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Polillo A, Voineskos AN, Foussias G, Kidd SA, Sav A, Hawley S, Soklaridis S, Stergiopoulos V, Kozloff N. Using Digital Tools to Engage Patients With Psychosis and Their Families in Research: Survey Recruitment and Completion in an Early Psychosis Intervention Program. JMIR Ment Health 2021; 8:e24567. [PMID: 34057421 PMCID: PMC8204241 DOI: 10.2196/24567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/10/2021] [Accepted: 04/04/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Barriers to recruiting and retaining people with psychosis and their families in research are well-established, potentially biasing clinical research samples. Digital research tools, such as online platforms, mobile apps, and text messaging, have the potential to address barriers to research by facilitating remote participation. However, there has been limited research on leveraging these technologies to engage people with psychosis and their families in research. OBJECTIVE The objective of this study was to assess the uptake of digital tools to engage patients with provisional psychosis and their families in research and their preferences for different research administration methods. METHODS This study used Research Electronic Data Capture (REDCap)-a secure web-based platform with built-in tools for data collection and storage-to send web-based consent forms and surveys on service engagement via text message or email to patients and families referred to early psychosis intervention services; potential participants were also approached or reminded about the study in person. We calculated completion rates and timing using remote and in-person methods and compensation preferences. RESULTS A total of 447 patients with provisional psychosis and 187 of their family members agreed to receive the web-based consent form, and approximately half of the patients (216/447, 48.3%) and family members (109/187, 58.3%) consented to participate in the survey. Most patients (182/229, 79.5%) and family members (75/116, 64.7%) who completed the consent form did so remotely, with more family members (41/116, 35.3%) than patients (47/229, 20.5%) completing it in person. Of those who consented, 77.3% (167/216) of patients and 72.5% (79/109) of family members completed the survey, and most did the survey remotely. Almost all patients (418/462, 90.5%) and family members (174/190, 91.6%) requested to receive the consent form and survey by email, and only 4.1% (19/462) and 3.2% (6/190), respectively, preferred text message. Just over half of the patients (91/167, 54.5%) and family members (42/79, 53.2%) preferred to receive electronic gift cards from a coffee shop as study compensation. Most surveys were completed on weekdays between 12 PM and 6 PM. CONCLUSIONS When offered the choice, most participants with psychosis and their families chose remote administration methods, suggesting that digital tools may enhance research recruitment and participation in this population, particularly in the context of the COVID-19 global pandemic.
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Affiliation(s)
- Alexia Polillo
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - George Foussias
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sean A Kidd
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andreea Sav
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Steve Hawley
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sophie Soklaridis
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Wanyonyi K, Couch C, John J, Louca C. e-Oral health interventions for older patients in an outreach primary dental care centre: A pilot trial nested acceptability study. Gerodontology 2021; 39:241-249. [PMID: 34018237 DOI: 10.1111/ger.12562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/21/2021] [Accepted: 04/28/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the acceptability and perceived helpfulness of an e-Oral Health intervention in form of text messages versus standard dental leaflets provided after a dental visit to patients aged 65 years and over. BACKGROUND Oral health care needs for older people are increasing. Remote interventions using e-Health can ensure oral care is provided despite physical hindrances or situations where dental appointments are limited such as has happened more widely during the COVID-19 pandemic. MATERIALS AND METHODS Mixed-method nested study within a pilot trial. Dental patients (n = 150) at an outreach primary dental care centre, ≥ 65 years old, were recruited and randomly allocated to e-Oral health text messages or leaflet intervention arms. Post-intervention (6 months), participants responded to open and closed-ended two-way survey phone texts. Survey questions investigated: (a) whether they would recommend the intervention, (b) intervention helpfulness and (c) OPEN feedback. Average helpfulness scores (Scale:1= Very Helpful to 5= Not Helpful at All) were compared for each arm using Independent Sample t-test. Percentage of participants providing positive recommendations in each arm were compared using chi-squared tests. Qualitative findings were analysed using thematic analysis. RESULTS N = 68 (45%) responded. Mean helpfulness scores in text group M = 2.2, SD=1.1) and leaflet group M = 2.3, SD=1.9, P = .29. Amongst the text arm respondents, 89% compared with 68.2% in leaflet arm; P = .005 would recommend the intervention. Four qualitative themes were outlined: intervention approach, content, behavioural impact and recommendations. CONCLUSION e-Oral Health text interventions are acceptable and helpful to older people, but these messages need to be tailored.
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Affiliation(s)
- Kristina Wanyonyi
- Queen Mary, Institute of Dentistry, Centre for Dental Public Health and Primary Care, Barts and The London School of Medicine and Dentistry, University of London, London, UK.,Formerly University of Portsmouth Dental Academy, Portsmouth, UK
| | | | - Jeyanthi John
- Public Health England South East (Wessex), London, UK
| | - Chris Louca
- University of Portsmouth Dental Academy, Portsmouth, UK
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Levine G, Salifu A, Mohammed I, Fink G. Mobile nudges and financial incentives to improve coverage of timely neonatal vaccination in rural areas (GEVaP trial): A 3-armed cluster randomized controlled trial in Northern Ghana. PLoS One 2021; 16:e0247485. [PMID: 34010312 PMCID: PMC8133473 DOI: 10.1371/journal.pone.0247485] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 02/07/2021] [Indexed: 12/22/2022] Open
Abstract
Background Despite progress in vaccination coverage, timeliness of childhood vaccination remains a challenge in many settings. We aimed to assess if mobile phone-based reminders and incentives to health workers and caregivers could increase timely neonatal vaccination in a rural, low-resource setting. Methods We conducted an open-label cluster randomized controlled 1:1:1 trial with three arms in 15 communities in Northern Ghana. Communities were randomized to 1) a voice call reminder intervention; 2) a community health volunteer (CHV) intervention with incentivized rewards; 3) control. In the voice call reminder arm, a study staff member made voice calls to mothers shortly after birth to encourage vaccination and provide personalized information about available vaccination services. In the incentive arm, CHVs promoted infant vaccination and informed women with recent births about available vaccination opportunities. Both CHVs and women were provided small monetary incentives for on-time early infant vaccination in this arm, delivered using mobile phone-based banking applications. No study activities were conducted in control communities. A population-based survey compared vaccination coverage across arms in the pre-intervention and intervention periods. The primary endpoint was completion of at least one dose of Polio vaccine within 14 days of life and BCG vaccination within 28 days of life. Results Six-hundred ninety births were identified; 106, 88, and 88 from pre-intervention and 150, 135, and 123 in the intervention period, in the control, voice call reminder and CHV incentive arms, respectively. In adjusted intent-to-treat analysis, voice call reminders were associated with 10.5 percentage point (95% CI: 4.0, 17.1) higher coverage of on-time vaccination, while mobile phone-based incentives were associated with 49.5 percentage point (95% CI: 26.4, 72.5) higher coverage. Conclusion Community-based interventions using mobile phone technologies can improve timely early vaccination coverage. A CHV approach with incentives to community workers and caregivers was a more effective strategy than voice call reminders. The impact of vaccination “nudges” via voice calls may be constrained in settings where network coverage and phone ownership are limited. Trial registration This trial was registered at ClinicalTrials.gov; NCT03797950.
