Use of SMS-Based Surveys in the Rapid Response to the Ebola Outbreak in Liberia: Opening Community Dialogue

Community interventions for pandemic preparedness: A scoping review of pandemic preparedness lessons from HIV, COVID-19, and other public health emergencies of international concern

Community action is broadly recognised as central to comprehensive and effective system responses to pandemics. However, there is uncertainty about how and where communities can be best supported to bolster long-term resilience and preparedness. We applied a typology of community interventions (Community Informing, Consulting, Involving, Collaborating or Empowering-or CICICE) to cover the diverse range of interventions identified across the literature and used this to structure a scoping review addressing three linked topics: (i) how CICICE interventions have been understood and applied in the literature on epidemic and pandemic preparedness; (ii) the spectrum of interventions that have been implemented to strengthen CICICE and (iii) what evidence is available on their effectiveness in influencing preparedness for current and future emergencies. We drew on peer-reviewed and grey literature from the HIV (from 2000) and COVID-19 pandemics and recent public health emergencies of international concern (from 2008), identified through systematic searches in MEDLINE, Scopus, the Cochrane Collaboration database, supplemented by keyword-structured searches in GoogleScholar and websites of relevant global health organisations. Following screening and extraction, key themes were identified using a combined inductive/deductive approach. 130 papers met the criteria for inclusion. Interventions for preparedness were identified across the spectrum of CICICE. Most work on COVID-19 focused on informing and consulting rather than capacity building and empowerment. The literature on HIV was more likely to report interventions emphasising human rights perspectives and empowerment. There was little robust evidence on the role of CICICE interventions in building preparedness. Evidence of effect was most robust for multi-component interventions for HIV prevention and control. Much of the reporting focused on intermediate outcomes, including measures of health service utilisation. We put forward a series of recommendations to help address evidence shortfalls, including clarifying definitions, organising and stratifying interventions by several parameters and strengthening evaluation methods for CICICE.

Public and health professional epidemic risk perceptions in countries that are highly vulnerable to epidemics: a systematic review

Background

Risk communication interventions during epidemics aim to modify risk perceptions to achieve rapid shifts in population health behaviours. Exposure to frequent and often concurrent epidemics may influence how the public and health professionals perceive and respond to epidemic risks. This review aimed to systematically examine the evidence on risk perceptions of epidemic-prone diseases in countries highly vulnerable to epidemics.

Methods

We conducted a systematic review using PRISMA standards. We included peer-reviewed studies describing or measuring risk perceptions of epidemic-prone diseases among the general adult population or health professionals in 62 countries considered highly vulnerable to epidemics. We searched seven bibliographic databases and applied a four-stage screening and selection process, followed by quality appraisal. We conducted a narrative meta-synthesis and descriptive summary of the evidence, guided by the Social Amplification of Risk Framework.

Results

Fifty-six studies were eligible for the final review. They were conducted in eighteen countries and addressed thirteen epidemic-prone diseases. Forty-five studies were quantitative, six qualitative and five used mixed methods. Forty-one studies described epidemic risk perceptions in the general public and nineteen among health professionals. Perceived severity of epidemic-prone diseases appeared high across public and health professional populations. However, perceived likelihood of acquiring disease varied from low to moderate to high among the general public, and appeared consistently high amongst health professionals. Other occupational groups with high exposure to specific diseases, such as bushmeat handlers, reported even lower perceived likelihood than the general population. Among health professionals, the safety and effectiveness of the work environment and of the broader health system response influenced perceptions. Among the general population, disease severity, familiarity and controllability of diseases were influential factors. However, the evidence on how epidemic risk perceptions are formed or modified in these populations is limited.

Conclusions

The evidence affords some insights into patterns of epidemic risk perception and influencing factors, but inadequately explores what underlies perceptions and their variability, particularly among diseases, populations and over time. Approaches to defining and measuring epidemic risk perceptions are relatively underdeveloped.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s40249-021-00927-z.

Participatory surveillance of COVID-19 in Lesotho via weekly calls: Protocol for cell phone data collection

Background

The increase in cell phone ownership in low- and middle-income countries (LMIC) has created an opportunity for low-cost, rapid data collection by calling participants on their cell phones. Cell phones can be mobilized for a myriad of data collection purposes, including surveillance. In LMIC, cell phone–based surveillance has been used to track Ebola, measles, acute flaccid paralysis, and diarrheal disease, as well as noncommunicable diseases. Phone-based surveillance in LMIC is a particularly pertinent, burgeoning approach in the context of the COVID-19 pandemic. Participatory surveillance via cell phone could allow governments to assess burden of disease and complements existing surveillance systems.

Objective

We describe the protocol for the LeCellPHIA (Lesotho Cell Phone PHIA) project, a cell phone surveillance system that collects weekly population-based data on influenza-like illness (ILI) in Lesotho by calling a representative sample of a recent face-to-face survey.

