Reinforcing Provider Training with Mobile Phone Text Messages in Ghana: Results from a Randomized Controlled Trial.
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Date
2015
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Abstract
Objectives: To describe the findings of an RCT to evaluate the impact of mobile phone text (SMS)
messaging in encouraging providers to recommend ORS and zinc instead of antibiotics for the
management of uncomplicated childhood diarrhea.
Methods: The intervention consisted of SMS messaging to licensed chemical sellers (LCS)
to reinforce training, detailing, and media interventions promoting new diarrhea management
protocols. We trained 1800 LCS, 900 of whom opted into the study; half (450) were randomly
selected for the SMS intervention (receiving informational messages and interactive quizzes over
an eight-week period). We measured the impact of SMS messages on reported and actual
behavior through mystery client surveys and interviews with 354 LCS in the intervention group and
345 LCS in the control group.
Results: Over 80 percent of both groups knew that zinc and ORS were the appropriate
treatment. Most (66 percent) respondents in both groups correctly dispensed zinc and ORS to the
mystery client. The intervention had a statistically significant impact on providers' knowledge of
appropriate diarrhea management, but not actual behaviors when dispensing treatments to
mystery clients. There was a sizable difference between knowing appropriate treatments, and
actually providing those treatments--only 12 percent of the control LCS reported recommending
antimicrobials for uncomplicated diarrhea, but the mystery client survey showed that 50 percent actually provided antimicrobials.
Conclusions: While training, detailing, and media campaigns significantly improved overall
provider behaviors in diarrhea management, and SMS messages for 8 weeks significantly
improved provider knowledge, the SMS campaign did not substantially improve actual behaviors of
front-line providers.
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Woodman Benjamin, Chatterji Minki, Friedman Willa, Riley Pamela, MacDonald Vicki. Reinforcing Provider Training with Mobile Phone Text Messages in Ghana: Results from a Randomized Controlled Trial. European Journal of Nutrition & Food Safety. 2015 Special issue; 5(5): 852-853.