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Affiliation(s)
- Gillian Levine
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| | | | | | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Bergroth R, Matikainen M, Rannikko A. Mobile PSA: A Novel Telehealth Tool for Prostate Cancer Follow-Up. EUR UROL SUPPL 2021; 28:43-46. [PMID: 34337524 PMCID: PMC8317875 DOI: 10.1016/j.euros.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/23/2022] Open
Abstract
The prevalence of prostate cancer (PCa) is increasing. As the prognosis of PCa continues to improve, the increasing follow-up requirements after radical prostatectomy or radiotherapy puts significant pressure on health care systems. Follow-up is typically conducted by treating urologists, specialized nurses, or general practitioners. Despite the increase in patient numbers, resources are not likely to increase in proportion. Furthermore, the ongoing COVID-19 pandemic has led to a paradigm shift in our thinking towards telehealth solutions, primarily to avoid or limit physical contact and to spare resources. Here we report our novel telehealth solution for PCa follow-up, called Mobile PSA. Currently, more than 4500 PCa patients have been using Mobile PSA follow-up in our center. Mobile PSA can increase follow-up accuracy, as all biochemical relapses will be detected in a timely manner, can significantly reduce delays in reporting prostate-specific antigen results to patients, and can significantly reduce costs. Patient summary We assessed a new telehealth information system for prostate cancer follow-up that does not use an app. More than 4500 prostate cancer patients in our center have used this system, called Mobile PSA, for follow-up. The system significantly reduces delays in reporting prostate-specific antigen (PSA) test results to patients, increases the accuracy of detecting recurrence of elevated PSA, and reduces costs.
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Affiliation(s)
- Robin Bergroth
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Corresponding author. Department of Urology, Helsinki University Hospital, P.O. Box 900, FI-00029 HUS, Finland. Tel. +358 9 4711; Fax: +358 9 47166684.
| | - Mika Matikainen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Rannikko
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Alsahli M, Abd-alrazaq A, Househ M, Konstantinidis S, Blake H. The Effectiveness of Mobile Phone Messaging–Based Interventions to Promote Physical Activity in Type 2 Diabetes Mellitus: Systematic Review and Meta-analysis (Preprint).. [DOI: 10.2196/preprints.29663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND
The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide. Physical activity (PA) is an important aspect of self-care and first line management for T2DM. SMS text messaging can be used to support self-management in people with T2DM, but the effectiveness of mobile text message–based interventions in increasing PA is still unclear.
OBJECTIVE
This study aims to assess the effectiveness of mobile phone messaging on PA in people with T2DM by summarizing and pooling the findings of previous literature.
METHODS
A systematic review was conducted to accomplish this objective. Search sources included 5 bibliographic databases (MEDLINE, Cochrane Library, CINAHL, Web of Science, and Embase), the search engine <i>Google Scholar</i> (Google Inc), and backward and forward reference list checking of the included studies and relevant reviews. A total of 2 reviewers (MA and AA) independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence evaluation. The results of the included studies were synthesized narratively and statistically, as appropriate.
RESULTS
We included 3.8% (6/151) of the retrieved studies. The results of individual studies were contradictory regarding the effectiveness of mobile text messaging on PA. However, a meta-analysis of the results of 5 studies showed no statistically significant effect (<i>P</i>=.16) of text messages on PA in comparison with no intervention. A meta-analysis of the findings of 2 studies showed a nonsignificant effect (<i>P</i>=.14) of text messages on glycemic control. Of the 541 studies, 2 (0.4%) found a nonsignificant effect of text messages on anthropometric measures (weight and BMI).
CONCLUSIONS
We could not draw a definitive conclusion regarding the effectiveness of text messaging on PA, glycemic control, weight, or BMI among patients with T2MD, given the limited number of included studies and their high risk of bias. Therefore, there is a need for more high-quality primary studies.
CLINICALTRIAL
PROSPERO International Prospective Register of Systematic Reviews CRD42020156465; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=156465
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Leal Neto O, Haenni S, Phuka J, Ozella L, Paolotti D, Cattuto C, Robles D, Lichand G. Combining Wearable Devices and Mobile Surveys to Study Child and Youth Development in Malawi: Implementation Study of a Multimodal Approach. JMIR Public Health Surveill 2021; 7:e23154. [PMID: 33536159 PMCID: PMC7980111 DOI: 10.2196/23154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/05/2020] [Accepted: 02/02/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Multimodal approaches have been shown to be a promising way to collect data on child development at high frequency, combining different data inputs (from phone surveys to signals from noninvasive biomarkers) to understand children's health and development outcomes more integrally from multiple perspectives. OBJECTIVE The aim of this work was to describe an implementation study using a multimodal approach combining noninvasive biomarkers, social contact patterns, mobile surveying, and face-to-face interviews in order to validate technologies that help us better understand child development in poor countries at a high frequency. METHODS We carried out a mixed study based on a transversal descriptive analysis and a longitudinal prospective analysis in Malawi. In each village, children were sampled to participate in weekly sessions in which data signals were collected through wearable devices (electrocardiography [ECG] hand pads and electroencephalography [EEG] headbands). Additionally, wearable proximity sensors to elicit the social network were deployed among children and their caregivers. Mobile surveys using interactive voice response calls were also used as an additional layer of data collection. An end-line face-to-face survey was conducted at the end of the study. RESULTS During the implementation, 82 EEG/ECG data entry points were collected across four villages. The sampled children for EEG/ECG were 0 to 5 years old. EEG/ECG data were collected once a week. In every session, children wore the EEG headband for 5 minutes and the ECG hand pad for 3 minutes. In total, 3531 calls were sent over 5 weeks, with 2291 participants picking up the calls and 984 of those answering the consent question. In total, 585 people completed the surveys over the course of 5 weeks. CONCLUSIONS This study achieved its objective of demonstrating the feasibility of generating data through the unprecedented use of a multimodal approach for tracking child development in Malawi, which is one of the poorest countries in the world. Above and beyond its multiple dimensions, the dynamics of child development are complex. It is the case not only that no data stream in isolation can accurately characterize it, but also that even if combined, infrequent data might miss critical inflection points and interactions between different conditions and behaviors. In turn, combining different modes at a sufficiently high frequency allows researchers to make progress by considering contact patterns, reported symptoms and behaviors, and critical biomarkers all at once. This application showcases that even in developing countries facing multiple constraints, complementary technologies can leverage and accelerate the digitalization of health, bringing benefits to populations that lack new tools for understanding child well-being and development.
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Affiliation(s)
- Onicio Leal Neto
- Department of Economics, University of Zurich, Zurich, Switzerland
| | - Simon Haenni
- Department of Economics, University of Zurich, Zurich, Switzerland
| | - John Phuka
- College of Medicine, University of Malawi, Lilongwe, Malawi
| | | | | | - Ciro Cattuto
- ISI Foundation, Turin, Italy
- Department of Computer Science, University of Torino, Turin, Italy
| | - Daniel Robles
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
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Conde-Caballero D, Rivero-Jiménez B, Cipriano-Crespo C, Jesus-Azabal M, Garcia-Alonso J, Mariano-Juárez L. Treatment Adherence in Chronic Conditions during Ageing: Uses, Functionalities, and Cultural Adaptation of the Assistant on Care and Health Offline (ACHO) in Rural Areas. J Pers Med 2021; 11:173. [PMID: 33801439 PMCID: PMC7999645 DOI: 10.3390/jpm11030173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 12/16/2022] Open
Abstract
The increasingly common scenario of an ageing population is related to a rise in the prevalence of problems associated with chronic conditions and comorbidities. Polypharmacy is frequent among this population, and it is a situation that can create medication management and adherence issues. This article introduces the features and functionalities of a voice assistant (Assistant on Health and Care Offline, ACHO) that aims to facilitate treatment adherence among elderly adults. Specifically adapted for its use in rural contexts, it does not require an Internet connection. Its development consisted of two stages: a first stage of problem diagnosis, in which the classic tools of ethnographic fieldwork were used, and a second stage of design implementing methodologies developed by Ambient Assisted Living (AAL) programmes. The main design characteristic of this new digital care system is that it is adapted to the needs of its end-users. It includes features such as voice customisation and the personal identification of medication, it can be connected to other digital devices, and information is introduced and supervised by healthcare professionals. These custom features introduce a safer medication administration procedure, improve supervision strategies, and increase patients' trust in the prescription process.