Methods

We established a phone-based surveillance system to collect ILI symptoms from approximately 1700 participants who had participated in a recent face-to-face survey in Lesotho, the Population-based HIV Impact Assessment (PHIA) Survey. Of the 15,267 PHIA participants who were over 18 years old, 11,975 (78.44%) consented to future research and provided a valid phone number. We followed the PHIA sample design and included 342 primary sampling units from 10 districts. We randomly selected 5 households from each primary sampling unit that had an eligible participant and sampled 1 person per household. We oversampled the elderly, as they are more likely to be affected by COVID-19. A 3-day Zoom training was conducted in June 2020 to train LeCellPHIA interviewers.

Results

The surveillance system launched July 1, 2020, beginning with a 2-week enrollment period followed by weekly calls that will continue until September 30, 2022. Of the 11,975 phone numbers that were in the sample frame, 3020 were sampled, and 1778 were enrolled.

Conclusions

The surveillance system will track COVID-19 in a resource-limited setting. The novel approach of a weekly cell phone–based surveillance system can be used to track other health outcomes, and this protocol provides information about how to implement such a system.

International Registered Report Identifier (IRRID)

DERR1-10.2196/31236

Media and Digital Technologies for Mixed Methods Research in Public Health Emergencies Such as COVID-19: Lessons Learned From Using Interactive Radio-SMS for Social Research in Somalia

Radio shows which invite audience participation via short message service (SMS)-interactive radio-SMS-can be designed as a mixed methods approach for applied social research during COVID-19 and other crises in low and middle income countries. In the aftermath of a cholera outbreak in Somalia, we illustrate how this method provides social insights that would have been missed if a purely qualitative or quantitative approach were used. We then examine the strengths and limitations associated with interactive radio-SMS through an evaluation using a multimethod comparison. Our research contributes an application of a mixed methods approach which addresses a specific challenge raised by COVID-19, namely utilizing media and digital technologies for social research in low and middle income countries.

Best practices for collecting repeated measures data using text messages

Background

Researchers and clinicians use text messages to collect data with the advantage of real time capture when compared with standard data collection methods. This article reviews project setup and management for successfully collecting patient-reported data through text messages.

Methods

We review our experience enrolling over 2600 participants in six clinical trials that used text messages to relay information or collect data. We also reviewed the literature on text messages used for repeated data collection. We classify recommendations according to common themes: the text message, the data submitted and the phone used.

Results

We present lessons learned and discuss how to create text message content, select a data collection platform with practical features, manage the data thoughtfully and consistently, and work with patients, participants and their phones to protect privacy. Researchers and clinicians should design text messages to include short, simple prompts and answer choices. They should decide whether and when to send reminders if participants do not respond and set parameters regarding when and how often to contact patients for missing data. Data collection platforms send, receive, and store messages. They can validate responses and send error messages. Researchers should develop a protocol to append and correct data in order to improve consistency with data handling. At the time of enrollment, researchers should ensure that participants can receive and respond to messages. Researchers should address privacy concerns and plan for service interruptions by obtaining alternate participant contact information and providing participants with a backup data collection method.

Conclusions

Careful planning and execution can reward clinicians and investigators with complete, timely and accurate data sets.

Does mobile phone survey method matter? Reliability of computer-assisted telephone interviews and interactive voice response non-communicable diseases risk factor surveys in low and middle income countries

Introduction

Increased mobile phone subscribership in low- and middle-income countries (LMICs) provides novel opportunities to track population health. The objective of this study was to examine reliability of data in comparing participant responses collected using two mobile phone survey (MPS) delivery modalities, computer assisted telephone interviews (CATI) and interactive voice response (IVR) in Bangladesh (BGD) and Tanzania (TZA).

Methods

Using a cross-over design, we used random digit dialing (RDD) to call randomly generated mobile phone numbers and recruit survey participants to receive either a CATI or IVR survey on non-communicable disease (NCD) risk factors, followed 7 days later by the survey mode not received during first contact; either IVR or CATI. Respondents who received the first survey were designated as first contact (FC) and those who consented to being called a second time and subsequently answered the call were designated as follow-up (FU). We used the same questionnaire for both contacts, with response options modified to suit the delivery mode. Reliability of responses was analyzed using the Cohen’s kappa statistic for percent agreement between two modes.

Results

Self-reported data on demographic characteristics and NCD behavioral risk factors were collected from 482 (CATI-FC) and 653 (IVR-FC) age-eligible and consenting respondents in BGD, and from 387 (CATI-FC) and 674 (IVR-FC) respondents in TZA respectively. Survey follow-up rates were 30.7% (n = 482) for IVR-FU and 53.8% (n = 653) for CATI-FU in BGD; and 42.4% (n = 387) for IVR-FU and 49.9% (n = 674) for CATI-FU in TZA respectively. Overall, there was high consistency between delivery modalities for alcohol consumption in the past 30 days in both countries (kappa = 0.64 for CATI→IVR (BGD), kappa = 0.54 for IVR→CATI (BGD); kappa = 0.66 for CATI→IVR (TZA), kappa = 0.76 for IVR→CATI (TZA)), and current smoking (kappa = 0.68 for CATI→IVR (BGD), kappa = 0.69 for IVR→CATI (BGD); kappa = 0.39 for CATI→IVR (TZA), kappa = 0.50 for IVR→CATI (TZA)). There was moderate to substantial consistency in both countries for history of checking for hypertension and diabetes with kappa statistics ranging from 0.43 to 0.67. There was generally lower consistency in both countries for physical activity (vigorous and moderate) with kappa statistics ranging from 0.10 to 0.41, weekly fruit and vegetable with kappa ranging from 0.08 to 0.45, consumption of foods high in salt and efforts to limit salt with kappa generally below 0.3.

Conclusions

The study found that when respondents are re-interviewed, the reliability of answers to most demographic and NCD variables is similar whether starting with CATI or IVR. The study underscores the need for caution when selecting questions for mobile phone surveys. Careful design can help ensure clarity of questions to minimize cognitive burden for respondents, many of whom may not have prior experience in taking automated surveys. Further research should explore possible differences and determinants of survey reliability between delivery modes and ideally compare both IVR and CATI surveys to in-person face-to-face interviews. In addition, research is needed to better understand factors that influence survey cooperation, completion, refusal and attrition rates across populations and contexts.

A Novel Mobile Phone Text Messaging Platform Improves Collection of Patient-Reported Post-operative Pain and Opioid Use Following Orthopedic Surgery

BACKGROUND

Prospective collection of patient-reported opioid consumption and pain levels post-surgically may hold value in highlighting solutions related to the opioid crisis. Traditional methods for collecting patient-reported outcomes after surgery, such as paper surveys, often have poor response rates, and electronic messaging may offer more convenience and therefore yield more robust data.

QUESTIONS/PURPOSES

The purpose of this study was to evaluate whether a novel mobile phone short message service (SMS) platform would lead to better patient response rates to surveys on pain and opioid use than data-collection tools.

METHODS

An SMS text messaging platform was created and implemented between September 2017 and May 2018 at an orthopedic specialty hospital. The purpose was to collect reports on opioid consumption and pain levels twice a day for 6 weeks post-surgery from patients who had undergone total hip or knee arthroplasty or a single-level lumbar microdiscectomy or decompression spine surgery. Patients who responded to fewer than 50% of the text messages were excluded.

RESULTS

Our mobile phone text messaging platform was used by 183 patients, demonstrating a significantly higher response rate (96.1%) than our institution's post-operative email registry capture, as well as the majority of published response rates for post-operative outcomes captured through electronic and traditional data-collection systems. Response rate remained consistently high among the various surgeons and across patients, regardless of age.

CONCLUSIONS

This application of a widely available technology can improve the measurement of post-operative patient-reported outcomes. Such data can in turn be used in the development of strategies to reduce post-operative opioid use. The adoption of novel technologies at a patient level will play a key role in combating the opioid epidemic.

Use of short message service for monitoring Zika-related behaviors in four Latin American countries: lessons learned from the field

BACKGROUND

Effective response to widespread epidemics relies in part on rapidly changing information from affected communities as individuals react to emergency response efforts. The short message service (SMS) approach was used to monitor knowledge, prevention, and behavior during an outbreak of Zika cases in Honduras, El Salvador, the Dominican Republic, and Guatemala in 2017. SMS methods supported collection of monitoring data at a time of heightened reliance on communication via mobile phones, and when the use of phones for epidemic-related communication was amplified. SMS methods were used to collect monitoring data on knowledge of Zika risk and prevention, and behaviors to prevent Zika infection.

METHODS

Serial SMS surveys were conducted over a seven-month period to capture changing community perceptions of risk and behaviors to prevent Zika during the epidemic. This article discusses the development of the SMS surveys, from planning and designing tools to collecting the data, and the unique experiences encountered during survey implementation.

RESULTS

Special considerations for the effective use of SMS for data collection are described, including market penetration of mobile phones, predominant phone types in use, preparation of communities and the target audience, options for tailoring questionnaires to the available technology, relationships with telecommunication companies, and supporting participants' ability to complete questionnaires. The article discusses issues related to the development of the questionnaires, context-specific challenges before and during implementation of the surveys, and creative strategies to overcome barriers. Lessons learned, and recommendations to increase opportunities for a successful SMS survey, are included.

CONCLUSIONS

Understanding the social and economic context of mobile phone use in the target area and careful crafting of SMS questionnaires can produce useful data that may rival information captured through other approaches, such as Knowledge, Attitudes and Practices (KAP) surveys. Despite the challenges experienced, there is room for more consistent and widespread use of SMS for data collection in Latin America.