Myths and Misinformation: An Analysis of Text Messages Sent to a Sexual and Reproductive Health Q & A Service in Nigeria

"We find a substantial unmet need for basic SRH information, with users' questions communicated in ways that convey considerable confusion, misinformation, and urgency."

This was the key finding resulting from content analysis of more than 300,000 text messages received by the MyQuestion SMS and hotline service in Nigeria between 2007 and January 2012. The MyQuestion platform allows young people to ask sexual and reproductive health (SRH) questions via text message, email, or an online form, which are answered by trained counsellors using a database of answers or customised replies. The content analysis sought to improve and inform this and similar Question & Answer services, as well as to help improve SRH services for young people more generally by better understanding the SRH information that young people desire, the misperceptions and myths they have acquired, and their concerns and worries.

This journal article discusses data gathered as part of the MyQuestion service, which was initiated as a pilot project from 2007 to 2009, and then scaled up to reach 19 states across Nigeria from February 2009 through January 2012. Users of the MyQuestion service can send their questions to a free short code through their mobile phone, or they can send an email, call a phone number, or complete a web form on the project website. "By the end of April 2012, over 120,000 students in 239 schools and seven out-of-school centers had used the eLearning platform, with over 2,500 teachers and about 1,000 peer educators trained."

The content analysis sought to address three questions: which health topics are most frequently submitted to the MyQuestion service; what kinds of questions are asked about these topics; and what language is used to convey the questions? The article discusses results based on each of these questions. In terms of kinds of questions asked, HIV/AIDS was the most commonly referenced sexual and reproductive health topic (MyQuestion was initially marketed primarily as a platform for HIV/AIDS information), but there was also a large volume of queries about topics unrelated to reproductive health, such as malaria, cancer, or general health symptoms. Many queries were related to early adolescence and what can be expected during puberty, as well as teenagers' physical and emotional struggles associated with puberty and sexual development.

The majority of text messages about sexual and reproductive health are requests for factual information, such as about contracting or preventing HIV/AIDS, as well as preventing pregnancy. Users also sought information about sex, menstruation, complications of abortions, side effects of taking medications and supplements, etc. In many cases questions sought to clarify accuracy of information. As stated in the article, "the database is a rich source of information on myths and misperceptions about sexual and reproductive health that may be common in Nigeria. There is a great deal of misinformation submitted about virginity, pregnancy prevention and termination, HIV infection, masturbation, and other sexual behaviors." Other questions centred on requests for advice and accessing services. The analysis also highlighted patterns in the language and phrasing used to express the health questions. "We consistently noted a sense of urgency in the questions. Many questions contain hypothetical scenarios or specific descriptions of an issue at hand." Many of the questions submitted ask for confirmation of perceptions and hearsay about sexual health issues.

The discussion of results notes that while anonymity offered by a text message service is an appealing feature for young people, this also limits the ability of counsellors to customise responses. Likewise, an SMS has a limited amount of information it can convey, and while some questions were referred to the telephonic helpline, users did not always follow up on referrals. However, based on the responses and analysis, the article concludes that "MyQuestion has clearly responded to a desire for a confidential, anonymous way for young people to address sexual and reproductive health issues." The analysis also suggests that "the knowledge gaps that are evident in the MyQuestion messages, paired with the volume of queries received by the system, indicate a substantial unmet need for basic sexual and reproductive health information and services in Nigeria." Users messages also highlight the need for non-judgmental and supportive responses. One suggestion mentioned in the article is that "there is potential for involving young people in composing such responses based on their own experience; this potential may be a distinct advantage of this type of service for providing sexual and reproductive health information for young people."