More mHealth Success with Text to Change (TTC)

Text to Change, or TTC for short, is an mHealth project that was carried out in Mbarra region of Uganda for 3 months, from February to April 2008. The main aim of the project was to increase awareness about HIV/AIDS among the people of Uganda. Additionally, the developers of the Text to Change (TTC) project hoped to persuade the people taking part to seek voluntary testing and counseling for HIV/AIDS. Through the TTC project a quiz was administered via SMS to mobile phone users. The quiz measured baseline knowledge, provided information, and in some cases spurred people to action.

Project Details:

A SMS-based multiple choice and interactive quiz was administered to about 15,000 individuals living in rural parts of Mbarra who were also subscribers of the Celtel mobile phone network. As an incentive to participate in the project, free airtime was provided to those who took part. This was an advantage for participants since airtime can be transferred to others and used as a kind of currency. As the quizzes were given, the cell phone provider notified participants of correct answers via SMS whenever the participant gave a wrong answer. The quiz was focused on general information about HIV that should have been common knowledge; questions covered how HIV spreads, as well as the advantages of going for counseling and voluntary testing. When the quiz ended, participants were given a concluding SMS in order to persuade them to go to the local health center for counseling and testing. Everyone who visited the health center for HIV testing was asked whether it was the first time he/she was being tested for HIV. Those tested were asked to provide the clinic with their mobile numbers so that test results and follow up counseling could be provided. For those participating in TTC, HIV testing was done free of charge. The program launch was supported by the US pharmaceutical company Merck, and the Dutch Ministry of Foreign Affairs.

There were 2 goals of the quiz:
• The first was to determine how much knowledge the general public had about HIV. This was done by calculating the rate for correct answers. Once this was determined, the data was sent to UNICEF where it could be used for other health interventions and education programs.
• The second goal was to encourage counseling as well as testing.

Text messages have several advantages for projects such as this that aims to provide information to the public.
• They offer the participant anonymity
• Mobile phone use and ability to send and receive text messages is pervasive among much of the Ugandan population of the region of Mbarra.

 The main objective of the TTC was to improve health education, increase public knowledge, and increase health seeking behaviors with regards to HIV/AIDS among the population of the Mbarra region. The results of the project were impressive! The six-week period when the TTC project was taking places saw an increase in the number of patients getting tested for HIVe from 1000 to 1400. That’s about a 40% increase that is attributed to taking the quiz.

The major discovery of that project was, though the public were aware of the preventive measures of AIDS, they didn’t realize the importance to the AIDS testing. TTC passed this information on to bigger health centers that operated in that area, so they would be able to adjust their health education programs to improve their effectiveness. TCC planned a follow up project for January 2009. In this program, non-English speaking subscribers were able to read SMS messages in their local languages.

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