Community-Level Text Messaging for 2009 H1N1 Prevention in China

Background: Although patients worldwide increasingly are using mobile phone text messaging (SMS) for clinical care, quality data are sparse on the community-level effectiveness of SMS to prevent and control disease. Purpose: To determine SMS effectiveness in improving 2009 H1N1 knowledge, attitudes, behaviors, and self-reported outcomes and to assess community SMS acceptability. Methods: A program evaluation of Shanghai, China's SMS system using a single-blinded, randomized-controlled method was conducted in 2010 and results were analyzed in 2010-2011. Randomly selected community residents who agreed to participate were assigned to receive 3 weeks of either 2009 H1N1 prevention and control or tobacco-cessation messages. Assessments were made of 2009 H1N1 knowledge, attitudes, behaviors, and self-reported influenza-like illness before and after sending messages to participants. Acceptability of SMS also was assessed. Results: Of 1992 respondents, those receiving 2009 H1N1 messages had higher scores measuring 2009 H1N1 knowledge (4.2% higher) and desired attitudes (9.4% higher) (p < 0.001); 1.77 times greater odds of new 2009 H1N1 vaccination (p < 0.001); and 0.12 times smaller odds of reporting influenza-like illness (p<0.001) than those receiving tobacco messages. More than 95% of participants found the SMS program useful and trustworthy; nearly 90% would use it again. Conclusions: SMS can improve self-reported uptake of short-term behaviors, such as vaccination, that can result in long-term prevention and control of disease. SMS can improve knowledge and influence attitudes about infection prevention and control and self-reported health outcomes. In Shanghai, health-based SMS is acceptable to users. Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine