Automated and Interviewer-Administered Mobile Phone Surveys in Burkina Faso: Sociodemographic Differences Among Female Mobile Phone Survey Respondents and Nonrespondents

Assessment of App-Based Versus Conventional Survey Modalities for Reproductive Health Research in India, South Africa, and the United States: Comparative Cross-Sectional Study

BACKGROUND

There is a widely acknowledged global need for more research on reproductive health (including contraception, menstrual health, sexuality, and maternal morbidities) and its impact on overall well-being. However, several factors-notably, high costs, considerable effort, and the sensitivity of these topics-impede the collection of the necessary data, especially in less accessible and lower-income populations. The burgeoning ownership of smartphones and growing use of menstrual tracking apps (MTAs) may present an opportunity to conduct reproductive health research with fewer impediments than those associated with conventional survey methods.

OBJECTIVE

The main objective was to ascertain the feasibility, potential usefulness, and limitations of conducting reproductive health research using a mainstream MTA.

METHODS

In each of the 3 countries, we evaluated questionnaire responses from (1) current users of an MTA (Clue) and (2) participants surveyed using conventional survey modalities (in-person interviews, SMS text messaging, and web-based questionnaires). We compared these responses with published data collected from large nationally representative benchmark samples (the United States Census and the Demographic and Health Surveys for South Africa and India).

RESULTS

Given a sufficiently large user base, app-distributed surveys were able to quickly capture large samples on par with other methods and at low cost, with the additional advantage of being able to deploy remotely and simultaneously across countries. In each country, neither the app nor the conventional modality sample emerged as a consistently closer match to the distributions of the demographic attributes and the patterns of contraceptive use reported for the respective benchmark sample. Despite efforts to obtain representative samples, the conventional modality samples sometimes over- and other times underrepresented some subgroups (eg, underrepresentation of married persons in the United States and overrepresentation of rural residents in India). In all 3 countries, app users were younger, more educated, more likely to be urban residents, and more likely to use nonhormonal rather than hormonal contraceptive methods compared with the respective national benchmark. App users, compared with the conventional modality samples, consistently reported being more comfortable discussing their menstrual periods with other persons (eg, family, friends, and health care providers), suggesting that MTA users may be more likely to respond truthfully to questions on sensitive or taboo health topics. The app samples' consistency across countries regarding users' demographic profiles, contraceptive choices, and personal attitudes toward menstruation supports the validity of making cross-country comparisons of survey findings for a given app's users.

CONCLUSIONS

MTAs such as Clue can provide a quick, scalable, and cost-effective method for collecting health data, including on sensitive topics, across a wide variety of settings and countries. With expanding global access to technology and the increasing use of these tools, consumer MTAs can be a viable survey modality to strengthen reproductive health research.

Examination of the demographic representativeness of a cross-sectional mobile phone survey in collecting health data in Colombia using random digit dialling

OBJECTIVES

As mobile phone ownership becomes more widespread in low-income and middle-income countries, mobile phone surveys (MPSs) present an opportunity to collect data on health more cost-effectively. However, selectivity and coverage biases in MPS are concerns, and there is limited information about the population-level representativeness of these surveys compared with household surveys. This study aims at comparing the sociodemographic characteristics of the respondents of an MPS on non-communicable disease risk factors to a household survey in Colombia.

DESIGN

Cross-sectional study. We used a random digit dialling method to select the samples for calling mobile phone numbers. The survey was conducted using two modalities: computer-assisted telephone interviews (CATIs) and interactive voice response (IVR). The participants were assigned randomly to one of the survey modalities based on a targeted sampling quota stratified by age and sex. The Quality-of-Life Survey (ECV), a nationally representative survey conducted in the same year of the MPS, was used as a reference to compare the sample distributions by sociodemographic characteristics of the MPS data. Univariate and bivariate analyses were performed to evaluate the population representativeness between the ECV and the MPSs.

SETTING

The study was conducted in Colombia in 2021.

PARTICIPANTS

Population at least 18 years old with a mobile phone.

RESULTS

We completed 1926 and 2983 interviews for CATI and IVR, respectively. We found that the MPS data have a similar (within 10% points) age-sex data distribution compared with the ECV dataset for some subpopulations, mainly for young populations, people with none/primary and secondary education levels, and people who live in urban and rural areas.

CONCLUSIONS

This study shows that MPS could collect similar data to household surveys in terms of age, sex, high school education level and geographical area for some population categories. Strategies are needed to improve representativeness of the under-represented groups.

Performance and Resource Requirements of In-Person, Voice Call, and Automated Telephone-Based Socioeconomic Data Collection Modalities for Community-Based Health Programs: A Systematic Review

IMPORTANCE

Gathering data on socioeconomic status (SES) is a prerequisite for health programs that aim to improve equity. There is a lack of evidence on which approaches offer the best combination of reliability, cost, and acceptability.

