Mobile devices are ubiquitous, and most of all personal: twenty years ago none of us would have dreamed of a computer in our pocket that went everywhere with us, and today a substantial portion of the population has exactly that. The public health ramifications are enormous. Think of the possible reach! We now have the chance to implement unique and targeted interventions that can go straight out directly to at-risk individuals, no matter what time, no matter where they are!
The temptation we must resist, however, is to “public health all the things!” Mobile campaigns have some unique considerations compared to other public health media interventions: they’re always on, practically omnipresent, and usually near by their owner. That means the opportunity is coloured just as strongly by the potential drawbacks: technical limitations, inadvertent invasion of privacy, and a very thin line between being useful and being annoying. Not every public health program should, or even can, translate to a mobile platform.
The question is obvious, then: what are some attributes that suggest a particular program or intervention could benefit from a mobile campaign? There are many variables to consider, but let’s look at a few:
- It’s narrowly focused. Most mobile programs are based on text messages, and text messages are limited to 140 characters each (now you know where the Twitter number came from). If your topic or desired intervention can be expressed very succinctly, it might be a good fit. For example, many successful programs use mobile messaging as a tickler or reminder system to do a particular thing (such as Text4Baby and prenatal appointments, or messaging diabetics to check their blood sugar). Reminding people of an important health goal using their mobile device almost seems obvious, and is simple to grasp conceptually and operationally.
By the same token, however, what about bigger public health issues like health equity? Unless you’re concentrating on a very small portion of it, you won’t be able to fit all of the specific nuances that fall under this topic into 140 characters, and unless you have a certain specific intervention to advance it, you probably won’t be able to tell people how to improve the situation in that space either. Sometimes multiple campaigns under one umbrella can get around this problem, but certain topic areas are hedges that are just way too thorny.
- It deals with a population that’s used to mobile devices. We’re trying not to say that a younger audience is probably a better fit, but we’re probably saying that too, you know? Your intervention or topic’s impact on the target audience will be filtered by mobile uptake in that population. If uptake is less common, or the mobile campaign depends on technology or features which are less available, your intervention or topic area may be less available also — which may mean, at minimum, you’d have to diversify your media channels to get adequate reach. HRSA, for example, estimated the 2013 percentage of seasoned citizens over 65 with cell phones at 76% — the lowest of any of the age groups studied — and just 18% for smart phones. For that matter, parents and older adults were the least likely in the HRSA review to accept messages this way, even though acceptance is slowly growing. We’re just saying.
- There’s something in it specially for them. You might use a mobile campaign to just push pre-fab messages at people, and you’d probably have a few people sign up initially, but you can expect retention to be a problem because it’s not meaningful to get a one-sided talking to all the time. Plus, text messages in particular can cost real money on some budget or prepaid mobile plans, so your campaign really needs to be worth the surcharge. While the evidence base is still scant, the HRSA review above noticed that in one of the studies they reviewed, campaigns not using “tailored text message content were among the studies with the highest participant attrition.”
Don’t get us wrong: mobile health is already growing rapidly, and has tremendous potential for improving the health and healthy behaviours of our populations. But even when it becomes ubiquitous and commonplace, some things will work better with it than others will. Resist the temptation to “mobile all the public things” unless it makes sense!