Module 6: Mobile Health Marketing Strategies

Mobile health, or “mHealth,” refers to the widespread use of mobile telecommunication and multimedia technology involved in the delivery of health services and distribution of health information.  Within the past decade, the definition of mHealth has expanded to encompass public health and wellness, and the definition of “mobile phone” has also stretched to include not only voice messaging, SMS (short messaging service), and MMS (multimedia messaging service), but also smart phone capabilities such as internet, video, and imaging functions.  Although smart phones are usually unaffordable in low income countries, mHealth has the potential to revolutionize health information systems and create an individualized health care experience for people around the globe.(1)

Over 3.3 billion individuals own mobile phones worldwide, equating to 2.5 times more cell owners than land-line owners.  As a point of comparison with other current technologies, only 1.3 billion people utilize the internet, and 1.5 billion own televisions.  Citizens utilize mobile communication for numerous purposes, including career, family, social networking, business, etc.  Overall, the opportunities offered by modern technology could tremendously enhance and change the social marketing framework.(2) While some people insist that mobile equipment fosters social seclusion, research has shown that mobile devices can serve as powerful tools for maintaining strong relationships that originated in person.  The inherent social networking quality of the mobile phone causes marketers to reconstruct their views of the target “audience” for publicity messages.  Craig Lefebvre, Research Professor of Public Health Communication and Marketing in the Department of Prevention and Public Health at The George Washington University, explains: “What these new technologies make plain is that it is, indeed, a networked world – one in which we do not design ‘messages’ for priority audiences, stakeholders, partners, donors, and other groups, but a world in which they talk back to us, and just as importantly, with each other.”(3)

As described earlier, “mobile technology” encompasses any device or tool that utilizes cellular or wireless machinery to communicate to other devices, which includes basic mobile telephone functions in addition to internet connectivity.  From a smart phone, an individual can access social networking sites, browse and search websites, and receive emails.  Innovative e-health applications are currently exploring how this expanded internet connectivity can be utilized to “provide remote sensing of health status, transmit clinical information, including x rays and other biometric data, and facilitate e-prescribing.”  One future goal is to create an application which allows for individuals to view their personal health record via a mobile device.  Mobile marketers approach the mobile phone as being far from simply another means of advertising, but instead as extremely distinctive due to its option for rapid response.  Certain combinations of resources exist exclusively within the mobile phone experience; for example, the community health department can call an individual to instruct them to fill out a questionnaire, which the subject can then click to take from their phone, which subsequently offers immediate data for the health program.(4)

The differences between various segments of the cell phone markets exist not due to demographics, but instead due to how people use their phones.  For example, adults between the ages of 18 and 29 use their cell phones for SMS, IM, email, and internet much more frequently than older adults do.  Users ages 35 and older are referred to as “adult adopters,” meaning that this cohort was not introduced to cell phones until adulthood and therefore primarily only use them for the most basic purposes (calling and the occasional texting).(5)

Mobile applications for public health programs can be applied to the four P’s of the marketing mix (described in Module 1). 

• Products and services: Mobiles have a lot of potential to enhance current intervention schemes. Phones are useful in behavior change campaigns, and are frequently utilized in conjunction with websites and social networking programs to monitor behavior and provide feedback for individuals.

• Price: A financial benefit of increased phone use is the rapidly expanding market for downloading applications. However, in addition to this, mobile phones create a unique opportunity to overcome many psychological and social barriers that prevent people from accessing public health services (an intangible version of “cost”). Through mobile-facilitated encouragement and motivation, phones can offer social support to foster behavioral changes. For example, in San Francisco, the health campaign SEXINFO reacted to the growing prevalence of sexually transmitted diseases in urban adolescence. Due to widespread cell phone use in their target audience (15 to 19 year old African Americans), they were able to create an “opt-in” text messaging provision to offer information regarding sexual health, relationship advice, and referrals to other helpful public services.

• Place: One asset of phones is the ability to “place-shift” multiple tasks, meaning that live, recorded, or stored media can be listened to on the device through the internet or an alternative data network. Additionally, Global Positioning Systems (GPS) can now be installed in phones, allowing for the creation of locator applications. For example, in 2007, a mobile phone service in South Africa utilized SMS text messages to notify community members about local HIV testing site locations. Individuals would send an SMS with the text “HIV” and their town postal code, and would receive an instant response that directed them to the two closest testing units.

