Understanding the Role of mHealth and Other Media Interventions for Behavior Change to Enhance Child Survival and Development in Low- and Middle-Income Countries: An Evidence Review

Abstract

Given the high morbidity and mortality among children in low- and middle-income countries as a result of preventable causes, the U.S. government and the United Nations Children's Fund convened an Evidence Summit on Enhancing Child Survival and Development in Lower- and Middle-Income Countries by Achieving Population-Level Behavior Change on June 3–4, 2013, in Washington, D.C. This article summarizes evidence for technological advances associated with population-level behavior changes necessary to advance child survival and healthy development in children under 5 years of age in low- and middle-income countries. After a rigorous evidence selection process, the authors assessed science, technology, and innovation papers that used mHealth, social/transmedia, multiplatform media, health literacy, and devices for behavior changes supporting child survival and development. Because of an insufficient number of studies on health literacy and devices that supported causal attribution of interventions to outcomes, the review focused on mHealth, social/transmedia, and multiplatform media. Overall, this review found that some mHealth interventions have sufficient evidence to make topic-specific recommendations for broader implementation, scaling, and next research steps (e.g., adherence to HIV/AIDS antiretroviral therapy, uptake and demand of maternal health service, and compliance with malaria treatment guidelines). While some media evidence demonstrates effectiveness in changing cognitive abilities, knowledge, and attitudes, evidence is minimal on behavioral endpoints linked to child survival. Population level behavior change is necessary to end preventable child deaths. Donors and low- and middle-income countries are encouraged to implement recommendations for informing practice, policy, and research decisions to fully maximize the impact potential of mHealth and multimedia for child survival and development.

Acknowledgments and Funding

The authors are grateful to the following members of the Evidence Review Team 6 who were important contributors to the preparation of the original evidence review paper, which was presented at the Evidence Summit, and contributed to this article: Scott Ratzan, Wendy Meltzer, Anand Narasimhan, Christine Saba, David Milestone, Dennis Israelski, John Parrish-Sprowl, Kristian Olson, Leslie Snyder, Pamela Riley, Patricia Mechael, Raj Pannu, Brianna Ferrigno, Rajiv Rimal, Ryan Phelps, Sean Southey, and Shannon Dorsey. The authors also acknowledge the expertise and assistance of the U.S. National Institutes of Health Library and their Biomedical Librarians, Janet Heekin, MLS, and Alicia Livinski, MPH, MA, who provided additional systematic search of the literature to identify relevant papers for the social/transmedia portion of this review.

Dr. Elizabeth Higgs conducted part of this work while detailed to the U.S. Agency for International Development (USAID) Global Health Bureau while being salaried by the Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Health and Human Services, and does not have any reported conflict of interest. Dr. Allison Goldberg participated in this evidence summit while completing her PhD at Columbia University Mailman School of Public Health, New York, and became an employee of Anheuser-Busch during the time this article was finalized. Stephanie Cook received financial support from USAID during the writing of this article. Dr. Rafael Obregón participated in the evidence review summit as a staff member of the United Nations Children's Fund and has no reported conflict of interest. Dr. Alain Labrique has no reported conflict of interest. Carina Schmid reports no conflict of interest. Dr. Charlotte Cole was employed by Sesame Street at the time of the evidence summit.

The views and opinions expressed in this paper are those of the authors and not necessarily the views and opinions of the U.S. Agency for International Development, the U.S. National Institutes of Health or the United Nations Children's Fund.

Notes

^a Evidence suggests that this is particularly helpful to children in low socioeconomic settings and is scalable to remote settings as well.

^b HIV incidence in young women is eight times that of their male counterparts (Abdool Karim & Dellar, 2014). Finding scalable sustainable interventions to change their behaviors is critical to reaching global goals of ending AIDS and creating an AIDS-free generation.

^c Strong findings in the cluster randomized cross over study suggest that this approach to early childhood obesity should be pursued further. It is particularly interesting that absent change in habits, young children had a dramatic change toward healthy BMI in both the initial intervention group and the crossover group, which was sustained at 12 months.

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