Direct to Consumer
This paper presents the positive outcomes of the confluence of three sciences, Emergency Medicine, Social Marketing, and mHealth.
An estimated 125m patients visit the Emergency Rooms (ER) of hospitals in USA every year. The ERs in the rest of the world are also over crowded. This leads to reduced patient safety, burnout of clinical staff, and waste of financial resources. Any intervention that can lead to preventing emergencies is in the interest of the patient, staff, and economy.
Social Marketing is the science of voluntary behavior change that helps people adopt, reject, or modify behavior for their own and communities well being. An estimated half of all deaths are premature as they are caused by preventable behaviors.
With more people having access to mobile phone than toilets, it is time to fully realize the potential of this technology for development. Even the most basic phone (non-smart phone) can send and receive sms and voice calls.
This paper presents the experience of using sms technology for behavior change of patients who had recently visited Pediatric ER of government hospital in Pakistan. The ChildLife Foundation, a private nonprofit organization, manages three Pediatric ERs at government hospitals in Pakistan under a Public-Private-Partnership agreement with the government. These hospitals are free of cost and are frequented by the poor. ChildLife Foundation treats half a million children in these ERs every year - free of cost.
Pakistan with a population of 200 million has the world's third highest under five mortality. Almost one in 10 ten children don't live to see their fifth birthday. This can be changed drastically by proven strategies such as breast feeding, weaning foods, oral rehydration therapy (ORS), immunization, hand washing, etc.
ChildLife Foundation had a unique advantage to encourage behavior change. With half a million patients passing through its ER every year, ChildLife had crucial information about these patients such as their mobile number, child's age, name of primary care giver, location, diagnosis, etc. This enabled ChildLife to customize the sms according to the need of the patient e.g. a parent bringing their child for diarrhea would receive message about ORS or immunization messages were sent based on age of the child. Moreover, these messages were also customized to address the primary care giver by name. This personalization of sms helps to differentiate the message from spam.
The biggest advantage was the timing. As ChildLife knew when the parents visited their children, they could establish contact with parents soon after the visit to ER. It was this 'while the iron is hot' factor that mattered most as parents were still recovering from the trauma of taking their child to ER.
Randomized Control Trials (RCTs) measured the impact of messages while altering their frequency. The impact of behavior change was significant proving that 'right message at right time' works.
This low cost intervention has huge scope for replication at ERs all over the world resulting in reduction of morbidity and mortality as well as efficient use of human and financial resources.
Senior Consultant - Pediatric Emergency Medicine
I developed special interest in Pediatric Emergency Medicine (PEM) during my pediatric postgraduate training at Aga Khan University Hospital, I joined emergency department and learnt that emergency room is all about changing an outcome within limited time frame. In 2014, I got an opportunity to get myself internationally trained from Hospital of Sick Children, University of Toronto. After completion of PEM fellowship, I came back to Pakistan and joined ChildLife Foundation (CLF) in February 2016. My aim and objective is to improve the emergency care of children of Pakistan for which I need a platform where I can teach and share my PEM knowledge and skills. I came to know about ChildLife foundation, which is also working on a 3-tier health pyramid divided into acute emergency, primary and preventive care. Today, ChildLife Foundation’s two emergency rooms treat more than 300,000 children annually, entirely free of cost. Later, last year CLF took an initiative to start Telemedicine project and I got the opportunity to lead this project.
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