# Process evaluation for the delivery of a water, sanitation, and hygiene mobile health program: randomized controlled trial of the WASHmobile PICHA7 program

## TL;DR

A mobile health program called WASHmobile was tested in the DRC to improve water, sanitation, and hygiene behaviors and reduce diarrheal diseases.

## Contribution

The study demonstrates the feasibility and high reach of a WASH mHealth program in a low-resource setting.

## Key findings

- 84% of households received unique text messages and 90% of voice and IVR messages were answered.
- 72% of households reported receiving a WASHmobile message in the past 2 weeks during surveillance visits.
- 74% of participants shared a WASHmobile message with others at least once.

## Abstract

Diarrhea outbreaks including cholera have reached global highs this year. In the Democratic Republic of the Congo (DRC), there are estimated to be over 93 million diarrhea episodes annually. Effective and scalable water, sanitation, and hygiene (WASH) interventions are urgently needed to reduce diarrheal diseases in the DRC. Mobile health (mHealth) reminders have been shown to reduce disease morbidity and increase health-protective behaviors. Therefore, WASH mHealth programs present a promising approach to improve WASH behaviors.

The WASHmobile Preventative-Intervention-for-Cholera-for-7-days (PICHA7) program is a targeted WASH intervention combining voice and SMS mHealth messages and quarterly in-person visits delivered to diarrhea patient households in DRC to reduce diarrheal diseases. During the randomized controlled trial of WASHmobile, 1196 participants received weekly WASHmobile program voice, Interactive Voice Response (IVR) quiz, and text messages over 12 months. Outcome indicators included % of unique voice, IVR, and text messages received (fidelity) and % of unique messages fully listened to (dose), assessed using the engageSPARK mobile message platform, and program reach to households assessed through monthly follow-up visits.

Eighty-four percent of households received unique text messages and 90% of unique voice and IVR messages were answered. Households reported receiving a WASHmobile mHealth message in the past 2 weeks at 72% of surveillance visits (844/1177). Seventy-four percent (309/418) of participants reported sharing a WASHmobile mHealth message with another person at least once.

These findings show high fidelity, dose, and reach of mobile message delivery in the WASHmobile mHealth program. This study demonstrates the feasibility of delivering the WASHmobile PICHA7 program in eastern DRC and provides important insights for delivering WASH mHealth programing in low- and middle-income countries globally.

NCT05166850.

The online version contains supplementary material available at 10.1186/s41182-025-00881-8.