title: Response patterns to interactive SMS health education quizzes at two sites in Uganda: a cohort study.
abstract: OBJECTIVE
  The use of mobile phones can improve and strengthen (preventive) health care in low- and middle-income countries. We aimed to retrospectively assess the response patterns of participants in free SMS health education quizzes in Uganda.
  
  
  METHODS
  Study participants were employees of two companies and their community networks. We investigated how quickly individuals responded to quiz question(s) and assessed possible influencing factors. Cox regression and anova analyses were used.
  
  
  RESULTS
  Fifty percentage of responders answered within 50 min. The response chance declined with every additional day after sending an incentive via SMS (Hazard Ratio 0.993, CI 95% 0.981-0.984). Quiz topics influenced both participation rates and response time. Response time was shortest for questions on HIV and sexual behaviour. Response rates were high for HIV (79%) and malaria (78.4%), but only 37.4% for demographic topics. Network providers had a substantial effect on response behaviour.
  
  
  CONCLUSIONS
  Interactive SMS programs are a fast method to reach the target population and incentives increase response rates. The most important factor influencing response time and participation rate is the network provider. Future research should focus on developing evidence-based guidelines for the design, implementation and evaluation of SMS-based interventions.
authors.affiliation: University Medical Centre Utrecht, Utrecht, the Netherlands.
authors.forename: Anne M
authors.initials: AM
authors.lastname: de Lepper
authors.forename: Marinus J C
authors.initials: MJ
authors.lastname: Eijkemans
authors.forename: Hajo
authors.initials: H
authors.lastname: van Beijma
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Loggers
authors.forename: Coosje J
authors.initials: CJ
authors.lastname: Tuijn
authors.forename: Linda
authors.initials: L
authors.lastname: Oskam
mesh_terms: D000704:Analysis of Variance; D015331:Cohort Studies; D003906:Developing Countries; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D016016:Proportional Hazards Models; D012423:Rural Health; D060145:Text Messaging / Q000706:statistics & numerical data*; D014454:Uganda