title: Assessing Mobile Phone Access and Perceptions for Texting-Based mHealth Interventions Among Expectant Mothers and Child Caregivers in Remote Regions of Northern Kenya: A Survey-Based Descriptive Study.
abstract: BACKGROUND
  With a dramatic increase in mobile phone use in low- and middle-income countries, mobile health (mHealth) has great potential to connect health care services directly to participants enrolled and improve engagement of care. Rural and remote global settings may pose both significant challenges and opportunities.
  
  
  OBJECTIVE
  The objective of our study was to understand the demographics, phone usage and ownership characteristics, and feasibility among patients in rural and remote areas of Kenya of having text messaging (short messaging service, SMS)-based mHealth intervention for improvements in antenatal care attendance and routine immunization among children in Northern Kenya.
  
  
  METHODS
  A survey-based descriptive study was conducted between October 2014 and February 2015 at 8 health facilities in Northern Kenya as part of a program to scale up an mHealth service in rural and remote regions. The study was conducted at 6 government health facilities in Isiolo, Marsabit, and Samburu counties in remote and northern arid lands (NAL). Two less remote health facilities in Laikipia and Meru counties in more populated central highlands were included as comparison sites.
  
  
  RESULTS
  A total of 284 participants were surveyed; 63.4% (180/284) were from NAL clinics, whereas 36.6% (104/284) were from adjacent central highland clinics. In the NAL, almost half (48.8%, 88/180) reported no formal education and 24.4% (44/180) self-identified as nomads. The majority of participants from both regions had access to mobile phone: 99.0% (103/104) of participants from central highlands and 82.1% (147/180) of participants from NAL. Among those who had access to a phone, there were significant differences in network challenges and technology literacy between the 2 regions. However, there was no significant difference in the proportion of participants from NAL and central highlands who indicated that they would like to receive a weekly SMS text message from their health care provider (90.0% vs 95.0%; P=.52). Overall, 92.0% (230/250) of participants who had access to a telephone said that they would like to receive a weekly SMS text message from their health care provider. Most phone users already spent the equivalent of 626 SMS text messages on mobile credit for personal use.
  
  
  CONCLUSIONS
  Despite the remoteness of northern Kenya's NAL, the results indicate that the majority of pregnant women or care givers attending the maternal, newborn, and child health clinics have access to mobile phone and would like to receive text messages from their health care provider. mHealth programs, if designed appropriately for these settings, may be an innovative way for engaging women in care for improved maternal and newborn child health outcomes in order to achieve sustainable development goals.
authors.affiliation: Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.|Division of Maternal and Child Health, Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan.
authors.forename: Abdul Momin
authors.identifier: http://orcid.org/0000-0001-8253-1777
authors.initials: AM
authors.lastname: Kazi
authors.affiliation: WelTel International mHealth Society, Vancouver, BC, Canada.
authors.forename: Jason-Louis
authors.identifier: http://orcid.org/0000-0002-0005-9999
authors.initials: JL
authors.lastname: Carmichael
authors.affiliation: WelTel International mHealth Society, Vancouver, BC, Canada.
authors.forename: Galgallo Waqo
authors.identifier: http://orcid.org/0000-0001-9471-233X
authors.initials: GW
authors.lastname: Hapanna
authors.affiliation: WelTel International mHealth Society, Vancouver, BC, Canada.
authors.forename: Patrick Gikaria
authors.identifier: http://orcid.org/0000-0002-6367-9773
authors.initials: PG
authors.lastname: Wangoo
authors.affiliation: AMREF Health Africa, Nairobi, Kenya.
authors.forename: Sarah
authors.identifier: http://orcid.org/0000-0001-5275-5534
authors.initials: S
authors.lastname: Karanja
authors.affiliation: AMREF Health Africa, Nairobi, Kenya.
authors.forename: Denis
authors.identifier: http://orcid.org/0000-0001-8389-7877
authors.initials: D
authors.lastname: Wanyama
authors.affiliation: AMREF Health Africa, Nairobi, Kenya.
authors.forename: Samuel Opondo
authors.identifier: http://orcid.org/0000-0001-7992-6532
authors.initials: SO
authors.lastname: Muhula
authors.affiliation: AMREF Health Africa, Nairobi, Kenya.
authors.forename: Lennie Bazira
authors.identifier: http://orcid.org/0000-0003-0581-1585
authors.initials: LB
authors.lastname: Kyomuhangi
authors.affiliation: AMREF Health Africa, Nairobi, Kenya.
authors.forename: Mores
authors.identifier: http://orcid.org/0000-0003-1125-0841
authors.initials: M
authors.lastname: Loolpapit
authors.affiliation: AMREF Health Africa, Nairobi, Kenya.
authors.forename: Gilbert Bwire
authors.identifier: http://orcid.org/0000-0002-1154-1203
authors.initials: GB
authors.lastname: Wangalwa
authors.affiliation: AMREF Health Africa, Nairobi, Kenya.
authors.forename: Koki
authors.identifier: http://orcid.org/0000-0002-2620-5771
authors.initials: K
authors.lastname: Kinagwi
authors.affiliation: Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Richard Todd
authors.identifier: http://orcid.org/0000-0003-1759-2236
authors.initials: RT
authors.lastname: Lester
keywords: Kenya; immunization; mobile health; prenatal care; text messaging