Just came across this pretty interesting use case for SMS reminders in mHealth: instead of being used as reminders to patients, they are being used to assist healthcare workers!

Most randomised controlled trials from high-income countries have focused on reminders to improve patients' adherence to treatment, and all studies assessed only short-term effects of the intervention. This is believed to be the first study to assess the use of text messaging to target the behaviour of health workers.

Examples of the actual messages: 

For five working days, two text messages (one at 9am and one at 2pm) were sent daily to every health worker's mobile phone. The same process was repeated every week for six months. The messages included both information from the guidelines and inspirational quotes. For example:

• Message one (Monday morning): Check ALL sick children <5yrs for any severe signs! Also check for fever, cough, diarrhea, pallor & any other problem. Quote: "Persistent work triumphs"
• Message two (Monday afternoon): Child has FEVER when complained by mother or child is hot or Temp is >=37•5 - Pls ask mother, touch child & take Temp! Quote: "Actions speak louder than words"
• Message three (Tuesday morning): TREAT with AL* all children under 5yrs weighing >=5kg coming with FEVER for first visit & without severe signs. Quote: "Opportunity seldom knocks twice"

*Artemether-lumefantrine, the recommended anti-malarial.

Dr Zurovac and colleagues believe the scheme may have been successful because text-message reminders address health workers' forgetfulness, emphasise the clinical importance of doing tasks described in the messages, and increase the priority of doing the tasks because the text messages represent the voice of authority of the health workers' employer (the Ministry of Health).

Low-cost solution

The simplicity and low cost of text messaging means that widespread implementation of an intervention that uses this technology can be done quickly and successfully. For example, the cost of a text message in Kenya is about US$0.01, resulting in the cost of full exposure to the intervention of $2.6 per health worker, or $39,000 if scaled up to an estimated 15,000 health workers in all rural facilities nationwide.