NightWatch 2.0: The Role of Mobile Phones in Malaria BCC

Hannah Bowen^1
1Malaria No More

Journal MTM 1:4S:11-12, 2012
DOI:10.7309/jmtm.35

Abstract

Two years ago, as governments across Africa began ramping up delivery of mosquito nets, diagnostic tests, and malaria treatments, we asked ourselves: how can we ensure these investments in malaria control tools translate into malaria control behavior (and therefore, into malaria control success)? Our answer: NightWatch. The idea is simple: send out messages with a signature style – delivered by recognized local celebrities – through multiple media channels every night, reminding people to protect themselves from malaria.

Developed by Malaria No More and Lalela Project, the NightWatch program aims to increase the utilization of malaria control tools, such as mosquito nets, through a targeted communications campaign. NightWatch campaigns in Senegal, Tanzania, Cameroon, and Chad all began with radio and TV spots, but immediately expanded to reach individuals through their mobile phones with SMS reminders to sleep under a mosquito net. NightWatch SMS messages are free to subscribers – and to Malaria No More – thanks to generous in-kind donations by leading African telecoms. Mobile partners MTN (Cameroon), Airtel (Chad), and Tigo (Senegal) have generously sent SMS messages to over 10 million subscribers. The messages are distinguished from “spam” by coming from trusted sources – the companies themselves, the Ministries of Health, and celebrity spokespeople.

Our research shows that SMS is expanding the reach of NightWatch and impacting behavior. In Cameroon, the “K.O. Palu” (“Knock Out Malaria”) NightWatch program reached over 6.8 million adults. In a nationally representative survey (n=2,176 adults 15+) conducted in March/April 2012, 22% of all respondents recalled receiving an SMS and one or more other elements of the campaign (anthem, radio or TV ads), and 8% – representing over 875,000 adults – only recalled the SMS without other elements; 30% recalled some element(s) of the campaign but not SMS and 40% did not recall the campaign. Thus, SMS not only increased the reach of the campaign by 15% over what it otherwise would have been, but also reinforced the messages for a large portion of the total campaign audience.

Analysis of the link between NightWatch campaign exposure and malaria control behavior in the Cameroon 2012 survey data shows a strong impact of the campaign on net use. Cameroonians exposed to the campaign were 13% more likely to sleep under a net, and 24% more likely to have their children sleep under a net, than those not exposed. Even after controlling for other factors through propensity score matching analysis, K.O. Palu NightWatch exposure was associated with 7 percentage point higher net usage by adults (12 percentage point higher net usage by respondents’ children) in households with at least one net.

However, our research suggests that the added value of SMS is still limited. Analyzed on its own, exposure to SMS still had a positive impact on net use, but not as large or significant as the impact of the K.O. Palu anthem or the joint impact of NightWatch elements together. Therefore, we are focusing on next steps: how do we build on the early success of SMS to use mobile phones better, to make NightWatch more interactive and engaging?

We’ve already begun experimenting with more interactive and engaging ways of incorporating mobile phones into NightWatch. In Tanzania, audience members were encouraged to vote via SMS for winners in the televised 2011 Tanzanian Gospel Music Awards; of more than 3 million subscribers who received voting reminders with malaria messaging, 192,000 responded by voting – and received another malaria-themed message. But we want to go further – using pre-recorded voice messages from celebrities to reach illiterate phone users, linking our successful malaria anthems to ring tones and call tones, having a presence on social media (accessed on mobile phones), and incorporating call-ins and SMS input into local radio programs.

With generous support from the IWG mHealth catalytic grant mechanism, funded by the Norwegian Agency for Development Cooperation (Norad) and implemented in partnership with the World Health Organization (WHO) and mHealth Alliance, Malaria No More will expand NightWatch mobile phone tools in Tanzania in 2013-2014. The lessons learned in Tanzania will then be used to enhance the mobile phone elements of NightWatch in other countries as well. Elements of the program that are successful in Tanzania can be rolled out with mobile phone partners in Cameroon, Chad, and Senegal. The results of the NightWatch mobile expansion will also be shared within the malaria control community to encourage adoption of interactive and engaging communication strategies by national malaria control programs.

SOLVE-IT: Socially Optimized Learning in Virtual Environments: A Web-Delivered HIV Prevention 3D Game Intervention for Young At-Risk MSM

LynnCarol Miller,¹Paul Robert Appleby,¹AlexandraN Anderson,² StephenJ Read,¹John L Christensen,³StacyMarsella^1
1University of Southern California, ²Stanford University, ³University of Connecticut

Journal MTM 1:4S:10, 2012
DOI:10.7309/jmtm.34

Abstract

Young men (18-24) who have sex with men (YMSM), especially men of color, are at high risk for contracting HIV. Most existing HIV prevention interventions focus on changing intervening cognitive and deliberative processes or outcomes (e.g., beliefs, norms, self-efficacy, intentions) to change behavior. Many MSM, however, guided by contextual cues in emotionally arousing scenarios, make more automatic risky decisions they later regret. One emotion in a sexual narrative that might precipitate more automatic risky choices for young MSM may be shame (e.g., in one’s sexual desires). But, HIV prevention interventions are not designed to reduce MSM’s shame. SOLVE (Socially Optimized Learning in Virtual Environments), as demonstrated by an NIAID RCT grant, used a sex-positive game to reduce MSM’s shame, increase traditional immediate cognitive outcomes, and reduce unprotected anal intercourse for young Black, Latino, and White MSM (18-24) over 3 months. Could interactive interventions be delivered more broadly over the web? In prior CHRP funded work, a SOLVE interactive video (IAV) intervention was streamed over the web throughout California. However, an IAV approach limits the amount of user interaction, risk challenges users receive, and intervention tailoring to MSM’s decisions. This is addressed using a nationally deliverable 3D animated intelligent agents/interactive digital storytelling game in UNITY. MSM design their own characters, make choices for them on dates and sexual interactions, and are scaffolded by the user character’s virtual future self (participant’s older chosen self-character) to enhance self-regulation when risky. The NIMH-funded SOLVE-IT game development process for young MSM is discussed. Results (N=876) from an ongoing 6-month randomized controlled trial (RCT) — conducted nationally, over the web, are promising. They reveal greater initial shame reduction and cognitive variable increase (e.g., intention, self-efficacy, consideration of future consequences p’s <.01) for at-risk YMSM immediately following the SOLVE-IT game compared to the wait-list control group.

Wrist-based accelerometers successfully differentiate walking from other activities

AmyPapadopoulos,¹Nicolas Vivaldi,²ChristineSilvers,^1
1AFrame Digital, Inc,²George Washington University

Journal MTM 1:4S:9, 2012
DOI:10.7309/jmtm.33

Abstract

There is a significant body of literature that demonstrates that accelerometers placed at various locations on the body can provide the data necessary to recognize walking. Most of this literature, though, either does not consider accelerometers placed at the wrist, or suggests that the wrist is not the ideal location. The wrist, however, is probably the most socially-acceptable location for a monitoring device. This study evaluates the possibility of using wrist accelerometers to recognize walking during everyday life in order to not only evaluate the amount of time spent walking, but also potentially recognize changes in stability that might lead to falls. Thirty elderly individuals aged 65 years and older were asked to wear a wrist accelerometer for four hours each while simultaneously being videorecorded. Study participants were instructed to go about their normal daily activities during those four hours. Activities captured in the videorecordings ranged from doing laundry and cooking lunch to watching television. Accelerometer data were then analyzed by looking for the well-recognized walking frequencies between 0.7 and 3.0 Hz, as well as by calculating a number of other features from the time-series data. Particular attention was given to features that are capable of being calculated on the wrist device so that future work will not require streaming large amounts of data from the device to a central server. Using the presence or absence of the walking frequencies to characterize the test set yielded results of 93% area under the receiver operating characteristic curve (AUC). Using an algorithm limited to features calculable on the wrist device, moreover, achieved an AUC of 90%. A wrist-based accelerometer, therefore, can successfully be used to differentiate walking from other activities, and, moreover, can do so on a small, socially-acceptable wrist-based device.

The project described was supported by Grant Number R43AG039176 from the National Institute On Aging. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute On Aging or the National Institutes of Health.

