title: Feasibility and Effectiveness of mHealth for Mobilizing Households for Indoor Residual Spraying to Prevent Malaria: A Case Study in Mali.
abstract: Components of mHealth are increasingly being added to development interventions worldwide. A particular case of interest is in Mali where the U.S. President's Malaria Initiative (PMI) Africa Indoor Residual Spraying (AIRS) Project piloted a mobile mass-messaging service in Koulikoro District in August 2014 to determine whether voice and/or text messages received on cell phones could effectively replace door-to-door mobilization for an indoor residual spraying (IRS) campaign. To measure the pilot's effectiveness, we evaluated structure preparedness (all household and food items removed) in 3 pilot intervention villages compared with 3 villages prepared for spray through door-to-door mobilization that was modified by incorporating town hall meetings and radio spots. Structure preparedness was significantly lower in households mobilized through the mobile-messaging approach compared with the door-to-door approach (49% vs. 75%, respectively; P = .03). Spray coverage of targeted households also was significantly lower among the mobile-messaging villages than the door-to-door mobilization villages (86% vs. 96%, respectively; P = .02). The mobile-messaging approach, at US$8.62 per structure prepared, was both more costly and less effective than the door-to-door approach at US$1.08 per structure prepared. While literacy and familiarity with technology were major obstacles, it also became clear that by removing the face-to-face interactions between mobilizers and household residents, individuals were not as trusting or understanding of the mobilization messages. These residents felt it was easier to ignore a text or voice message than to ignore a mobilizer who could provide reassurances and preparation support. In addition, men often received the mobile messages, as they typically owned the mobile phones, while women-who were more likely to be at home at the time of spray-usually interacted with the door-to-door mobilizers. Future attempts at using mHealth approaches for similar IRS mobilization efforts in Mali should be done in a way that combines mHealth tools with more common human-based interventions, rather than as a stand-alone approach, and should be designed with a gender lens in mind. The choice of software used for mass messaging should also be considered to find a local option that is both less expensive and perhaps more attuned to the local context than a U.S.-based software solution.
authors.affiliation: Abt Associates, U.S. President's Malaria Initiative (PMI), Africa Indoor Residual Spraying (AIRS) Project, Bethesda, MD, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Mangam
authors.affiliation: Abt Associates, U.S. President's Malaria Initiative (PMI), Africa Indoor Residual Spraying (AIRS) Project, Bethesda, MD, USA.
authors.forename: Elana
authors.initials: E
authors.lastname: Fiekowsky
authors.affiliation: Abt Associates, PMI AIRS Project, Bamako, Mali.
authors.forename: Moussa
authors.initials: M
authors.lastname: Bagayoko
authors.affiliation: U.S. Agency for International Development, PMI, Washington, DC, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Norris
authors.affiliation: U.S. Agency for International Development, PMI, Washington, DC, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Belemvire
authors.affiliation: U.S. Agency for International Development, PMI, Washington, DC, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Longhany
authors.affiliation: U.S. Agency for International Development, PMI, Washington, DC, USA.
authors.forename: Christen
authors.initials: C
authors.lastname: Fornadel
authors.affiliation: U.S. Agency for International Development, PMI, Washington, DC, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: George
mesh_terms: D040421:Cell Phone; D003142:Communication; D032882:Comprehension; D003362:Cost-Benefit Analysis; D005191:Family Characteristics; D006078:Government Programs; D006801:Humans; D058980:Information Literacy; D007306:Insecticides; D007398:Interpersonal Relations; D008288:Malaria / Q000517:prevention & control*; D009032:Mosquito Control; D010865:Pilot Projects; D015397:Program Evaluation; D017216:Telemedicine; D060145:Text Messaging; D035502:Trust
chemical_list: D007306:Insecticides