title: Potential Reach of mHealth Versus Traditional Mass Media for Prevention of Chronic Diseases: Evidence From a Nationally Representative Survey in a Middle-Income Country in Africa.
abstract: BACKGROUND
  Public radio and television announcements have a long tradition in public health education. With the global rise of computer and mobile device ownership, short message service (SMS) and email-based health services (mHealth) are promising new tools for health promotion.
  
  
  OBJECTIVE
  Our objectives were to examine 1) self-reported exposure to programs related to noncommunicable diseases (NCDs) on national public television and radio during the 12 months preceding the survey (2013-2014), 2) current ownership of a mobile phone, smartphone, computer, or tablet, and use of the Internet, and 3) willingness of individuals to receive SMS or emails with information on health, with a focus on distribution of these variables across different demographic, socioeconomic status (SES), and NCD risk groups.
  
  
  METHODS
  We obtained data in a population survey of 1240 participants aged 25-64 years conducted in 2013-2014 in the Seychelles, a rapidly developing small island state in the African region. We administered a structured questionnaire and measured NCD risk factors. Univariate and multivariate analyses explored the relationships between outcomes and sociodemographic variables.
  
  
  RESULTS
  Of 1240 participants, 1037 (83.62%) reported exposure to NCD-related programs on public television, while a lower proportion of 740 adults (59.67%), reported exposure via public radio (P<.001). Exposure to NCD-related programs on public television was associated with older age (P<.001) and female sex (P<.001), but not with SES, while exposure to NCD-related programs on public radio was associated with older age (P<.001) and lower SES (P<.001). A total of 1156 (93.22%) owned a mobile phone and ownership was positively associated with female sex (P<.001), younger age (P<.001), and higher SES (P<.001). Only 396 adults (31.93%) owned a smartphone and 244 adults (19.67%) used their smartphone to access the Internet. A total of 1048 adults (84.51%) reported willingness to receive health-related SMS, which was positively associated with female sex (P<.001), younger age (P<.001), and higher SES (P<.001). Controlling for SES, exposure to NCD-related programs on public television or radio and willingness to receive health-related SMS were not independently associated with a person's NCD risk.
  
  
  CONCLUSIONS
  Broadcasting health programs through traditional mass media (national public radio and television) reached the majority of the population under study, including older adults and those in lower socioeconomic groups. With a high penetration of mobile phones and willingness to receive health-related SMS, mHealth presents an opportunity for health programs, especially when targeted SMS messages are intended for younger adults and those in higher socioeconomic groups. By contrast, due to reduced Internet access, email-based programs had a more limited reach for health promotion programs. These findings emphasize the different reach of interventions using SMS or email versus traditional mass media, according to demographic and socioeconomic categories, for health education programs in a developing country.
authors.affiliation: University Institute of Social and Preventive Medicine (IUMSP), Department of Biology and Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
authors.forename: Maryam
authors.identifier: http://orcid.org/0000-0002-1660-8147
authors.initials: M
authors.lastname: Yepes
authors.forename: Jürgen
authors.identifier: http://orcid.org/0000-0002-3923-677X
authors.initials: J
authors.lastname: Maurer
authors.forename: Barathi
authors.identifier: http://orcid.org/0000-0002-8857-7271
authors.initials: B
authors.lastname: Viswanathan
authors.forename: Jude
authors.identifier: http://orcid.org/0000-0002-9731-6778
authors.initials: J
authors.lastname: Gedeon
authors.forename: Pascal
authors.identifier: http://orcid.org/0000-0002-0242-4259
authors.initials: P
authors.lastname: Bovet
mesh_terms: D000328:Adult; D044383:Black People; D002908:Chronic Disease / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008402:Mass Media / Q000706:statistics & numerical data*; D008875:Middle Aged; D012307:Risk Factors; D012923:Social Class; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000706:statistics & numerical data*
keywords: Africa; developing countries; digital divide; eHealth; email; internet access; low- and middle-income countries; mHealth; mass media; mobile phone; noncommunicable diseases; short message service