A Tablet Game for Risk Reduction and HIV Prevention in Adolescents

Kimberly Hieftje,¹Lindsay Duncan,¹Benjamin Sawyer,²Sabrina Haskell,²Lynn Fiellin,^1
1Yale University,²Digitalmill, ³Schell Games

Journal MTM 1:4S:8, 2012
DOI:10.7309/jmtm.32

Abstract

Background: Thirty-nine percent of new HIV infections in 2009 occurred among individuals aged 13-29 years. Videogames are ubiquitous, can improve health behavior, but have not been evaluated as a tool for HIV/AIDS prevention in adolescents.

Purpose:  To develop and evaluate a videogame designed to help teens acquire and practice skills to avoid or reduce overall and HIV risk behaviors.

Methods: Yale’s Play2PreventTM, Digitalmill, and Schell Games are developing PlayForward: Elm City Stories, a videogame that incorporates evidence-based tools for behavior change. We will evaluate the efficacy of thegame by conducting a randomized trial in 330 youths assigned to play PlayForward or a commercial videogame. Subjects will play two sessions/week of their assigned game for six weeks. Assessments will evaluate the game’s efficacy for reducing risk and promoting good decision making.

Results: The videogame will be ready for testing as a final playable iPad product in late Fall 2012. The player uses a personalized avatar to “travel” through life, making decisions and facing challenges in a repetitive and meaningful way, equipping them with skills that potentially translate to real life. During this talk we will describe how an originally planned desktop application was quickly retooled for touch interface tablets. While many traditional desktop and Web-based applications will easily move to tablet and mobile phone frameworks, understanding some of the nuances involved will provide new insights. We will outline specific approaches to game development for behavior change and discuss the potential global implications of our work.

Conclusions:  This videogame represents a paradigm shift, hopefully providing evidence for the role of games as risk reduction and HIV/AIDS prevention in youth. Videogame technology has the potential to expand the available vehicles for HIV/AIDS prevention to the increasing number of electronic gaming platforms including mobile technologies, creating a new venue for public health interventions.

Feasibility of a Virtual Exercise Coach to Promote Walking in Community-Dwelling Persons with Parkinson’s Disease

Nancy K Latham,¹TerryEllis,²Tamara De Angelis,² Katy Hendron,²CathiA Thomas,³ MarieSaint-Hilaire,³ Timothy Bickmore^4
1Boston University School of Public Health,²Boston University, ³Boston University Medical Campus,⁴College of Computer and Information Science, Northeastern University

Journal MTM 1:4S:7, 2012
DOI:10.7309/jmtm.31

Abstract

Objective: Exercise improves function and quality of life in persons with Parkinson’s Disease (PD), but few people adhere long-term to home-based programs. A Virtual Exercise Coach (VEC) is an animated character viewed on a notebook computer in the subject’s home that emulates face to face interactions. The effectiveness of VECs to improve exercise adherence in people with PD or any other neurodegenerative disease has never been explored. The aim of this study is to explore the feasibility, acceptability and preliminary evidence of efficacy of a VEC to promote daily walking in community dwelling persons with PD over a one month period.

Methods: 20 sedentary subjects with a diagnosis of PD participated in this Phase I clinical trial. Subjects were instructed to interact with the VEC for 5 minutes, wear a pedometer and walk daily for one month. Mobility (six-minute walk and gait speed) and exercise self-efficacy were assessed at baseline and one-month. Retention rate, satisfaction and interaction history were assessed at 1-month.

Results: Participants were 55% female, mean age 65.6. At study completion, there was a 100% retention rate and subjects had an average satisfaction score of 5.6/7 (with seven maximal satisfaction) with the VEC. Mean adherence to daily walking was 85% of prescribed sessions. Both gait speed and the 6-minute walk test significantly improved (P<0.05) from baseline to one month. No adverse events were reported.

Conclusions: Sedentary persons with PD successfully used a computer and interacted with a VEC. Retention, satisfaction and adherence to daily walking were high over one-month and significant improvements were seen in mobility assessments. Longer, controlled trials are needed to assess the effectiveness of the VEC in promoting adherence to long-term exercise in persons with PD.