OBJECTIVE

To compare the performance of different approaches to gathering data on SES in community health programs.

DATA SOURCES

A search of the Cochrane Library, MEDLINE, Embase, Global Health, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and OpenGrey from 1999 to June 29, 2021, was conducted, with no language limits. Google Scholar was also searched and the reference lists of included articles were checked to identify further studies. The search was performed on June 29, 2021.

STUDY SELECTION

Any empirical study design was eligible if it compared 2 or more modalities to elicit SES data from the following 3 categories: in-person, voice call, or automated telephone-based systems.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently screened titles, abstracts, and full-text articles and extracted data. They also assessed the risk of bias using Cochrane tools and assessed the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. Findings were synthesized thematically without meta-analysis.

MAIN OUTCOMES AND MEASURES

Response rate, equivalence, time, costs, and acceptability to patients and health care professionals.

RESULTS

The searches returned 3943 records. The 11 included studies reported data on 14 036 individuals from 7 countries, collecting data on 11 socioeconomic domains using 2 or more of the following modes: in-person surveys, computer-assisted telephone interviews (CATIs), and 2 types of automated data collection: interactive voice response calls (IVRs) and web surveys. Response rates were greater than 80% for all modes except IVRs. Equivalence was high across all modes (Cohen κ > 0.5). There were insufficient data to make robust time and cost comparisons. Patients reported high levels of acceptability providing data via IVRs, web surveys, and CATIs.

CONCLUSIONS AND RELEVANCE

Selecting an appropriate and cost-effective modality to elicit SES data is an important first step toward advancing equitable effective service coverage. This systematic review did not identify evidence that remote and automated data collection modes differed from human-led and in-person approaches in terms of reliability, cost, or acceptability.

Representativeness of individual-level data in COVID-19 phone surveys: Findings from Sub-Saharan Africa

The COVID-19 pandemic has created urgent demand for timely data, leading to a surge in mobile phone surveys for tracking the impacts of and responses to the pandemic. Using data from national phone surveys implemented in Ethiopia, Malawi, Nigeria and Uganda during the pandemic and the pre-COVID-19 national face-to-face surveys that served as the sampling frames for the phone surveys, this paper documents selection the biases in individual-level analyses based on phone survey data. In most cases, individual-level data are available only for phone survey respondents, who we find are more likely to be household heads or their spouses and non-farm enterprise owners, and on average, are older and better educated vis-a-vis the general adult population. These differences are the result of uneven access to mobile phones in the population and the way that phone survey respondents are selected. To improve the representativeness of individual-level analysis using phone survey data, we recalibrate the phone survey sampling weights based on propensity score adjustments that are derived from a model of an individual's likelihood of being interviewed as a function of individual- and household-level attributes. We find that reweighting improves the representativeness of the estimates for phone survey respondents, moving them closer to those of the general adult population. This holds for both women and men and for a range of demographic, education, and labor market outcomes. However, reweighting increases the variance of the estimates and, in most cases, fails to overcome selection biases. This indicates limitations to deriving representative individual-level estimates from phone survey data. Obtaining reliable data on men and women through future phone surveys will require random selection of adult interviewees within sampled households.

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

Design and Field Methods of the ARISE Network COVID-19 Rapid Monitoring Survey

The coronavirus disease 2019 (COVID-19) pandemic has significant health and economic ramifications across sub-Saharan Africa (SSA). Data regarding its far-reaching impacts are severely lacking, thereby hindering the development of evidence-based strategies to mitigate its direct and indirect health consequences. To address this need, the Africa Research, Implementation Science, and Education (ARISE) Network established a mobile survey platform in SSA to generate longitudinal data regarding knowledge, attitudes, and practices (KAP) related to COVID-19 prevention and management and to evaluate the impact of COVID-19 on health and socioeconomic domains. We conducted a baseline survey of 900 healthcare workers, 1,795 adolescents 10 to 19 years of age, and 1,797 adults 20 years or older at six urban and rural sites in Burkina Faso, Ethiopia, and Nigeria. Households were selected using sampling frames of existing Health and Demographic Surveillance Systems or national surveys when possible. Healthcare providers in urban areas were sampled using lists from professional associations. Data were collected through computer-assisted telephone interviews from July to November 2020. Consenting participants responded to surveys assessing KAP and the impact of the pandemic on nutrition, food security, healthcare access and utilization, lifestyle, and mental health. We found that mobile telephone surveys can be a rapid and reliable strategy for data collection during emergencies, but challenges exist with response rates. Maintaining accurate databases of telephone numbers and conducting brief baseline in-person visits can improve response rates. The challenges and lessons learned from this effort can inform future survey efforts during COVID-19 and other emergencies, as well as remote data collection in SSA in general.