You Have an Important Message! Evaluating the Effectiveness of a Text Message HIV/AIDS Campaign in Northwest Uganda

This journal article shares findings from a pilot study exploring the efficacy of an mHealth campaign initiated by Text to Change using SMS as a platform to disseminate and measure HIV/AIDS knowledge, and to promote HIV/AIDS testing at clinics in rural Uganda. Over a 1-month period, 13 HIV/AIDS quiz questions were sent to 10,000 mobile subscribers. An evaluation study found that despite participation incentives, only one-fifth of the mobile subscribers responded to any of the questions. The campaign also had proportionately limited success in increasing knowledge levels on a mass scale and the evaluation found that the programme design may be reinforcing entrenched knowledge gaps. The results suggest that it is important to be conservative when considering the potential overall effect of SMS-based programmes. However, the article recognises the potential of mHealth tools when extended to millions of mobile phone users as part of an integrated health campaign approach.

The evaluation study found that of those who answered the question about gender, 421 were male and 202 were female. The average age of those responding to the age question was 28 years. Of the 10,000 mobile numbers who were sent messages, 2,363 numbers responded, of which 1,954 answered the quiz questions (the rest responded to the gender and/or age questions). Three hundred fifteen mobile numbers sent responses to more than half of the questions (i.e., 7 or more), with 30 responding to all 13 questions. More than half the sample (61%) answered at least one HIV knowledge question, 46% answered at least one HIV testing knowledge question, and 45% answered at least one HCT service question.

On average, quiz question respondents got about 68% of the total questions responded to correct. Less than one-fifth (19%) did not respond to any questions correctly, while almost half (44%) only provided correct answers to the questions answered. More than half had correct responses for all except two of the quiz questions and more than three-quarters were correct for more than half of the quiz questions. The questions answered least frequently tended to also have the lowest percentage of correct answers recorded. For example, only 286 unique mobile numbers responded to the question that asked “How can you tell whether one has HIV,” and only 45% of the responses received were correct. The most frequently missed question - "If you are exposed to HIV, how long should you wait to be tested?” (answered correctly by 8.5%) - was only answered by 314 mobile numbers.

According to the article, the results of this analysis suggest that, while there is evidence of limited effects, it is important to be conservative when considering the potential overall effect of such an innovative SMS tool. The campaign had proportionately limited success in increasing knowledge levels on a mass scale because correct knowledge was only provided to respondents who answered questions (and people who answered incorrectly tended to answer fewer questions). Furthermore, the programme design may be reinforcing entrenched divides in terms of knowledge across various groups. On the basis of the quiz results, one might conclude that overall HIV/AIDS knowledge is fairly high within the rural Ugandan population, compared to prior results of comprehensive knowledge. Specific knowledge questions that scored low could highlight focus for future campaigns.