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Background Voice messages have been employed as an effective and efficient approach for increasing health service utilization and health promotion in low- and middle-income countries. However, unlike SMS, voice message services require their users to pick up a phone call at its delivery time. Furthermore, voice messages are difficult for the users to review their contents afterward. While recognizing that voice messages are more friendly to specific groups (eg, illiterate or less literate populations), there should be several challenges in successfully operationalizing its intervention program. Objective This study is aimed to estimate the extent to which voice message service users pick up the phone calls of voice messages and complete listening up to or beyond the core part of voice messages. Methods A voice message service program composed of 14 episodes on maternal, newborn, and child health was piloted in Lagos, Nigeria, from 2018 to 2019. A voice message call of each of 14 episodes was delivered to the mobile phones of the program participants per day for 14 consecutive days. A total of 513 participants in the voice message service chose one of five locally spoken languages as the language to be used for voice messages. Two multilevel logistic regression models were created to understand participants’ adherence to the voice message: (a) Model 1 for testing whether a voice message call is picked up; and (b) Model 2 for testing whether a voice message call having been picked up is listened to up to the core messaging part. Results The greater the voice message episode number became, the smaller proportion of the participants picked up the phone calls of voice message (aOR: 0.98; 95% CI: 0.97–0.99; P = .01). Only 854 of 3765 voice message calls having been picked up by the participants (22.7%) were listened to up to their core message parts. It was found that picking up a phone call did not necessarily ensure listening up to the core message part. This indicates a discontinuity between these two actions. Conclusions The participants were likely to stop picking up the phone as the episode number of voice messages progressed. In view of the discontinuity between picking up a phone call and listening up to the core message part, we should not assume that those picking up the phone would automatically complete listening to the entire or core voice message.

BACKGROUND Voice messages have been employed as the effective and efficient means for increasing health service utilizations and health promotion in low- and middle-income countries. Yet, unlike SMS, voice message services require their users to pick up a phone call at the time of its delivery. Furthermore, voice messages are difficult for the users to review their contents afterwards. While recognizing that voice messages are more friendly to specific groups (eg, illiterate or less literate populations), there should be several challenges in successfully operationalizing its intervention program. OBJECTIVE This study is aimed at estimating the extent to which voice message service users pick up the phone calls of voice messages and complete listening up to or beyond the core part of voice messages. METHODS A voice message service program composed of 14 episodes on maternal, newborn and child health was piloted in Lagos, Nigeria, during the period from 2017 to 2019. A voice message call of each of 14 episodes was delivered to the mobile phones of the program participants, per day for 14 consecutive days. A total of 513 participants in the voice message service chose one of five locally spoken languages as the language to be used for voice messages. Two multilevel logistic regression models were created: (1) Model 1 for testing whether a voice message call is picked up; and (2) Model 2 for testing whether a voice message call having been picked up is listened to up to the core messaging part. RESULTS The greater the voice message episode number became, the smaller proportion of the participants picked up the phone calls of voice message (aOR: 0.98; 95% CI: 0.97-0.99; P=.01). Only 854 of 3765voice message calls having been picked up by the participants (22.7%) were listened to up to their core message parts. It was found that the level of sequentiality between picking up a phone call of a voice message and listening up to the core message part was low. This indicates discontinuity between these two actions. CONCLUSIONS The participants were likely to stop picking up the phone as the episode number of voice messages progressed. In view of discontinuity and independence between picking up a phone call and listening up to the core message part, we should not assume that those picking up the phone would automatically complete listening to the entire or core voice message.