Society for Advanced Learning Technology: New Learning Technologies 2010 Conference

Mobile Outreach to Underserved Demographics

Cesar Bandera, Peter Schmitt Mitchel Rosen Founding Partners, Cell Podium Director of the Office of Public Health Practice [email protected] University of Med. & Dentistry of New Jersey [email protected] [email protected]

ABSTRACT

Demographics underserved by the digital divide do not have access to the web but are frequent users of multimedia messaging on cell phones. Multimedia messaging can serve as an alternate medium for outreach, with the added benefits that messages are pushed and easy to share. Text messaging has become commonplace in mobile outreach (m-outreach) campaigns, but multimedia messaging has not because a lack of interoperability prevents the reliable delivery of content to the mobile device. The use of messaging and the web by underserved demographics is analyzed. We then discuss obstacles and solutions to m-outreach interoperability, including content adaptation. Lastly, we present lessons learned from the deployment of an m-outreach system that pushes rich media, including the high retention graphics and video characteristic of web-based mobile e-learning (m-learning), while maintaining the ubiquity of text-based m-outreach. The social nature of pushed multimedia is observed, including peer-to-peer forwarding and the contribution of new content by recipients. We conclude that m-outreach can serve as a cost- effective multimedia dissemination tool among both technology immigrants and natives.

KEY WORDS: mobile messaging, digital divide, outreach, media adaptation

M-OUTREACH VERSUS M-LEARNING Most m-learning is an extension of web-based e-learning. Unlike emerging services specific to the mobile medium In 2008, 61% of adults in the US searched the Web for such as location-aware social networking, current m- health information, most of which was then shared learning is not yet fully exploiting the medium’s adoption, within the user’s social ecosystem (Fox, 2009). just as television was first treated as an extension of radio Underserved populations affected by the digital divide and the web was treated as an extension of linear print. have less access to the web and are more vulnerable to M-learning participants are typically part of an enterprise; health disparities. However, their use of data functions they pull content onto web-enabled smartphones on cell phones is reported greater than their use of the subscribed to a data plan and with greater functionality Internet (Horrigan, 2008). These functions can deliver than legacy wireless application protocol browsers. shareable health outreach across the digital divide if the m-learning paradigm is changed to one of m-outreach. Whereas m-learning is an asynchronous transaction initiated by the recipient, m-outreach is a multicast 90% use the search health use mobile (one sender, many recipients) that pushes media to the internet info on internet media 80% 77% recipient automatically without his/her initiation or 76% intervention. M-outreach is commonly used for alerts 70% 65% 64% and periodic tips, such as the HEALTH-87000 program 60% 58% of the Centers for Disease Control (CDC). Because the 54% 56% 51% 50% participants are an ad-hoc group and not part of a 44% configuration-controlled enterprise, m-outreach uses 40% the most broadly supported mobile protocol: the Short 30% Message Service (SMS, i.e. text messaging). Ubiquity is achieved but at the expense of media richness. 20% 10% To disseminate effective health information to under- served, m-outreach must push rich media, including the 0% White African American Hispanic high retention graphics, video and animation with Figure 1. Access to mobile media contrasts with voiceovers characteristic of good m-learning, while access to online health information maintaining the ubiquity of SMS-based m-outreach.

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Society for Advanced Learning Technology: New Learning Technologies 2010 Conference

MOBILE MULTIMEDIA ADOPTION AMONG and fastest growing mobile protocol is the Multimedia UNDERSERVED DEMOGRAPHICS Messaging Service (MMS, i.e., picture and video messaging). MMS promotes health outreach by multi- The 2009 Spring Tracking Survey of 2,253 adults from casting rich media and by enabling the recipient to the Pew Internet and American Life Project provides forward it to others in his/her support ecosystem. insight into the access of underserved demographics to digital outreach. Use of a computer, whether at home Forty percent of adults who do not use a computer or work (green in Figure 2), correlates with education. view multimedia using MMS and mobile web versus Some of those who use a computer also access the web 4.7% who use mobile web alone (Figure 4). This with their cell phones (light green versus dark green in disparity is consistent across education categories, and Figure 2). However, among those who do not use a we can expect it to increase while the adoption rate of computer, few access the web with their cell phones MMS remains higher (possibly due to its lower cost, (light red versus dark red). The adoption of cell phone simpler interface, and peer-to-peer nature of MMS). data functions is thus not sufficient to significantly help convey web-based content across the digital divide. 100% 75 70 100% 80 80% 65 70 60 80% 60% 60 55 50 60% 50 40% 40 45 40% 30 20% 40 35 20 20% 0% 30 10

CHALLANGES TO MMS IN M-OUTREACH 80%

70% In spite of the ratification of the MMS protocol in 2001 and high user adoption, implementations of the MMS 60% protocol by device manufacturers and wireless service 50% providers (i.e., carriers) lack the interoperability of their SMS implementations (Smith, 2008). Multimedia 40% messages are occasionally received without content, 30% with poorly down-sampled content, or with content

20% replaced by a URL where the carrier posted the SMS multimedia (precluding MMS as an alternative to the % of wireless subscribers wireless of % 10% MMS web). Impediments to interoperability include the Internet following, which are mostly independent of the 0% Downloads Q2 2007 sophistication of the mobile device itself: Q3 2007 Video Q4 2007 Q1 2008 Q2 2008 1. Device manufacturers and carriers employ many Figure 3. MMS is the fastest growing and 2nd media formats and delivery protocols, but any one largest data service among cell phone users user will only be able to receive a small subset of Whereas the web is the protocol most used to access these formats and protocols depending on the on-line media with a tethered device, it is only the third user’s device, its date of manufacture, subscription most used protocol among mobile devices (Gill, 2008, plan, and carrier (LeBodic, 2005). Figure 3). The mobile media protocol most used is 2. Software compliance with communications SMS, which conveys only text; the second most used protocol and multimedia format standards varies among device manufacturers and carriers.

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Society for Advanced Learning Technology: New Learning Technologies 2010 Conference

3. Carriers employ a “walled garden” approach to subscriber retention that promotes multimedia services among its subscribers at the expense of interoperability with subscribers on different carriers (Bryce, 2006, Wu, 2007). 4. Some carriers block subscribers from installing 3rd party applications on non-smart phones. These subscribers can only install software purchased from their carrier. 5. Repurposing traditional e-learning content to mobile devices involves extensive adaptation due Figure 5. High-contrast gradients, wipes, and wide to the instructional design issues unique to their audio power spectrum in sample multimedia clips small screens, keypads, and bandwidth. We previously implemented an opt-in protocol that The successful delivery of m-outreach content requires required the user to enroll by sending an SMS or MMS tailoring it to each recipient. One approach is to call message. However, a significant number of users had User Agent Profiles, on-line descriptions of cell phone never sent an SMS or MMS message from their phone. models (e.g., screen size, codecs) developed to assist The current opt-in protocol does not assume of the user automated content adaptation, but 20% of these are any prior experience with SMS/MM, nor any technical incorrect (OMA, 2006). Moreover, a user’s preferred knowledge of mobile multimedia formats (the different media format is not determined exclusively by the sample clips are identified only by a large ID number device capabilities; two users with the same cell phone rendered in the video, audio, and message header). may prefer different formats (among those supported Interestingly, while users with no prior experience with by their device) because viewing the higher resolution SMS or MMS sometimes have a difficult time sending format requires pushing more keypad buttons. a message for the first time, they rarely have difficulty viewing a message that was sent to them. To prevent tailoring content to an incompatible or suboptimal format, we implemented an opt-in protocol for m-outreach that asks each user to select a favorite MOBILE MULTIMEDIA OUTREACH TRIAL format from among a set of device-specific options. The user enrolls in m-outreach by calling a VoiceXML Cell Podium and UMDNJ have tested this m-outreach server that captures the cell phone’s caller-ID, pushes design in the Just-In-Time Training for Emergency to the cell phone a set of numbered sample multimedia Incidents System (JITTEIS), which serves skilled clips, and asks the user to speak the number of his/her support personnel (SSP) (Bandera, 2007). SSP are favorite clip. All subsequent m-outreach to that user is deployed to aid first responders in emergency then tailored to the format of preferred clip. The user incidents, and include laborers, operating engineers, can also call to opt-out or change preferences. The carpenters, ironworkers, sanitation and utility workers. user cannot select a format that is incompatible with Often exposed to the same hazards as responders, SSP his/her phone, carrier, or account because the lack incident preparedness because their employment associated sample clip will not have been rendered. reinforces skill development and the range of potential scenarios is too broad. These factors increase personal Most modern cell phones will display at least two (and risk to the SSP and mission risk at the incident site. up to four) of the sample clips sent, and the opt-in protocol should “encourage” the user to select the clip JITTEIS maintains a collection of brief theme-specific whose format yields future m-outreach content with the multimedia safety courses. Upon an emergency, the best audiovisual quality. Consequently, the multimedia Incident Commander, Safety Officer, or dispatcher sample clips are authored to exercise the internal selects relevant safety courses (Figure 6). SSP components of the cell phone, including its audiovisual deployed to the incident are enrolled in JITTEIS which codecs, processing speed, speaker fidelity, and screen sends to their cell phones all lessons and messages resolution. All sample clips include smooth color associated with that incident, including updates. At gradients that are best rendered with large color any time, SSP can view the content on their cell palettes (many bits per pixel), motion that is best phones, and forward it to colleagues. SSP can also rendered with high frame rates and artifact-free send photos and videos captured on their cell phones to temporal video decompression, and an audio power JITTEIS via MMS or email; JITTEIS stores all media spectrum that extends beyond voice band (Figure 5). submitted from the field and assigns it to the selection of incident-relevant safety courses.

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Society for Advanced Learning Technology: New Learning Technologies 2010 Conference

Sites of influenza rash Testing PPE for proper fit Skin lesion from anthrax Suspicious plume at fire HTC on Verizon Motorola on Verizon LG on Cingular Nokia on T-Mobile Figure 6. Multimedia learning modules on different devices and carriers.

On April 2009, JITTEIS was evaluated by the Worker also high during the transmission of exercise courses at Education and Training Program (WETP) of the 8am on 5/1, as more conference attendees witnessed National Institute of Environmental Health Sciences at the receipt of multimedia by users registered in an emergency response training exercise involving a JITTEIS and opted to register as well. hazardous chemical leak in downtown Cincinnati. JITTEIS was used to disseminate videos to the cell 30 450 400 phones and mobile devices of the exercise participants, Exercise 25 Briefing 350 including the event alert; safety, chemical threat, and JITTEIS Instructions Distributed atSession preparedness instructions; site coordination; and live 20 300 Sent Courses pictures and videos submitted from the incident site by 250 the participants themselves. 15 200

Exercise participants enrolled in JITTEIS by calling the 10 150

Registered in JITTEIS Lunch 100 phone number of an automated attendant that recorded Exhibit # of Conference Participants 5 Opens 50 the participant’s cell phone number and multimedia Coffee Break preference. During the actual emergency response 0 0 exercise, thirteen courses were sent to each enrolled participant: seven previously authored and stored in the content management system and six provided by Figure 7. JITTEIS activity at 2009 WETP exercise participants for immediate dissemination. JITTEIS sent a total of 438 multimedia clips during the exercise (Figure 7). All registered users were able to view the clips on their mobile devices, even when their signal CONCLUSIONS AND NEXT STEPS coverage did not permit them to make or receive phone calls. The average time between JITTEIS sending M-outreach via SMS has become commonplace. content and users receiving it was 30 seconds. However, a lack of interoperability has precluded m- outreach with multimedia, and advances in mobile The social nature of m-outreach is visible in the logs of devices will not guarantee interoperability while JITTEIS activity during the WETP exercise (Figure 7). carriers and device manufacturers emphasize product NIEHS announced enrollment instructions at 4:30pm and service differentiation. on 4/30, but enrollment activity began at 9am as early adopters showed the JITTEIS sample multimedia clips The opportunity to span the digital divide by building they had received on their cell phones to others, on the high adoption of mobile multimedia among particularly during breaks. Enrollment activity was underserved demographics makes addressing the

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Society for Advanced Learning Technology: New Learning Technologies 2010 Conference

interoperability issues of multimedia m-outreach an REFERENCES important research agenda. Moreover, pushed m- outreach could address health disparities better than Bandera, C.; Rosen, M.; Schlegel, B. (2007). Just-In- pulled web-based content; the former does not require Time Training of Deployed Skilled Support the user to initiate the media transfer, it is shared more Personnel via Cell Phone Multimedia. I/ITSEC easily, and MMS is cheaper than mobile web access. Proceedings. Fox, Susannah; Jones, Sydney. (2009). The social life We present a middleware that achieves reliable of health information. Pew Internet & American profiling of the user’s mobile multimedia capabilities, Life Project, June 2009, San Diego, CA. which are a function of device, subscription, and user Gill, David. (2008). Mobile Data Usage and Users: preference. To simplify enrollment, this one-time Future Opportunities in Mobile Entertainment. operation is combined with an opt-in process, the latter Nielsen Mobile Customer Value Metrics, Q3 2008 being mandated by anti-spam regulations of the FCC. National. Retrieved December 1, 2008 from www.cdg.org/news/events/CDMASeminar/08_NAR Ongoing research is progressing along three directions. C/presentations/13_GILL%20NARC.pdf First, successful enrollment is being promoted by Horrigan, John (2008). Mobile access to data and enabling the VoiceXML server to call back users who information. Pew Internet and American Life have started the not completed the enrollment process. Project. March, 2008. This functionality was deemed necessary because a LeBodic, Gwenaël (2005). Mobile Messaging significant fraction of users were calling the server but Technologies and Services: SMS, EMS and MMS, not specifying their preference. Second, location- John Wiley & Sons. awareness is being added to m-outreach to enable the Norwood, Bryce (2006). Using NowSMS as an MMSC delivery of spatially targeted content. Open Geospatial in CDMA or CDMA2000 Environments, Document Consortium protocols are used to obtain the locations ID: TB-NOWSMS-010, Last Update: February 24, of enrolled cell phones. Lastly, scalability techniques 2006, NowSMS, UK. are being applied to m-outreach like those used to OMA (2006). White Paper on UAProf Best Practices lower the per-client cost of web-based outreach. Guide, 18 Jul 2006, Open Mobile Alliance. Smith, Brad (2008). MMS Expands, Just Not ACKNOWLEDGEMENTS Everywhere. WirelessWeek - December 01, 2008. Wu, Tim (2007). Wireless Net Neutrality: Cellular This work is supported by NIEHS grant Carterfone and Consumer Choice in Mobile 2R44ES014793-02. The authors thank The Center to Broadband, Working Paper #17, The New America Protect Workers’ Rights for permission to use training Foundation, Washington, DC. content in JITTEIS field trials.

ABOUT THE AUTHORS

Cesar Bandera is co-founder of Cell Podium and principle investigator for the just-in-time training program under NIEHS/WETP which received the 2007 New Jersey Entrepreneurial Award. He has been researching multimedia and computer vision since 1985, first at Amherst Systems, NY, and then as Senior Systems Engineer at AT&T Labs. Dr. Bandera lectures on video processing for autonomous systems and holds patents in this field. He received his Masters in Computer Engineering and Ph.D. in Signal Processing at the University of Buffalo.

Peter Schmitt is co-founder of Cell Podium and lead developer for JITTEIS. He has been involved in mobile systems engineering from its beginning, managing the development of the first digital car phone at AEG Mobile Communication (Ulm, Germany). In 2001, Dr. Schmitt formed Schmitt and Associates, a company dedicated to web-based e-learning and multimedia. He received his Ph.D. in physics from the University of Würzburg, and conducted in high energy research at the CERN and Harvard University.

Mitchel Rosen is the Director of the Office of Public Health Practice at the UMDNJ-School of Public Health. Since 1992 he has been the Center Manager of the NIEHS sponsored New Jersey/New York Hazardous Materials Worker Training Center, overseeing a training program that has provided hazardous materials training to over 350,000 workers. Mr. Rosen has a MS in Public Health from the University of Massachusetts, Amherst and is a PhD candidate at the Rutgers University Bloustein School of Planning and Public Policy.

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