contacting the helpline.	Pilot project; duration: 6 months; N = 1169 calls; 12 health workers and 135 MSMc randomly selected. Outcome: objective and subjective, interview and focus groups.	Participants: reach in first month: 5 counselors counseled 439 MSM clients = average of 88 MSM clients per counselor per month compared with 50 MSM clients per peer educator or health worker per month in facilities and communities; 87% shared the information with others: 40% did it by SMS to a mean of 8.6 persons; increased knowledge and intention to use condoms; 47% went to health services as counseled voluntary counseling and testing uptake increased after launch of campaign.	Challenges: lack of monetary incentives related by counselors.
Text to Change [49,50]	HIV/AIDS	Understand satisfaction with and use of pilot system.	Pilot project; duration: 8 weeks; N = 15,000. Outcome: objective, number of answers, and voluntary counseling and testing attendance.	Participants: 2610 actively participated, 807 texted back their age (mean 29.2 years), 801 texted back their gender (70.8% male; 29.2% female). Number of questions/participant: >1 (17.4%); voluntary counseling and testing attendance: 255 people.	Challenges: language barriers, confidentiality concerns (33.8%), lack of information on voluntary counseling and testing participants.
Text to Change [51]	HIV/AIDS	Assess access to and interest in receiving health information on mobile phone.	Survey; duration: 6 months. Outcome: number of answers.	Participants: 1506 with response rate of 86.7%; 62% male, 42% between 12 and 14 years and 51% between 15 and 17 years, 27% owned a mobile phone, among whom 93% sent SMS over past 12 months (34% every day, 35% weekly, 21% monthly, 9% <1/month), 19% of those who sent SMS said they did it to get health information in the last year; 51% of all adolescents said they were somewhat or extremely likely to access health education program through SMS, which was associated with owning a mobile phone; high-risk adolescents were equally likely to be interested in receiving HIV prevention program via SMS.	Limitations: low rate of mobile phone ownership in Mbarra, self-administered questionnaire, with results relevant to secondary school students with good English literacy. Large number of missing data.
Breast cancer awareness [63]	Cancer	To assess SMS effectiveness as reminders for making women aware of breast cancer.	Participants: 106 women; duration: 6 months; SMS to remind to conduct breast self-examination.	Participants: 20–54 years old. Outcome: among those who forgot, 54% forgot and intended to do it, 47% were busy, and 4% had some questions regarding the exam. After 2 months of reminders, the practice of breast self-examination improved significantly.	Limitations: small sample, little information on methods. Women working in private sector.

^a Human immunodeficiency virus/acquired immunodeficiency syndrome.

^b Sexual and reproductive health.

^c Men who have sex with men.