Studies by Johns Hopkins Researchers Seek to Improve Mobile Phone Health Surveys in Colombia

Two studies conducted by researchers at the Johns Hopkins Bloomberg School of Public Health, in collaboration with researchers at the Pontificia Universidad Javeriana in Bogotá, Colombia, explored methods for implementing mobile phone surveys (MPS) for public health surveillance data on noncommunicable disease risk factors in Colombia. The studies were conducted as part of the Data for Health Initiative, funded by Bloomberg Philanthropies and the Government of Australia. The studies looked specifically at strategies to increase the response rate of MPS, and processes for obtaining consent to participate in the surveys. The studies found that trust in the institution conducting the survey and providing clear communication on the purpose of the survey before administering it were key factors, both in obtaining consent from respondents, and in the willingness of participants to complete the health survey. 

The first study, published in Global Health Action on August 28, 2020, explored the perceptions and strategies to increase the acceptability and response rate of health surveys delivered via mobile phones with a particular focus on the interactive voice response (IVR) survey method, where respondents select responses to prerecorded questions via a keypad or voice recognition software. 
   
 “This study lays the foundations for implementing rapid mobile phone surveys in Colombia and other Latin American countries,” says Andres Vecino-Ortiz, MD, PhD ‘16, assistant scientist in the Department of International Health at the Bloomberg School and senior author on the study. 

The study found that trust was a barrier to agreeing to take the survey, as most participants were suspicious of calls received from unknown numbers, due to the high frequency of phone surveys used for other purposes—particularly deceiving people into providing personal information—in Colombia. The study also found that different population groups have different survey preferences according to phone-related skill levels, age, and educational level. The ‘digital divide’ can feel like a barrier to some, particularly elderly populations who may not have an advanced or moderate technological capacity, and who can feel frustrated at the inability to use certain digital devices. These groups preferred the IVR format, while younger and more educated groups felt more comfortable with short message service (SMS) format. Another important factor reported to affect response rate is the prevalence of connectivity issues for rural responders.

The second study, published in the Journal of Empirical Research on Human Research Ethics on September 25, 2020, captured the perspectives of key stakeholders—both experts and community members—on consent processes for participation in public health surveys conducted via mobile phones.  The conduct of large-scale automated MPS raises important and potentially unique ethical and regulatory challenges, including defining appropriate processes for obtaining respondent consent. The study aimed to identify the critical elements to consider when obtaining consent from potential respondents to a MPS on NCD risk factors.

“While simple automated mobile phone surveys present the potential for greater efficiency in global data collection, there is limited understanding of what various stakeholders perceive necessary to include in consent modules, and how to communicate that information both effectively and succinctly,” says Joseph Ali, JD, assistant professor in the Department of International Health at the Bloomberg School and senior author on the study. 

The study found that when such surveys are designed to contribute to the enhancement of public policies, some respondents believed formal consent was less critical.  Providing information about the institution administering the survey and what the data will be used for through simple consent disclosures and media campaigns in advance of the survey being administered was found to enhance trust, particularly to counteract the widespread fear of data misuse. The respondents emphasized giving survey participants simple, clear, and relevant information about risk factors related to specific public health problems and the potential benefits of participant responses for health surveillance and public policy. The study also found that it was key to make sure respondents felt as if they could end the survey at any point. 

Data collection on NCD risk factors has traditionally been conducted through face-to-face household surveys. Mobile phone technology can reduce implementation and personnel costs associated with face-to-face surveys and provide access to a broader range of participants, particularly in low- and middle-income countries. Mobile phone surveys offer an opportunity to provide policymakers and key decision-makers with more up-to-date monitoring data on the prevalence of risk factors for NCDs and other conditions. The findings from these studies can be used to help improve the quality of mobile phone surveys and fill informational gaps in monitoring population health.

“These two papers, done in collaboration with our country partners in Colombia, are great examples of how international partnerships can advance and contribute to the research capacity for designing and conducting mobile phone surveys in low- and middle-income countries,” says George Pariyo, PhD ’00 principal investigator of the Data for Health project and senior scientist in the Department of International Health.

In addition to Ali, Pariyo, and Vecino-Ortiz, authors of the publications at the Bloomberg School include Dustin Gibson, PhD ‘14, assistant scientist and Alain Labrique, PhD ‘07, professor, based in the Department of International Health.  

The Data for Health Initiative aims to improve the availability of public health data so that governments can make informed decisions to prioritize health challenges, develop policies, deploy resources, and measure success. The Data for Health team at Johns Hopkins Bloomberg School of Public Health conducts research and development to inform the future design and delivery of mobile phone surveys in low- and middle-income country settings. Read more on the research conducted by the team.