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Affiliation(s)
- David Conde-Caballero
- Department of Nursing, Faculty of Nursing and Occupational Therapy, University of Extremadura, 10003 Cáceres, Spain; (D.C.-C.); (L.M.-J.)
| | - Borja Rivero-Jiménez
- Department of Computer and Telematic Systems Engineering, Polytechnic School, University of Extremadura, 10003 Cáceres, Spain; (M.J.-A.); (J.G.-A.)
| | - Carmen Cipriano-Crespo
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla La Mancha, 13071 Ciudad Real, Spain;
| | - Manuel Jesus-Azabal
- Department of Computer and Telematic Systems Engineering, Polytechnic School, University of Extremadura, 10003 Cáceres, Spain; (M.J.-A.); (J.G.-A.)
| | - Jose Garcia-Alonso
- Department of Computer and Telematic Systems Engineering, Polytechnic School, University of Extremadura, 10003 Cáceres, Spain; (M.J.-A.); (J.G.-A.)
| | - Lorenzo Mariano-Juárez
- Department of Nursing, Faculty of Nursing and Occupational Therapy, University of Extremadura, 10003 Cáceres, Spain; (D.C.-C.); (L.M.-J.)
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Lee M, You M. Effects of COVID-19 Emergency Alert Text Messages on Practicing Preventive Behaviors: Cross-sectional Web-Based Survey in South Korea. J Med Internet Res 2021; 23:e24165. [PMID: 33544691 PMCID: PMC7909457 DOI: 10.2196/24165] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/23/2020] [Accepted: 02/04/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Sending emergency messages via mobile phone text messaging can be a promising communication tool to rapidly disseminate information and promote preventive behavior among the public during epidemic outbreaks. The battle to overcome COVID-19 is not yet over; thus, it is essential that the public practices preventive measures to prevent the spread of COVID-19. OBJECTIVE This study aimed to investigate the effectiveness of reading and obtaining information via emergency alert SMS text messages and their effects on the individual's practice of preventive behaviors during the early stages of the COVID-19 outbreak in South Korea. METHODS A cross-sectional web-based survey comprising 990 participants was conducted over 3 days (March 25-27, 2020). A multivariable logistic regression analysis revealed the sociodemographic factors that might influence the behavior of reading emergency alert text messages. A hierarchical linear regression model estimated the associations between reading emergency alert text messages for each precautionary behavior practiced against COVID-19. Additionally, the indirect effects of reading the text messages on each precautionary behavior via psychological factors (ie, perceived risk and response efficacy) were calculated. All data were weighted according to the 2019 Korea census data. RESULTS Overall, 49.2% (487/990) of the participants reported that they always read emergency alert text messages and visited the linked website to obtain more information. Factors such as female sex (odds ratio [OR] 1.68, 95% CI 1.28-2.21) and older age (30-39 years: OR 2.02, 95% CI 1.25-3.28; 40-49 years: OR 2.84, 95% CI 1.80-4.47; 50-59 years: OR 3.19, 95% CI 2.01-5.06; 60 years and above: OR 3.12, 95% CI 2.00-4.86 versus 18-29 years) were identified to be associated with a higher frequency of reading the text messages. Participants who always read the text messages practiced wearing facial masks (β=.074, P=.01) more frequently than those who did not. In terms of social distancing, participants who reported they always read the text messages avoided crowded places (β=.078, P=.01) and canceled or postponed social gatherings (β=.103, P<.001) more frequently than those who did not read the text messages. Furthermore, reading text messages directly and indirectly affected practicing precautionary behaviors, as the mediation effect of response efficacy between reading text messages and practicing preventive behaviors was significant. CONCLUSIONS Our findings suggest that emergency alert text messages sent to individuals' mobile phones are timely and effective strategies for encouraging preventive behavior in public. Sending emergency alert text messages to provide the public with accurate and reliable information could be positively considered by the health authorities, which might reduce the negative impact of infodemics.
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Affiliation(s)
- Minjung Lee
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.,Office of Dental Education, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Myoungsoon You
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
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Randomized controlled study using text messages to help connect new medicaid beneficiaries to primary care. NPJ Digit Med 2021; 4:26. [PMID: 33589706 PMCID: PMC7884833 DOI: 10.1038/s41746-021-00389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 01/05/2021] [Indexed: 11/08/2022] Open
Abstract
Accessing primary care is often difficult for newly insured Medicaid beneficiaries. Tailored text messages may help patients navigate the health system and initiate care with a primary care physician. We conducted a randomized controlled trial of tailored text messages with newly enrolled Medicaid managed care beneficiaries. Text messages included education about the importance of primary care, reminders to obtain an appointment, and resources to help schedule an appointment. Within 120 days of enrollment, we examined completion of at least one primary care visit and use of the emergency department. Within 1 year of enrollment, we examined diagnosis of a chronic disease, receipt of preventive care, and use of the emergency department. 8432 beneficiaries (4201 texting group; 4231 control group) were randomized; mean age was 37 years and 24% were White. In the texting group, 31% engaged with text messages. In the texting vs control group after 120 days, there were no differences in having one or more primary care visits (44.9% vs. 45.2%; difference, −0.27%; p = 0.802) or emergency department use (16.2% vs. 16.0%; difference, 0.23%; p = 0.771). After 1 year, there were no differences in diagnosis of a chronic disease (29.0% vs. 27.8%; difference, 1.2%; p = 0.213) or appropriate preventive care (for example, diabetes screening: 14.1% vs. 13.4%; difference, 0.69%; p = 0.357), but emergency department use (32.7% vs. 30.2%; difference, 2.5%; p = 0.014) was greater in the texting group. Tailored text messages were ineffective in helping new Medicaid beneficiaries visit primary care within 120 days.
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Sagalla N, Lee R, Lyles K, Vognsen J, Colón-Emeric C. Extent of and reasons for osteoporosis medication non-adherence among veterans and feasibility of a pilot text message reminder intervention. Arch Osteoporos 2021; 16:21. [PMID: 33527160 PMCID: PMC8300873 DOI: 10.1007/s11657-021-00889-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/06/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED We determined the extent of and reasons for non-adherence to oral bisphosphonates among veterans and conducted a pilot text message reminder application aimed at the most commonly cited reason for non-adherence. The intervention was found to be acceptable and feasible. PURPOSE To evaluate the extent of and reasons for non-adherence to oral bisphosphonates among veterans and to assess the acceptability and feasibility of a pilot text message reminder application. METHODS We surveyed 105 veterans initiating oral bisphosphonates for osteoporosis/osteopenia within the prior 18 months utilizing a validated self-report measure adapted for osteoporosis. Additionally, we conducted a pilot text message reminder to determine feasibility in 12 veterans who were initiating or were currently non-adherent to oral bisphosphonates. RESULTS Of the 43 (40.9% response rate) completed surveys, the most common reasons for non-adherence were "I forgot" (37.5%), "I had other medications to take" (20.5%), "my bones are not weak" (18.4%), "I felt well" (18.4%), and "I worried about taking them for the rest of my life" (17.9%). Median MPR for the 49 (46.7%) non-adherent (MPR < 0.80) veterans was 0.35 (IQR 0.21-0.64). Of veterans offered a weekly automated text message reminder, 12 (50%) accepted. Nine of these 12 veterans reported that the text message reminders did "very well" at reminding them to take their medication and would recommend the application to other patients/family/friends. The median 6-month MPR for the reminder group was 0.96 (IQR 0.54-1.00). CONCLUSION Half the veterans in our sample were taking insufficient doses of oral bisphosphonates to attain the full benefit of fracture risk reduction. Reasons for poor adherence included forgetfulness, polypharmacy, and misconceptions about osteoporosis. A pilot text message reminder intervention targeted to one of the most commonly cited reasons was found to be acceptable and feasible among veterans.
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Affiliation(s)
- Nicole Sagalla
- Duke University Medical Center, Department of Medicine, Division of Endocrinology, Durham, NC, USA
| | - Richard Lee
- Duke University Medical Center, Department of Medicine, Division of Endocrinology, Durham, NC, USA,Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham, NC, USA
| | - Kenneth Lyles
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham, NC, USA,Duke University Medical Center, Department of Medicine, Division of Geriatrics, Durham, NC, USA
| | - Julie Vognsen
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham, NC, USA
| | - Cathleen Colón-Emeric
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham, NC, USA,Duke University Medical Center, Department of Medicine, Division of Geriatrics, Durham, NC, USA
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Weber K, DaSilva AF, Dault JT, Eber R, Huner K, Jones D, Kornman K, Ramaswamy V, Snyder M, Ward BB, Nalliah RP. Using business intelligence and data visualization to understand the characteristics of failed appointments in dental school clinics. J Dent Educ 2021; 85:521-530. [PMID: 33508149 DOI: 10.1002/jdd.12538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVES Broken appointments are an important cause of waste in health care. Patients who fail to attend incur costs to providers, deny trainees learning opportunities, and impact their own health as well as that of other patients who are waiting for care. METHODS A total of 410,000 appointment records over 3 years were extracted from our electronic health record. We conducted exploratory data analysis and assessed correlations between appointment no-shows and other attributes of the appointment and the patient. The University of Michigan Medical School's Committee on Human Research reviewed the study and deemed that no Institutional Review Board oversight was necessary for this quality improvement project that was, retrospectively, turned into a study with previously de-identified data. RESULTS The patient's previous attendance record is the single most significant correlation with attendance. We found that patients who said they are "scared" of dental visits were 62% as likely to attend as someone reporting "no problem." Patients over 65 years of age have better attendance rates. There was a positive association between receiving email/text confirmation and attendance. A total of 94.9% of those emailed a reminder and 92.2% of those who were texted attended their appointment. CONCLUSION(S) We were able to identify relationships of several variables to failed and attended appointments that we were previously unknown to us. This knowledge enabled us to implement interventions to support better attendance at Dental Clinics at the University of Michigan, improving patient health, student training, and efficient use of resources.
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Affiliation(s)
- Kate Weber
- Health Infrastructures and Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexandre F DaSilva
- Dental, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Jean T Dault
- University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Robert Eber
- Dental, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Kim Huner
- University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Darlene Jones
- Dental Hygiene, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Kenneth Kornman
- Dental, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Vidya Ramaswamy
- Assessment, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Mark Snyder
- Vertically Integrated Clinic, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Brent B Ward
- Oral Maxillofacial Surgery, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Romesh P Nalliah
- Patient Services, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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van Leer E, Lewis B, Porcaro N. Effect of an iOS App on Voice Therapy Adherence and Motivation. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:210-227. [PMID: 33476177 PMCID: PMC8740599 DOI: 10.1044/2020_ajslp-19-00213] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 12/17/2019] [Accepted: 09/28/2020] [Indexed: 05/22/2023]
Abstract
Purpose Patients commonly report difficulties adhering to voice therapy. An iOS app was developed in our lab that assists practice via reminder notifications, instructional recordings, and cepstral peak prominence analysis results. The purpose of this study was to assess the effect of such homework support modality on adherence behavior and associated motivation in a comparison of app support and written homework instructions and to assess the usability and utility of the app. Method Thirty-four individuals exhibiting adducted hyperfunction were randomized to receive either written homework instructions or the app when practicing resonant voice exercises for 3 weeks. All patients digitally audio-recorded all home practice, provided self-reported estimates of generalization, and completed weekly motivation scales. Results App support significantly increased practice frequency but did not affect self-reported generalization or motivation. Practice was significantly predicted by System Usability Scale scores. Utility of reminders and instructions were good, but cepstral peak prominence feedback was considered useful to only a subset of participants. Conclusion Interactive mobile therapy support can significantly increase practice of resonant voice homework without influencing motivation.
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Affiliation(s)
- Eva van Leer
- Department of Communication Sciences and Disorders, Georgia State University, Atlanta
| | - Brittney Lewis
- Autonomous Reanimation and Evacuation Program, The Geneva Foundation, San Antonio, TX
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Winter Sports Resorts and Natural Environment—Systematic Literature Review Presenting Interactions between Them. SUSTAINABILITY 2021. [DOI: 10.3390/su13020636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The systematic literature review method was adopted to analyze the content of papers published since 2001 that focused on interactions between winter sports resort operations and the natural environment. A total of 86 papers published in journals indexed in SCOPUS data base were analyzed. Three main groups of topics presented in analyzed papers were found: the environmental impact of winter sports resorts, the management of environmental impacts and sustainable development of winter sports resorts, and finally the impact of climate change on winter sports resort operations. The biggest number of publications were devoted to the latter topic, and interest in conducting research within this area has apparently grown during the last two decades. However, most conclusions reached by the authors of numerous studies are site-specific and difficult to extend to other resorts/destinations. Additionally, the conclusions presented in many papers are contrary to the results achieved in other publications. Several gaps in our contemporary scientific knowledge and directions of future research are suggested in addition to the abovementioned results of the analysis conducted in the presented paper as the final conclusion of the research.
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Iribarren SJ, Akande TO, Kamp KJ, Barry D, Kader YG, Suelzer E. Effectiveness of Mobile Apps to Promote Health and Manage Disease: Systematic Review and Meta-analysis of Randomized Controlled Trials. JMIR Mhealth Uhealth 2021; 9:e21563. [PMID: 33427672 PMCID: PMC7834932 DOI: 10.2196/21563] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/13/2020] [Accepted: 10/28/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Interventions aimed at modifying behavior for promoting health and disease management are traditionally resource intensive and difficult to scale. Mobile health apps are being used for these purposes; however, their effects on health outcomes have been mixed. OBJECTIVE This study aims to summarize the evidence of rigorously evaluated health-related apps on health outcomes and explore the effects of features present in studies that reported a statistically significant difference in health outcomes. METHODS A literature search was conducted in 7 databases (MEDLINE, Scopus, PsycINFO, CINAHL, Global Index Medicus, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews). A total of 5 reviewers independently screened and extracted the study characteristics. We used a random-effects model to calculate the pooled effect size estimates for meta-analysis. Sensitivity analysis was conducted based on follow-up time, stand-alone app interventions, level of personalization, and pilot studies. Logistic regression was used to examine the structure of app features. RESULTS From the database searches, 8230 records were initially identified. Of these, 172 met the inclusion criteria. Studies were predominantly conducted in high-income countries (164/172, 94.3%). The majority had follow-up periods of 6 months or less (143/172, 83.1%). Over half of the interventions were delivered by a stand-alone app (106/172, 61.6%). Static/one-size-fits-all (97/172, 56.4%) was the most common level of personalization. Intervention frequency was daily or more frequent for the majority of the studies (123/172, 71.5%). A total of 156 studies involving 21,422 participants reported continuous health outcome data. The use of an app to modify behavior (either as a stand-alone or as part of a larger intervention) confers a slight/weak advantage over standard care in health interventions (standardized mean difference=0.38 [95% CI 0.31-0.45]; I2=80%), although heterogeneity was high. CONCLUSIONS The evidence in the literature demonstrates a steady increase in the rigorous evaluation of apps aimed at modifying behavior to promote health and manage disease. Although the literature is growing, the evidence that apps can improve health outcomes is weak. This finding may reflect the need for improved methodological and evaluative approaches to the development and assessment of health care improvement apps. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42018106868; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=106868.
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Affiliation(s)
- Sarah J Iribarren
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
| | - Tokunbo O Akande
- Department of Pediatrics, Sanford Health, Bemidji, MN, United States
| | - Kendra J Kamp
- Division of Gastroenterology, School of Medicine, University of Washington, Seattle, WA, United States
| | - Dwight Barry
- Enterprise Analytics, Seattle Children's Hospital, Seattle, WA, United States
| | - Yazan G Kader
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
| | - Elizabeth Suelzer
- Medical College of Wisconsin Libraries, Medical College of Wisconsin, Milwaukee, WI, United States
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Staras SAS, Richardson E, Merlo LJ, Bian J, Thompson LA, Krieger JL, Gurka MJ, Sanders AH, Shenkman EA. A feasibility trial of parent HPV vaccine reminders and phone-based motivational interviewing. BMC Public Health 2021; 21:109. [PMID: 33422047 PMCID: PMC7797089 DOI: 10.1186/s12889-020-10132-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/25/2020] [Indexed: 11/28/2022] Open
Abstract
Background We assessed the feasibility and acceptability of a sequential approach of parent-targeted HPV vaccine reminders and phone-based Motivation Interviewing (MI). Methods In 2016, we selected all 11- to 12-year-old boys and girls seen in one clinic whose vaccine records did not include the HPV vaccine (n=286). By gender, we individually randomized parents of adolescents to an interactive text message (74 girls and 45 boys), postcard reminder (46 boys and no girls because of previously demonstrated efficacy), or standard care group (75 girls and 46 boys). Reminders were sent with medical director permission and a HIPAA waiver. Two months after reminders, among the adolescents whose vaccine records still did not include the HPV vaccine, we selected a gender-stratified random sample of 20 parents for phone-based MI. We assessed the percentage of deliverable messages, the percentage of parents’ responding to the interactive text message, parent acceptability of receiving a text message, and MI parent responsiveness and interviewer competence (MI Treatment Integrity Coding system). Results Nearly all messages were deliverable (98% of postcards and 74% of text messages). Six of the 88 parents (7%) receiving text messages scheduled an appointment through our interactive system. The acceptability survey response rate was 37% (38/102). Respondents were favorable toward vaccine reminders for all parents (82%). Among 20 sampled parents, 17 were reached by phone of whom 7 completed MI, 4 had or were getting the HPV vaccine for their child, and 5 expressed disinterest. Across the 7 MI calls, the interviewer was rated 100% MI adherent and scored an average 4.19 rating for Global Spirit. Conclusion Without providing explicit consent to receive vaccine-related messages, parents nonetheless found postcards and interactive text messages acceptable. Centralizing MI to phone calls with trained staff was acceptable to parents and resulted in highly MI-adherent interviews. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10132-6.
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Affiliation(s)
- Stephanie A S Staras
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA. .,The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Eric Richardson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lisa J Merlo
- The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA.,Department of Psychiatry, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.,The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA.,Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Janice L Krieger
- Department of Advertising, College of Journalism and Communication, University of Florida, Gainesville, FL, USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.,The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ashley H Sanders
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.,The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.,The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA
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Pedersen MU, Hesse M, Thylstrup B, Jones S, Pedersen MM, Frederiksen KS. Vouchers versus reminders to prevent dropout: Findings from the randomized youth drug abuse treatment project (youthDAT project). Drug Alcohol Depend 2021; 218:108363. [PMID: 33153829 DOI: 10.1016/j.drugalcdep.2020.108363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/14/2020] [Accepted: 10/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Over the last few decades, evidence-based treatments for emerging adults with drug use disorder (DUD) have been developed, but dropout and inconsistent session attendance persist. This study assessed the efficacy of voucher reinforcement and/or text reminders for treatment attendance and completion in emerging adults with DUD in Denmark. METHODS The study compared four levels of treatment intensity, with participants randomly assigned to standard outpatient counseling only (STD), outpatient counseling plus vouchers for attendance (VOU), outpatient counseling plus text reminders (REM), or outpatient counseling plus vouchers and text reminders (REM + VOU). A total of 460 individuals aged 15-25 years seeking treatment for DUD were randomly assigned to the four treatment conditions across nine sites. RESULTS STD counseling had the lowest completion rate (25%), followed by REM (39%), VOU (46%), and REM + VOU (49%). Additionally, post hoc comparisons indicated that clients randomized to the REM + VOU condition differed in terms of zero no-shows from clients who were randomized to the VOU condition (χ2(1) = 6.90, p = 0.009) and the REM condition (χ2(1) = 5.87, p = 0.015). CONCLUSIONS Vouchers and text reminders contribute to reduced dropout and increased treatment attendance in emerging adults with DUD. The combination of vouchers and reminders in particular has the potential to reduce the number of no-shows.
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Affiliation(s)
- Mads Uffe Pedersen
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark.
| | - Morten Hesse
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Birgitte Thylstrup
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Sheila Jones
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Michael Mulbjerg Pedersen
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
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Xiao S, Li T, Zhou W, Shen M, Yu Y. WeChat-based mHealth intention and preferences among people living with schizophrenia. PeerJ 2020; 8:e10550. [PMID: 33362979 PMCID: PMC7749651 DOI: 10.7717/peerj.10550] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/20/2020] [Indexed: 01/15/2023] Open
Abstract
Background The past few decades have seen a rapid expansion of mHealth programs among people with serious mental illness, yet mHealth for schizophrenia is in a much earlier stage of development. This study examined the intention of WeChat-based mHealth programs among people living with schizophrenia (PLS) and evaluated correlates of the intention. Methods A total of 400 PLS aged 18–77 completed a cross-sectional survey by face-to-face interviews. The survey included a general question asking about participants’ willingness to attend WeChat-based mHealth programs, followed by preferences of three specific WeChat-based programs: psychoeducation, peer support, and professional support. PLS symptoms, functioning and disability were measured using the 18-item Brief Psychiatric Rating Scale (BPRS-18), the Global Assessment of Functioning (GAF), and the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), respectively. A multivariate logistic regression was used to determine correlates of program participation intention. Results Over forty percent (43%, n = 172) of participants were willing to participate in WeChat-based mHealth programs, among whom preferences for each specific program were shown in descending order: psychoeducation (68.60%), professional support (60.47%), and peer support (52.33%). A multivariate analysis revealed that younger age (OR: 0.13–0.20, 95% CI [0.05–0.43]), higher education (OR: 3.48–6.84, 95% CI [1.69–18.21]), and lower disability (OR: 0.97, 95% CI [0.94–0.99]) were all independently associated with WeChat-based mHealth program participation intention. Conclusion The findings provide guidance for further development of WeChat-based mHealth programs among PLS in China, and targeted at those who are younger, well-educated and with lower disability.
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Affiliation(s)
- Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Tongxin Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Wei Zhou
- School of Public Administration, Hunan University, Changsha, Hunan, China
| | - Minxue Shen
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yu Yu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.,Division of Prevention and Community Research, Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
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Al Ghunimat A, Hind J, Abouelela A, Sidhu GAS, Lacon A, Ashwood N. Communication With Patients Before an Operation: Their Preferences on Method of Communication. Cureus 2020; 12:e11431. [PMID: 33324514 PMCID: PMC7732730 DOI: 10.7759/cureus.11431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background With the constantly evolving communication technologies, it is essential for all healthcare professionals to try utilising various methods in communicating with patients. This will lead to better healthcare outcomes and patient satisfaction. Objective The aim of the study was to compare a patient's preference to various communication methods regarding their appointments and to evaluate if we're giving our patients an appropriate notice period prior to their operation. Methods A questionnaire was given to 111 patients who underwent elective orthopaedic procedures. Results Factors like age and gender affect the choice of communication method. Traditional letters still have a role for an older population aged 65 and over. However, younger patients showed higher preference for other communication methods such as phone calls, texts, and e-mails. Gender also had a role in choosing a preference where male patients chose a range of options whilst female patients preferred phone calls. Most patients stated they received an appropriate notice period, with 88% of patients stating they would like to be notified one-two weeks prior to their operation. Conclusion More research needs to be conducted into using text messages and e-mails in communicating with elective surgical patients, in addition to implementing newer technologies like mobile phone applications and secure online messaging portals, as this has the potential to reshape the communication process with our patients and lead to better health outcomes and patient satisfaction.
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Affiliation(s)
- Abdallah Al Ghunimat
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Burton-on-Trent, GBR
| | - Jamie Hind
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Burton-on-Trent, GBR
| | - Amr Abouelela
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Burton-on-Trent, GBR
| | - Gur Aziz Singh Sidhu
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Burton-on-Trent, GBR
| | - Andrew Lacon
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Burton-on-Trent, GBR
| | - Neil Ashwood
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Burton-on-Trent, GBR
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Ceballos F, Hernandez MA, Olivet F, Paz C. Assessing the use of cell phones to monitor health and nutrition interventions: Evidence from rural Guatemala. PLoS One 2020; 15:e0240526. [PMID: 33141833 PMCID: PMC7608922 DOI: 10.1371/journal.pone.0240526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/29/2020] [Indexed: 12/31/2022] Open
Abstract
In-person (face-to-face) data collection methods offer many advantages but can also be time-consuming and expensive, particularly in areas of difficult access. We take advantage of the increasing mobile phone penetration rate in rural areas to evaluate the feasibility of using cell phones to monitor the provision of key health and nutrition interventions linked to the first 1,000 days of life, a critical period of growth and development. We examine response rates to calendarized text messages (SMS) and phone calls sent to 1,542 households over a period of four months. These households have children under two years old and pregnant women and are located across randomly selected communities in Quiche, Guatemala. We find that the overall (valid) response rate to phone calls is over 5 times higher than to text messages (75.8% versus 14.4%). We also test whether simple SMS reminders improve the timely reception of health services but do not find any effects in this regard. Language, education, and age appear to be major barriers to respond to text messages as opposed to phone calls, and the rate of response is not correlated with a household’s geographic location (accessibility). Moreover, response veracity is high, with an 84–91% match between household responses and administrative records. The costs per monitored intervention are around 1.12 US dollars using text messages and 85 cents making phone calls, with the costs per effective answer showing a starker contrast, at 7.76 and 1.12 US dollars, respectively. Our findings indicate that mobile phone calls can be an effective, low-cost tool to collect reliable information remotely and in real time. In the current context, where in-person contact with households is not possible due to the COVID-19 crisis, phone calls can be a valuable instrument for collecting information, monitoring development interventions, or implementing brief surveys.
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Affiliation(s)
- Francisco Ceballos
- Markets, Trade and Institutions Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States of America
| | - Manuel Alejandro Hernandez
- Markets, Trade and Institutions Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States of America
- * E-mail:
| | - Francisco Olivet
- Escuela de Ingeniería en Agronomía, Universidad Mariano Galvez, Ciudad de Guatemala, Guatemala City, Guatemala
| | - Cynthia Paz
- Markets, Trade and Institutions Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States of America
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Salamzadeh J, Torabi Kachousangi S, Hamzelou S, Naderi S, Daneshvar E. Medication adherence and its possible associated factors in patients with acne vulgaris: A cross-sectional study of 200 patients in Iran. Dermatol Ther 2020; 33:e14408. [PMID: 33084227 DOI: 10.1111/dth.14408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/14/2020] [Accepted: 10/06/2020] [Indexed: 01/03/2023]
Abstract
There are several etiologic factors involved in the pathogenesis of acne vulgaris. Therefore, current treatment guidelines recommend applying different classes of medications for it. This makes medication adherence a challenging issue in acne patients. The current study was designed to assess medication adherence and its possible associated factors in patients with acne vulgaris. This study was performed on patients with acne vulgaris in two dermatology clinics of Imam Khomeini Hospital and Razi Hospital. A validated questionnaire (ECOB, Elaboration d'un outil d'evaluation de l'observance des traitements medicamenteux) was applied to evaluate adherence to topical and oral therapies. We assessed relationship between patients' medication adherence and their sociodemographic, medication, and medical histories. A total of 200 patients, 136 females (68%), and 64 males (32%), with a mean age of 22 years were entered into the study. Overall, only 30 out of 200 patients (15%) were adherent to their treatments. Based on the bivariate analyses, food exacerbations, and severity of the disease by the patient's opinion was significantly associated with overall medication adherence (P = .03). Moreover, patients who were more adherent to topical treatment were more adherent to systemic treatment, as well (P = .007). The current study showed that treatment adherence was very low among patients with acne vulgaris. It is recommended to educate patients on the proper use of anti-acne medications. Besides, it is highly recommended that physicians and pharmacists use ECOB questionnaire regularly to guide patients accurately with the use of their drug regimens.
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Affiliation(s)
- Jamshid Salamzadeh
- School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Shahin Hamzelou
- Department of Dermatology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Naderi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Daneshvar
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Kincl LD, Hess JA, Weeks DL, Vaughan A, Anton D. Efficacy of text messaging apprentices to reinforce ergonomics and safety voice training. JOURNAL OF SAFETY RESEARCH 2020; 74:35-43. [PMID: 32951794 DOI: 10.1016/j.jsr.2020.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/04/2020] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Injuries and work-related musculoskeletal disorders (MSDs) are common among masons. SAfety Voice for Ergonomics (SAVE) integrates training in ergonomic and safety problem-solving skills into masonry apprenticeship training. The purpose of this study was to assess the efficacy of text messaging to reinforce SAVE program content. METHOD SAVE effectiveness was evaluated at masonry apprenticeship training centers across the United States by comparing three experimental groups: (1) Ergonomics training, (2) Ergonomics and Safety Voice training, and a (3) Control. Apprentices received SAVE training with their standard instruction. To reinforce classroom training, refresher training was implemented by sending weekly text messages for six months. Half of the text messages required a response, which tested knowledge or assessed behavior, while the remaining reiterated knowledge. Apprentices (n = 119) received SAVE text messages. Response rates and percentage of correct responses were compared with chi-square tests and independent group t-tests. Multivariable logistic regression analysis predicted apprentice response with selected demographic and work experience variables. Finally, feedback on of the use of text messaging was obtained. RESULT Of 119 participants, 61% (n = 72) responded to at least one text message. Logistic regression revealed that being a high school graduate and a brick and block mason significantly affected the odds of responding. Sixty-nine percent of apprentices agreed that text messages reinforced SAVE content. CONCLUSION Even though there was no training center requirement to respond, the high response rate suggests that text messaging can effectively be used to reinforce ergonomics and safety voice training for both knowledge and behavior. Practical Application: The prevalent use of text messaging creates opportunities to reinforce health and safety training and engage workers, especially for populations that may be at various locations over time such as construction sites. Instructors and practitioners should consider the utility of text messaging for supporting their training and safety programs.
