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Effect of SMS Health Messages on Attendance at Routine Health Screening among Adults in Nigeria

Abstract

Routine health screening is an important component of preventive healthcare because it facilitates the early identification of health risks and diseases before they progress to serious complications. Adults in Nigeria may have low attendance at routine health screening due to limited awareness, forgetfulness, competing work and family responsibilities, financial constraints, fear of unfavourable results, and limited knowledge of recommended screening services. Short Message Service (SMS) health messages provide a relatively simple and accessible means of sending health information, screening reminders, appointment notifications, and preventive health messages directly to individuals' mobile phones. Regular and timely SMS communication may encourage adults to remember scheduled screening appointments and improve their participation in routine health assessments. Against this background, this study investigates the effect of SMS health messages on attendance at routine health screening among adults in Nigeria. The study will be anchored on the Health Belief Model, Andersen's Behavioral Model of Health Services Use, and the Information-Motivation-Behavioral Skills Model. The Health Belief Model explains how perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action may influence adults' decisions to attend routine health screening. Andersen's Behavioral Model emphasizes predisposing characteristics, enabling resources, and healthcare needs as determinants of healthcare utilization. The Information-Motivation-Behavioral Skills Model emphasizes the role of health information, motivation, and behavioural skills in influencing preventive health actions. Collectively, these theoretical perspectives provide a suitable framework for explaining how SMS health messages may influence attendance at routine health screening among adults in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise adults aged 18 years and above who are eligible for selected routine health screening services in Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, healthcare facilities, communities, and eligible participants. SMS health messages will be assessed using indicators such as frequency of messages, timing, message content, reminder frequency, clarity, language, personalization, inclusion of appointment dates, screening locations, service information, health education content, and message delivery. Attendance at routine health screening will be assessed using indicators such as attendance at scheduled screening appointments, completion of recommended screening, repeat attendance, adherence to appointment dates, and attendance following SMS reminders. Data will be collected using structured questionnaires, SMS intervention records, mobile-message delivery reports where available, healthcare facility appointment registers, screening attendance records, and relevant programme documents. Descriptive statistics will be used to summarize participants' characteristics, SMS exposure, and screening attendance patterns. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of SMS health messages on attendance at routine health screening. Where a quasi-experimental design is adopted, screening attendance before and after introduction of SMS messages may be compared with attendance among a comparison group to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that SMS health messages have a significant positive effect on attendance at routine health screening among adults in Nigeria. Adults who receive regular and appropriately timed SMS health messages are expected to demonstrate higher attendance at routine health screening than adults who do not receive comparable reminders. SMS messages may serve as effective cues to action by reminding individuals of screening appointments, communicating the benefits of early detection, providing information about screening locations, and reducing forgetfulness. The relatively low cost and broad reach of mobile phones may also make SMS-based interventions useful for reaching adults across different geographical and socioeconomic settings. However, incorrect phone numbers, limited mobile network coverage, message fatigue, low literacy, language barriers, privacy concerns, financial constraints, transportation difficulties, and lack of available screening appointments may reduce effectiveness. The study therefore expects well-designed, timely, understandable, and appropriately targeted SMS health messages to contribute significantly to improved attendance at routine health screening among adults in Nigeria. The study is expected to contribute to the literature on mobile health communication, SMS health interventions, preventive healthcare utilization, routine health screening, appointment reminders, digital health, health promotion, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, healthcare facilities, public health practitioners, healthcare providers, telecommunications stakeholders, development partners, and policymakers regarding the use of mobile communication to improve preventive healthcare participation. The study will also provide evidence-based recommendations for developing targeted SMS screening reminders, maintaining accurate patient contact information, using simple and locally understandable language, optimizing message timing and frequency, protecting recipient privacy, and integrating SMS interventions with healthcare appointment and screening systems across Nigeria.

Keywords: SMS health messages, routine health screening, screening attendance, mobile health, health reminders, preventive healthcare, digital health communication, health promotion, healthcare utilization, adults, Nigeria, public health.