The authors found that clients’ experiences with the technology were mixed. Some felt the communications gave them a sense of support and connectedness and said they shared the messages with friends and family. Other clients, however, difficulty with the communications because of poor cell or Internet service, lack of a phone, or problems affording the cost of airtime. Women and teenagers, in particular, had their access to phones controlled by others.
Looking at economics, some respondents said that the cost of messages was a problem and many wanted them to be free of charge. Language used and ability to read, write, and use mobile phones also also could be problematic.
Among issues highlighted by the research were client requests for:
- Messages at a time and frequency convenient to them
- Assurances about privacy and confidentiality, particularly if they had a stigmatized or personal health condition
- Use of neutral language to deal with sensitive issues
The authors suggested that health systems planning to using digital communication with clients ask questions such as the following:
- Do clients own or have access to a functioning mobile device? If no, have solutions to access issues been considered?
- Is participating in the digital health intervention free or of very limited cost to ensure there are no barriers to participation? If not have solutions to access issues been considered?
- Have solutions been considered for when clients have their access to a phone controlled by someone else?
- Have solutions been considered for tailoring or changing intervention content to engage clients who have low literacy, differing language skills, or limited digital literacy?
- Have solutions been considered for tailoring or changing intervention content to ensure the privacy and confidentiality of clients and to avoid any harms that a break in this privacy may cause?