Remote consent approaches for mobile phone surveys of non-communicable disease risk factors in Colombia and Uganda: A randomized study

PLOS ONE RESEARCH ARTICLE Remote consent approaches for mobile phone surveys of non-communicable disease risk factors in Colombia and Uganda: A randomized study a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 Joseph Ali ID1,2*, Madhuram Nagarajan1, Erisa S. Mwaka ID3, Elizeus Rutebemberwa3, Andres I. Vecino-Ortiz ID1, Angelica Tórres Quintero ID4, Mariana Rodriguez-Patarroyo5, Vidhi Maniar ID1, Gulam Muhammed Al Kibria1, Alain B. Labrique1, George W. Pariyo ID1, Dustin G. Gibson1 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America, 2 Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, United States of America, 3 College of Health Sciences, Makerere University, Kampala, Uganda, 4 Public Health Institute, Pontificia Universidad Javeriana, Bogotá, Colombia, 5 Bioethics Institute, Pontificia Universidad Javeriana, Bogotá, Colombia * OPEN ACCESS Citation: Ali J, Nagarajan M, Mwaka ES, Rutebemberwa E, Vecino-Ortiz AI, Quintero AT, et al. (2022) Remote consent approaches for mobile phone surveys of non-communicable disease risk factors in Colombia and Uganda: A randomized study. PLoS ONE 17(12): e0279236. https://doi. org/10.1371/journal.pone.0279236 Editor: Tarik A. Rashid, University of Kurdistan Hewler, IRAQ Received: February 3, 2022 Accepted: December 3, 2022 Abstract Introduction Automated mobile phone surveys (MPS) can be used to collect public health data of various types to inform health policy and programs globally. One challenge in administering MPS is identification of an appropriate and effective participant consent process. This study investigated the impact of different survey consent approaches on participant disposition (response characteristics and understanding of the purpose of the survey) within the context of an MPS that measured noncommunicable disease (NCD) risk factors across Colombia and Uganda. Published: December 21, 2022 Copyright: © 2022 Ali et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All data files are available from the ICPSR database (https://deposit. icpsr.umich.edu/deposit/workspace?goToPath=/ ddf/167023&goToLevel=project). Researchers can access the data set from the ICPSR link provided after creating an account. Funding: This study was made possible with the support of Bloomberg Philanthropies (https://www. bloomberg.org) and the people of Australia through the Department of Foreign Affairs and Methods Participants were randomized to one of five consent approaches, with consent modules varying by the consent disclosure and mode of authorization. The control arm consisted of a standard consent disclosure and a combined opt-in/opt-out mode of authorization. The other four arms consist of a modified consent disclosure and one of four different forms of authorization (i.e., opt-in, opt-out, combined opt-in/opt-out, or implied). Data related to respondent disposition and respondent understanding of the survey purpose were analyzed. Results Among 1889 completed surveys in Colombia, differences in contact, response, refusal, and cooperation rates by study arms were found. About 68% of respondents correctly identified the survey purpose, with no significant difference by study arm. Participants reporting higher PLOS ONE | https://doi.org/10.1371/journal.pone.0279236 December 21, 2022 1 / 17 PLOS ONE Trade (https://www.dfat.gov.au/) through award number 119668. The contents are the responsibility of the authors and do not necessarily reflect the views of Bloomberg Philanthropies or the Government of Australia. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Remote consent approaches for mobile phone surveys levels of education and urban residency were more likely to identify the purpose correctly. Participants were also more likely to accurately identify the survey purpose after completing several survey modules, compared to immediately following the consent disclosure (78.8% vs 54.2% correct, p<0.001). In Uganda, 1890 completed surveys were collected. Though there were differences in contact, refusal, and cooperation rates by study arm, response rates were similar across arms. About 37% of respondents identified the survey purpose correctly, with no difference by arm. Those with higher levels of education and who completed the survey in English were able to more accurately identify the survey purpose. Again, participants were more likely to accurately identify the purpose of the survey after completing several NCD modules, compared to immediately following the consent module (42.0% vs 32.2% correct, p = 0.013). Conclusion This study contributes to the limited available evidence regarding consent procedures for automated MPS. Future studies should develop and trial additional interventions to enhance consent for automated public health surveys, and measure other dimensions of participant engagement and understanding. Introduction As has been well documented, low- and middle-income countries (LMICs) are experiencing major shifts in disease burdens, with significant increases in the prevalence of noncommunicable diseases (NCDs) [1]. The paucity and cost of acquiring timely data on the underlying prevalence of NCDs in many countries makes the impact of any public health intervention difficult to evaluate, especially where target populations are relatively hard to reach [2, 3]. Evidence-based policy development to advance NCD control is a key goal, and effective approaches need to be advanced if countries are to meet local and global targets [4]. Given the widespread access to mobile phones globally and rapidly expanding capabilities of digital devices, mobile technology is increasingly finding a place in monitoring communicable and noncommunicable diseases, and their associated risk factors [5–7]. Simple mobile phone surveys (MPS) deployed through live operator administered interviews, pre-recorded automated interactive voice response (IVR) surveys, or automated text messaging have recently been trialed to facilitate large-scale population monitoring of NCD risk factors in Colombia, Uganda, and other countries [8–12]. What makes these efforts particularly attractive to policymakers, public health practitioners, and researchers is their relatively low cost, minimal technological requirements, and potential to cut data collection and processing times down from year(s) to weeks [5, 7]. While mobile phone-based NCD risk factor monitoring presents opportunities for the advancement of global public health surveillance, emerging practices (...truncated)