title: Hypertension Health Promotion via Text Messaging at a Community Health Center in South Africa: A Mixed Methods Study.
abstract: BACKGROUND
  The use of mobile phones to deliver health care (mHealth) is increasing in popularity due to the high prevalence of mobile phone penetration. This is seen in developing countries, where mHealth may be particularly useful in overcoming traditional access barriers. Non-communicable diseases may be particularly amenable to mHealth interventions, and hypertension is one with an escalating burden in the developing world.
  
  
  OBJECTIVE
  The objective of this study was to test whether the dissemination of health information via a short message service (SMS) led to improvements in health knowledge and self-reported health-related behaviors.
  
  
  METHODS
  A mixed methods study was carried out among a cohort of 223 hypertension clinic patients, in a resource-poor setting in Cape Town, South Africa, in 2012. Hypertensive outpatients were recruited at the clinic and administered a baseline questionnaire to establish existing knowledge of hypertension. Participants were then randomly assigned to intervention or control groups. The intervention group received 90 SMSes over a period of 17 weeks. Thereafter, the baseline questionnaire was readministered to both groups to gauge if any improvements in health knowledge had occurred. Those who received SMSes were asked additional questions about health-related behavior changes. A focus group was then conducted to obtain in-depth feedback about participants' experience with, and response to, the SMS campaign.
  
  
  RESULTS
  No statistically significant changes in overall health knowledge were observed between the control and intervention groups. The intervention group had positive increases in self-reported behavior changes. These were reaffirmed by the focus groups, which also revealed a strong preference for the SMS campaign and the belief that the SMSes acted as a reminder to change, as opposed to providing new information.
  
  
  CONCLUSIONS
  Although the content of the SMSes was not new, and did not improve health knowledge, SMSes were effective in motivating positive self-reported behavior change among hypertensive patients.
  
  
  BACKGROUND
  Pan African Clinical Trials Registry Number: PACTR201412000968462. Registered 18 December 2014 (Archived by WebCite at http://www.webcitation.org/6fhtyLRcO).
authors.affiliation: Health and Human Rights Programme, Department of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. damianuct@gmail.com.
authors.forename: Damian
authors.identifier: http://orcid.org/0000-0003-2187-0526
authors.initials: D
authors.lastname: Hacking
authors.forename: Hanne J
authors.initials: HJ
authors.lastname: Haricharan
authors.forename: Kirsty
authors.identifier: http://orcid.org/0000-0003-3940-1242
authors.initials: K
authors.lastname: Brittain
authors.forename: Yan Kwan
authors.identifier: http://orcid.org/0000-0002-1612-9912
authors.initials: YK
authors.lastname: Lau
authors.forename: Tali
authors.identifier: http://orcid.org/0000-0003-1268-3331
authors.initials: T
authors.lastname: Cassidy
authors.forename: Marion
authors.identifier: http://orcid.org/0000-0003-2735-8187
authors.initials: M
authors.lastname: Heap
keywords: developing countries; health knowledge, attitudes, practice; hypertension; telemedicine