Natural language processing to evaluate texting conversations between patients and healthcare providers during COVID-19 Home-Based Care in Rwanda at scale
Authors: Lester Richard T , Manson Matthew , Semakula Muhammed , Jang Hyeju , Mugabo Hassan , Magzari Ali , Blackmer Junhong Ma , Fattah Fanan , Niyonsenga Simon Pierre , Rwagasore Edson , Ruranga Charles , Remera Eric , Ngabonziza Jean Claude S. , Carenini Giuseppe , Nsanzimana Sabin 
Published: August 2024

Isolation of patients with communicable infectious diseases limits spread of pathogens but can be difficult to manage outside hospitals. Rwanda deployed a digital health service nationally to assist public health clinicians to remotely monitor and support SARS-CoV-2 cases via their mobile phones using daily interactive short message service (SMS) check-ins. We aimed to assess the texting patterns and communicated topics to understand patient experiences. We extracted data on all COVID-19 cases and exposed contacts who were enrolled in the WelTel text messaging program between March 18, 2020, and March 31, 2022, and linked demographic and clinical data from the national COVID-19 registry. A sample of the text conversation corpus was English-translated and labeled with topics of interest defined by medical experts. Multiple natural language processing (NLP) topic classification models were trained and compared using F1 scores. Best performing models were applied to classify unlabeled conversations. Total 33,081 isolated patients (mean age 33·9, range 0-100), 44% female, including 30,398 cases and 2,683 contacts) were registered in WelTel. Registered patients generated 12,119 interactive text conversations in Kinyarwanda (n=8,183, 67%), English (n=3,069, 25%) and other languages. Sufficiently trained large language models (LLMs) were unavailable for Kinyarwanda. Traditional machine learning (ML) models outperformed fine-tuned transformer architecture language models on the native untranslated language corpus, however, the reverse was observed of models trained on English-only data. The most frequently identified topics discussed included symptoms (69%), diagnostics (38%), social issues (19%), prevention (18%), healthcare logistics (16%), and treatment (8·5%). Education, advice, and triage on these topics were provided to patients. Interactive text messaging can be used to remotely support isolated patients in pandemics at scale. NLP can help evaluate the medical and social factors that affect isolated patients which could ultimately inform precision public health responses to future pandemics.

Author Summary

We present the first application of NLP for categorizing text messages between patients and healthcare providers within a nationally scaled digital healthcare program. This study provides unique insights into the circumstances of home-based COVID-19 patients during the pandemic. Our trained topic classification models accurately categorized topics in both English and African language texts. Patients reported and discussed both medical and social issues with public healthcare providers. This approach has the potential to guide precision public health decisions and responses in future outbreaks, pandemics, and remote healthcare scenarios.