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Affiliation(s)
- Laurel D Kincl
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA.
| | - Jennifer A Hess
- Labor Education and Research Center, University of Oregon, Eugene, OR, USA
| | - Douglas L Weeks
- Department of Rehabilitation Research, St. Luke's Rehabilitation Institute, Spokane, WA, USA
| | - Amelia Vaughan
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Dan Anton
- Department of Physical Therapy, Eastern Washington University, Spokane, WA, USA
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Kiruparan P, Kiruparan N, Debnath D. Impact of pre-appointment contact and short message service alerts in reducing 'Did Not Attend' (DNA) rate on rapid access new patient breast clinics: a DGH perspective. BMC Health Serv Res 2020; 20:757. [PMID: 32807150 PMCID: PMC7429943 DOI: 10.1186/s12913-020-05627-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/05/2020] [Indexed: 11/25/2022] Open
Abstract
Background Failure to attend the clinic without prior intimation, known as “Did Not Attend” (DNA) is a significant global issue. There have been no published studies attempting to reduce DNA rates in breast clinics. We aimed to assess the impact of contacting patients prior to clinic attendance and Short Message Service (SMS) reminder on DNA rates in rapid access new patient breast clinics, evaluate ‘Could Not Attend’ (CNA) rate, and explore any correlation between age, sex, clinic days and sessions. Methods Initially, DNAs at the rapid access new patient breast clinic between 01/04/2018 and 31/03/2019 at a district general hospital in the North-West of England was assessed (Cycle 1). Changes were introduced in terms of contacting patients prior to offering appointments, followed by SMS reminders nearer the clinic dates. Subsequently, DNA was reassessed between 01/10/2019 and 31/03/2020 (Cycle 2). Results Following implementation of changes, DNA rate reduced from 8.2 to 4.1% (p < 0.00001). CNA rates were 0.9% (Cycle 1) and 1.1% (Cycle 2) [p = 0.36]. Evening clinics had the lowest DNA rates throughout. DNA patients in cycle 2 were significantly older than those in cycle 1 (p = 0.002). Conclusions Contacting patients prior to clinic appointments and sending SMS reminders helped reduce DNA rates significantly in rapid access new patient breast clinics. Scheduling clinic sessions with least DNA rates, such as evening clinics, should be contemplated. One should be cautious of mobile phone technology that conveys SMS, which can potentially disadvantage the older age group. This model could be considered across the board to improve DNA rates.
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Affiliation(s)
| | | | - Debasish Debnath
- Breast Unit, Blackpool Victoria Hospital, Blackpool, FY3 8NR, UK
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Ganapathy S, de Korne DF, Chong NK, Car J. The Role of Text Messaging and Telehealth Messaging Apps. Pediatr Clin North Am 2020; 67:613-621. [PMID: 32650857 DOI: 10.1016/j.pcl.2020.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article focuses on the role of text messaging and messaging applications, discusses technical and legal issues, and reviews current examples of the application of text messaging in the clinical adult and pediatric practice. Reviews of current examples of text messaging in adult and pediatric practice show uptake has been increasing substantially in recent years. In pediatric care text messaging has been used for behavior intervention and outcomes tracking. Although applications are promising, the potential of nonsynchronic messaging in the formal delivery of care is still in the neonatal phase compared with its grown-up existence in day-to-day modern life.
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Affiliation(s)
- Sashikumar Ganapathy
- KK Women's & Children's Hospital, 100, Bukit Timah Road 229899 Singapore; Duke-NUS School of Medicine, Singapore, Singapore
| | - Dirk F de Korne
- Duke-NUS School of Medicine, Singapore, Singapore; Medical Innovation & Care Transformation, KK Women's & Children's Hospital, Singapore, Singapore; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands; Care & Welfare, SVRZ Cares in Zeeland, Middelburg, SVRZ, Koudekerkseweg 143, Middelburg 4335 SM, Netherlands. https://twitter.com/dirkdekorne
| | - Ng Kee Chong
- KK Women's & Children's Hospital, 100, Bukit Timah Road 229899 Singapore; Duke-NUS School of Medicine, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Clinical Sciences Building, 11 Mandalay Road, Singapore 308232, Singapore.
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Tan EH, Wong ALA, Tan CC, Wong P, Tan SH, Ang LEY, Lim SE, Chong WQ, Ho J, Lee SC, Tai BC. Improving medication adherence with adjuvant aromatase inhibitor in women with breast cancer: A randomised controlled trial to evaluate the effect of short message service (SMS) reminder. Breast 2020; 53:77-84. [PMID: 32652462 PMCID: PMC7375684 DOI: 10.1016/j.breast.2020.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 01/21/2023] Open
Abstract
Background Medication adherence is crucial for improving clinical outcomes in the treatment of patients. We evaluate the effect of short message service (SMS) reminder on medication adherence and serum hormones in patients with breast cancer on aromatase inhibitors. Methods An open-label, multi-centre, prospective randomised controlled trial of SMS versus Standard Care was conducted. Medication adherence was assessed via self-report using the Simplified Medication Adherence Questionnaire at baseline, 6 month, and 1 year. Androstenedione, estradiol, and estrone were measured at baseline and 1 year. The χ2 test and mixed effects logistic regression was performed to compare medication adherence between groups. Difference in androstenedione and estrone levels were assessed using analysis of covariance, whereas χ2 test and logistic regression was used for estradiol. Analysis was based on intention-to-treat. Results A total of 244 patients were randomised to receive weekly SMS reminder (n = 123) or Standard Care (n = 121) between May 2015 and December 2018. The odds of adherence was higher at 6-month in SMS (OR = 1.78, 95% CI 1.04–3.05, p = 0.034), and not significantly different at 1-year (OR = 1.15, 95% CI: 0.67–1.96 p = 0.617). Mixed effects logistic regression analysis showed higher odds of adherence in SMS over the 1-year period (OR = 2.35, 95% CI: 1.01–5.49, p = 0.048). There was no difference in serum hormone levels between groups. Conclusion SMS reminder improved medication adherence in the short-term but had no effect on serum hormones levels in the longer term. Future studies could investigate the use of tailored SMS intervention according to patient preference to improve its sustainability. Patients on aromatase inhibitors were randomised to SMS reminder or Standard Care. SMS reminder improved medication adherence in the short-term. There was no effect on serum hormones levels in the longer term.
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Affiliation(s)
- Eng Hooi Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-03F, 117549, Singapore
| | - Andrea Li Ann Wong
- Department of Haematology-Oncology, National University Cancer Institute, NUHS Tower Block Level 7, 1E Kent Ridge Road, 119228, Singapore
| | - Chuan Chien Tan
- Department of General Surgery, Ng Teng Fong General Hospital, 1 Jurong East Street 21, 609606, Singapore
| | - Patrick Wong
- Division of Oncology Pharmacy, National University Cancer Institute, NUHS Tower Block Level 7, 1E Kent Ridge Road, 119228, Singapore
| | - Sing Huang Tan
- OncoCare Cancer Centre, 6 Napier Road, #02-17/18/19, Gleneagles Medical Centr, 258499, Singapore
| | - Li En Yvonne Ang
- Department of Haematology-Oncology, National University Cancer Institute, NUHS Tower Block Level 7, 1E Kent Ridge Road, 119228, Singapore
| | - Siew Eng Lim
- Department of Haematology-Oncology, National University Cancer Institute, NUHS Tower Block Level 7, 1E Kent Ridge Road, 119228, Singapore
| | - Wan Qin Chong
- Department of Haematology-Oncology, National University Cancer Institute, NUHS Tower Block Level 7, 1E Kent Ridge Road, 119228, Singapore
| | - Jingshan Ho
- Department of Haematology-Oncology, National University Cancer Institute, NUHS Tower Block Level 7, 1E Kent Ridge Road, 119228, Singapore
| | - Soo Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, NUHS Tower Block Level 7, 1E Kent Ridge Road, 119228, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-03F, 117549, Singapore; Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 1E Kent Ridge Road, 119228, Singapore.
