Texting is not just for catching up with your friends or alerting loved ones that you will be late for dinner, but texting may also be used to rapidly gather information during a public health crisis. According to the new study published in Nature Digital Medicine, researchers from NYU College of Global Public Health and NYU Tandon School of Engineering have used text message surveys in determining in real time how people used maternal health services during a recent Ebola outbreak. They measured a drop in hospital-based births during the outbreak.
"Sourcing data from individuals directly, such as through mobile phones, has the potential to provide windows into public health phenomena, especially during an acute situation like an Ebola outbreak," say’s Rumi Chunara, assistant professor of computer science and engineering and global public health at NYU and the study's senior author. "While text messages will not replace national surveys, they can capture changes in health behavior more nimbly. With appropriate methodological approaches, they can be a valuable tool for population health intelligence that allows us to quickly target the affected regions with public health messaging or deploy appropriate interventions."
As witnessed in the Ebola outbreak of 2014-2016, public health emergencies have a profound effect on local healthcare systems leading to overwhelming clinics, eroding public trust, and a reduction in health care utilization. "During the Ebola outbreak, it was suspected that people were hesitant to go to hospitals because they would be more likely to contract Ebola. If you want to deploy treatment or interventions, you need to know if people are coming to hospitals or staying in their communities," said Chunara.
Current data collection systems are lengthy in time and analysis and more than often are disrupted by emergencies in regions with weaker infrastructure. However, the emergence of mobile technology provides a promising method of quick, effective, and low-cost data collection amongst regions that are difficult to reach. However, users of mobile technology are usually younger and are able to afford a phone which is not always representative of the general population.
The research study conducted a poll via text message to ask Liberians a series of 10 questions about their health with a focus on maternal health services. Questions included whether they knew anyone with Ebola, whether they recently gave birth, and if so, did they deliver in 1. a government hospital or clinic, 2. a private hospital or clinic, 3. at home or someone else's home, or another location. The poll collected responses from 6,694 individuals between March 2015 to June 2015.
Chunara and research team used a method known as propensity score to make the data from their text message poll comparable with the recent national survey of women of child-bearing age, 2013 Liberian Demographic Health Survey. The researchers were able to match a cell phone poll participant who reported giving birth within the past year to women who reported a birth in the 2013 Demographic Health Survey. The propensity score matching allowed the researchers to balance the populations across variable factors such as age, occupation, education, and location. "Using these statistical methods to adjust for the populations being different, we were able to make sure we were comparing apples to apples and generating matched groups across which to compare outcomes," Chunara said.
Results of the study indicated is a reduction of hospital-based deliveries during the Ebola outbreak in comparison after the outbreak. The findings were consistent with many retrospective studies on health care utilization during the Ebola outbreak.
Watch the video below to learn more about the Ebola outbreak: