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Original Articles
Open Access

SMS versus voice messaging to deliver MNCH communication in rural Malawi: assessment of delivery success and user experience

Jessica Crawford, Erin Larsen-Cooper, Zachariah Jezman, Stacey C Cunningham and Emily Bancroft
Global Health: Science and Practice February 2014, 2(1):35-46; https://doi.org/10.9745/GHSP-D-13-00155
Jessica Crawford
aVillageReach, Balaka, Malawi
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  • For correspondence: jessica.crawford{at}villagereach.org
Erin Larsen-Cooper
bVillageReach, Seattle, WA, USA
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Zachariah Jezman
aVillageReach, Balaka, Malawi
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Stacey C Cunningham
cVillageReach, Seattle, WA, USA. Now with Ipas, Chapel Hill, NC, USA.
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Emily Bancroft
bVillageReach, Seattle, WA, USA
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Figures & Tables

Figures

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  • Figure1
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    A communication poster encourages caregivers of children to call the Chipatala Cha Pa Foni hotline to get answers to their health-related questions.

  • Figure2
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    A hotline worker answers an incoming calling using a touch screen device that prompts the worker to identify the client's symptoms and information needs.

  • Figure3
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    A woman uses a community volunteer's mobile phone to access the health message delivered by the Chipatala Cha Pa Foni project.

  • FIGURE 1.
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    FIGURE 1.

    Delivery Success Rates of Messages Over Time, by Delivery Method, September 2011–June 2013

    Success rate for pushed SMS and voice messages is the percent of messages successfully received within 3 attempts; for retrieved voice messages, the success rate is the percent of expected messages successfully retrieved.

  • FIGURE 2.
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    FIGURE 2.

    Percentage of Successful Message Retrieval Attempts Among Retrieved Voice Message Subscribers, by Type of Subscriber, September 2011–June 2013

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    TABLE 1. Sample SMS and Voice Messages
    SubscriberMessage Type
    SMSVoice
    Pregnant WomenMessage 1: When you and your family know that you are pregnant, a visit to ANC will help you understand everything you need to do to keep the baby healthy.Message 2: You and your growing baby need food for energy, body building, and protection. Meat, eggs, greens, vegetables, rice, and fruits help your baby grow.The ANC is your partner in the pregnancy. It is important to go to all 4 of your visits and to use the tablets that they have given to you. Your baby is continuing to grow! Your baby's fingernails and fuzzy hair are appearing and it's able to do things like swallow and kick. In the next 3 weeks, your baby will double in size. Body building foods like meat, beans and eggs are important for you and your baby. Try to take some every day. And remember; only take medicines given to you by a nurse. Traditional medicines can be dangerous for your baby. You might be feeling that you need to urinate a lot. This is a normal part of pregnancy. Try to drink less water before bed. If you feel pain or burning when you urinate you may have infection.
    Caregivers of Children Under 1Message 1: Make sure your baby has its vaccination. In the first week, your baby should get polio vaccine by mouth and the BCG vaccine against TB by injection.Message 2: Keep the cord stump clean and dry. Do not force it to fall off. If there is discharge or redness visit the clinic. Infections can be serious.Congratulations on being a new mom! This week, make sure your baby has all its vaccinations, including the polio vaccine and the BCG vaccine against tuberculosis. You should start breastfeeding immediately and remember to only give your child breast milk for the first 6 months of his life. Carry your baby close to your breasts because it will help give your baby good physical and emotional conditions and help you to grow close. Keep your baby's cord stump clean and dry and do not force it to fall off. If there is discharge or redness visit the clinic. Infections can be serious. Your baby should be placed on his back for sleeping until he is strong enough to roll over himself.
    • Abbreviations: ANC, antenatal care; BCG, bacille Calmette-Guérin; SMS, short message service; TB, tuberculosis.

    • View popup
    TABLE 2. Demographics of Registered Users, by Subscriber Type and Delivery Method (July 2011–June 2013)
    Pushed SMSPushed VoiceRetrieved Voice
    Pregnant Women
    No. of registered users7042381,559
    Age, mean, y252625
    Employed in formal sector, %1398
    No. of weeks eligible for messages, mean161616
    Caregivers of Children Under 1
    No. of registered users7332241,654
    Age of child, mean, mo444
    Female, %545355
    No. of weeks eligible for messages, mean363536
    • View popup
    TABLE 3. Delivery Success of Messages, by Delivery Method and Subscriber Type (September 2011–June 2013)
    Pushed SMSPushed VoiceRetrieved Voice
    MessagesPregnancyChildPregnancyChildPregnancyChild
    No. attempted or expecteda19,35620,3633,0222,81532,05452,829
    No. successfully received or retrieved11,82513,0531,8201,51512,25714,455
    Percent success61%64%60%54%38%27%
    • ↵a For retrieved voice messages, the expected number of messages retrieved is calculated weekly based on the number of current subscribers. For pushed SMS and voice messages, the number of messages attempted was based on actual number of attempts.

    • View popup
    TABLE 4. Phone-Based Survey Sample Characteristics, by Delivery Method
    PushedPushedRetrieved
    SMSVoiceVoiceTotal
    (n = 96)(n = 30)(n = 140)(N = 266)
    No. of subscribers
     Pregnancy messages481366127
     Child messages481774139
    No. of messages received, mean6.93.13.74.7
    • View popup
    TABLE 5. Quality of User Experience, by Delivery Method
    PushedPushedRetrieved
    SMSVoiceVoiceTotal
    Outcome(n = 96)(n = 30)(n = 140)(N = 266)
    Acceptability99%94%100%99%
    Comprehension75%63%76%75%
    New information79%76%71%77%
    Behavior change (intended or actual)91%56%66%74%
    • Missing information was excluded from the analysis. If respondents answered that they had not received any messages, they were not asked questions about the message service.

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Global Health: Science and Practice: 2 (1)
Global Health: Science and Practice
Vol. 2, No. 1
February 01, 2014
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SMS versus voice messaging to deliver MNCH communication in rural Malawi: assessment of delivery success and user experience
Jessica Crawford, Erin Larsen-Cooper, Zachariah Jezman, Stacey C Cunningham, Emily Bancroft
Global Health: Science and Practice Feb 2014, 2 (1) 35-46; DOI: 10.9745/GHSP-D-13-00155

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SMS versus voice messaging to deliver MNCH communication in rural Malawi: assessment of delivery success and user experience
Jessica Crawford, Erin Larsen-Cooper, Zachariah Jezman, Stacey C Cunningham, Emily Bancroft
Global Health: Science and Practice Feb 2014, 2 (1) 35-46; DOI: 10.9745/GHSP-D-13-00155
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