• Promotion: Perhaps the most obvious strength of the mobile health revolution is that the devices allow for consistent back-and-forth and one-to-one communication. Also, health information can be provided on demand to individuals whenever they desire access. For example, The Mayo Clinic InTouch Program offers a “Symptom Checker” for subscribers to rapidly evaluate the severity of their illness, along with “a first aid guide with detailed tips on treating and responding to medical emergencies, an emergency room finder to locate nearby locations, health alerts, healthy living tips,” and other benefits.(6)

The mHealth revolution is just beginning, and technologies are becoming an increasingly viable option in developing nations.  For example, the Indian company IdeaForge just developed a hand-powered cell phone charger, which can be cranked for just one minute to yield three minutes of phone time.  Because having a phone is such a vital component of emergency obstetric care, Maternova is evaluating the product’s effectiveness by having midwives test it.(7)  New innovations such as this one demonstrate how mHealth is an ever-growing sector and is ripe with marketing opportunities.

Despite the great successes of mobile health that have been achieved thus far, many research gaps and policy barriers remain.  In a paper published by the mHealth Alliance, Mechael et. al. explores the primary obstacles to mHealth in low and middle income countries.  Five major themes of mHealth applications can be defined:(8)

• Treatment compliance: This refers to the use of mobile applications to ensure that patients strictly adhere to their drug treatment schedule. In lower and middle income countries, infectious disease compliance must be monitored. In high income countries, chronic disease is a more common problem. One challenge to this monitoring system is that medications are not always accessible in resource-poor areas, making it impossible for patients to properly adhere to the treatment plan.

• Data and Disease Surveillance: The former tedious techniques of collecting data by hand have been replaced by digital methods, and the outcomes in terms of error reduction, time, and cost savings are not entirely clear but seem to be positive. Barriers in this area include developing an effective coordination system of data sharing between different health information systems locally and globally, and determining what the rights and guidelines for usage of this data should be.

• Health Information Systems and Point-of-Care Support: Whereas health information systems were formerly created only for physicians and doctors, community health workers are now included in the target group. This new age of “telemedicine” can drastically expand the dissemination of information and expertise through user-friendly technologies and systems. Barriers to making this vision a reality include clinician resistance to the new equipment, as well as unknown expenses and consequences of universally accessible support systems.

• Health Promotion and Disease Prevention: SMS text messages can be extremely useful for the distribution of essential health education materials, as well as information about disease prevention and public clinic locations. Current barriers to further expanding this beneficial teaching method include legal responsibilities, accuracy of information, and security risks.

• Emergency Medical Response: This area of mHealth has been the most difficult to study, simply due to the nature and tendencies of emergencies themselves. However, mobile technologies are potentially an extremely useful means of quickly accumulating assistance in a disastrous situation. Barriers include restrictions such as network capacity, as well as infrastructure costs (transportation and roads), particularly for national emergency call locations.(9)

Further research in all five of these areas is necessary, as well as continued development of mHealth to overcome the limitations and barriers within the current system.(10)  While the majority of results from widespread use of mobile devices have been positive, some negative repercussions may surface as well.  For example, “the data challenge” refers to the fact that household data can no longer be collected by randomly dialing telephone numbers within a certain area.  Especially in younger populations or in underprivileged areas, it is growing increasingly difficult to contact people who “more and more choose who they want to contact them.”(11)

Overall, the use of mobile devices among public health workers provides the opportunity for an expanded and improved relationship with the target audience.  The benefits of the phone go beyond communication, as mobile devices can serve as marketing tools that recognize each part of the marketing mix.  Mobile devices have the potential to revolutionize social marketing in the public health sector, as they offer immediate access to health information, provide social support and networking capabilities, effectively engage audiences, and assist in collecting data from and providing feedback to individuals.

Footnotes

(1) Mechael, P., Batavia, H., Kaonga, N., Searle, S., Kwan, A., Goldberger, A., ... & Ossman, J. (2010). Barriers and gaps affecting mHealth in low and middle income countries: Policy white paper. 

(2) Lefebvre, C. (2009). Integrating cell phones and mobile technologies into public health practice: a social marketing perspective. Health promotion practice, 10(4), 490-494. 

(3) Ibid.

(4) Ibid. 

(5) Ibid.

(6) Ibid. 

(7) Maternova, “Hand Powered Cell Charger.” 

(9) Mechael, P., Batavia, H., Kaonga, N., Searle, S., Kwan, A., Goldberger, A., ... & Ossman, J. (2010). Barriers and gaps affecting mHealth in low and middle income countries: Policy white paper. 

(9) Ibid. 

(10) Ibid.

(11) Lefebvre, C. (2009). Integrating cell phones and mobile technologies into public health practice: a social marketing perspective. Health promotion practice, 10(4), 490-494.