JMIR Publications

ABSTRACT

Background:

With mobile phone coverage and ownership increasing globally, mhealth interventions are increasingly being used to improve coverage and quality of health and nutrition services; yet, evidence on mhealth intervention feasibility and factors to consider during program design are limited in low- and middle-income countries like Nepal.

Objective:

This study examined the potential of using text messages to improve health and nutrition services by exploring mobile phone ownership and sharing; mobile phone use and skills; and interest, preferences and limitations regarding mhealth interventions.

Methods:

We conducted 35 in-depth interviews with 1000-day women (the period from conception to a child’s second birthday), health facility staff and female community health volunteers (FCHVs) and 8 focus group discussions with health facility staff, FCHVs and 1000-day household decision makers (i.e., husbands, mothers- and fathers-in-law). We also conducted a mobile phone skills test. We employed thematic analysis using framework matrices and analytical memos.

Results:

Overall, 97% of study participants had a mobile phone and phone sharing was uncommon. Use of text messages were most commonly reported by 1000-day women and health facility staff then household decision makers and FCHVs. Nearly all participants could dial numbers and the majority of 1000-day women, health facility staff and male decision makers could also read and write text messages. 1000-day women preferred educational and reminder messages whereas health facility staff and FCHVs desired educational and motivational messages. Participants suggested different types of texts for 1000-day women, families, FCHVs and health facility staff and reported less value for texts received from unknown numbers.

Conclusions:

A text message based mhealth intervention is acceptable in the hills of Nepal and has the potential to improve community health and nutrition service utilization, particularly by sending meeting reminders and by providing information. Our findings contribute to text message-based mhealth intervention design in under-resourced settings.