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Safety and feasibility of various fasting-mimicking diets among people with multiple sclerosis. Mult Scler Relat Disord 2020; 42:102149. [PMID: 32408153 DOI: 10.1016/j.msard.2020.102149] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/14/2020] [Accepted: 04/22/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Fasting-mimicking diets have shown promise in experimental autoimmune encephalitis and are currently being investigated among people with multiple sclerosis (MS). Ensuring adherence to diet changes is critical to determining the efficacy of such interventions. OBJECTIVE Our primary aim was to evaluate the safety and feasibility of several fasting-mimicking diets and investigate whether various levels of clinical support improve diet adherence among people with MS. Secondarily, this study evaluated the impact of fasting-mimicking diets on weight and patient-reported outcomes (PROs). METHODS We conducted three pilot studies (two randomized controlled for 6 months; one randomized with transition to single arm) restricting either the amount or timing of calorie intake over 24 or 48 weeks. Interventions included calorie restriction (daily or intermittently) or time-restricted feeding. Adherence measures varied across studies but were collected at study visits along with weight and PRO data. RESULTS A total of 90 participants enrolled; 70 completed the studies, with no serious adverse events reported. Overall adherence to the calorie restriction diets was poor. When participants were tasked with maintaining a diet in a pragmatic setting, neither previously completed intense clinical support and education, nor weekly electronic communication throughout the diet period appeared to improve diet adherence. Participants who were able to adhere to a calorie restriction diet predictably lost weight. In contrast to calorie restriction, adherence to a time-restricted feeding (TRF) diet was relatively good. No statistically significant changes in PROs were observed in an intention-to-treat analysis. CONCLUSION The role diet may play in clinical outcomes in MS remains unknown, as class I evidence is lacking. Diet adherence remains a primary barrier to the feasible conduct of large, randomized controlled diet trials. Strict adherence to a TRF dietary change may be more feasible than calorie restriction and should be considered in future fasting-mimicking diet trials. ClinicalTrials.gov Registry:A Pilot Study of Intermittent Calorie Restriction in Multiple Sclerosis - NCT02647502. A Pragmatic Trial of Dietary Programs in People with Multiple Sclerosis (MS) - NCT02846558.
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Ruggeri K, Folke T, Benzerga A, Verra S, Büttner C, Steinbeck V, Yee S, Chaiyachati K. Nudging New York: adaptive models and the limits of behavioral interventions to reduce no-shows and health inequalities. BMC Health Serv Res 2020; 20:363. [PMID: 32336283 PMCID: PMC7184714 DOI: 10.1186/s12913-020-05097-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/10/2020] [Indexed: 11/21/2022] Open
Abstract
Background Missed healthcare appointments (no-shows) are costly and operationally inefficient for health systems. No-show rates are particularly high for vulnerable populations, even though these populations often require additional care. Few studies on no-show behavior or potential interventions exist specifically for Federally Qualified Health Centers (FQHCs), which care for over 24 million disadvantaged individuals in the United States. The purpose of this study is to identify predictors of no-show behavior and to analyze the effects of a reminder intervention in urban FQHCs in order to design effective policy solutions to a protracted issue in healthcare. Methods This is a retrospective observational study using electronic medical record data from 11 facilities belonging to a New York City-based FQHC network between June 2017 to April 2018. This data includes 53,149 visits for 41,495 unique patients. Seven hierarchical generalized linear models and generalized additive models were used to predict no-shows, and multiple regression models evaluated the effectiveness of a reminder. All analyses were conducted in R. Results The strongest predictor of no-show rates in FQHCs is whether or not patients are assigned to empaneled providers (z = − 91.45, p < 10− 10), followed by lead time for appointments (z = 23.87, p < 10− 10). These effects were fairly stable across facilities. The reminder had minimal effects on no-show rates overall (No show rate before: 41.6%, after: 42.1%). For individuals with appointments before and after the reminder, there was a small decrease in no-shows of 2%. Conclusions The limited effects of the reminder intervention suggest the need for more personalized behavioral interventions to reduce no-shows. We recommend that these begin with increasing the use of empaneled providers for preventive care appointments and reducing the lag time between setting the appointment and the actual date of the appointment, at least for individuals with a high rate of no-show. By complementing these with low-intensity, low-cost behavioral interventions, we would expect greater impacts for improved access to care, contributing to the well-being of vulnerable populations.
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Affiliation(s)
- Kai Ruggeri
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY, 10032, USA.
| | - Tomas Folke
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY, 10032, USA
| | - Amel Benzerga
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY, 10032, USA
| | - Sanne Verra
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY, 10032, USA
| | - Clara Büttner
- Faculty of Health, Medicine and Life Science, Maastricht University, Universiteitssingel 40, 6229, ER, Maastricht, The Netherlands
| | - Viktoria Steinbeck
- Faculty of Health, Medicine and Life Science, Maastricht University, Universiteitssingel 40, 6229, ER, Maastricht, The Netherlands
| | - Susan Yee
- Community Healthcare Network, New York City, 60 Madison Ave., New York, NY, 10010, USA
| | - Krisda Chaiyachati
- Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Blockley Hall Room 1313, Philadelphia, PA, 19104, USA
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D'Arcey J, Collaton J, Kozloff N, Voineskos AN, Kidd SA, Foussias G. The Use of Text Messaging to Improve Clinical Engagement for Individuals With Psychosis: Systematic Review. JMIR Ment Health 2020; 7:e16993. [PMID: 32238334 PMCID: PMC7163420 DOI: 10.2196/16993] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/03/2020] [Accepted: 01/14/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Individuals experiencing psychosis are at a disproportionate risk for premature disengagement from clinical treatment. Barriers to clinical engagement typically result from funding constraints causing limited access to and flexibility in services. Digital strategies, such as SMS text messaging, offer a low-cost alternative to potentially improve engagement. However, little is known about the efficacy of SMS text messaging in psychosis. OBJECTIVE This review aimed to address this gap, providing insights into the relationship between SMS text messaging and clinical engagement in the treatment of psychosis. METHODS Studies examining SMS text messaging as an engagement strategy in the treatment of psychosis were reviewed. Included studies were published from the year 2000 onward in the English language, with no methodological restrictions, and were identified using 3 core databases and gray literature sources. RESULTS Of the 233 studies extracted, 15 were eligible for inclusion. Most studies demonstrated the positive effects of SMS text messaging on dimensions of engagement such as medication adherence, clinic attendance, and therapeutic alliance. Studies examining the feasibility of SMS text messaging interventions found that they are safe, easy to use, and positively received. CONCLUSIONS Overall, SMS text messaging is a low-cost, practical method of improving engagement in the treatment of psychosis, although efficacy may vary by symptomology and personal characteristics. Cost-effectiveness and safety considerations were not adequately examined in the studies included. Future studies should consider personalizing SMS text messaging interventions and include cost and safety analyses to appraise readiness for implementation.
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Affiliation(s)
- Jessica D'Arcey
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medial Science, University of Toronto, Toronto, ON, Canada
| | - Joanna Collaton
- Department of Clinical Psychology, University of Guelph, Guelph, ON, Canada
| | - Nicole Kozloff
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medial Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sean A Kidd
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medial Science, University of Toronto, Toronto, ON, Canada
| | - George Foussias
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medial Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Sanchez Antelo V, Kohler RE, Curotto M, Viswanath KV, Paolino M, Arrossi S. Developing SMS Content to Promote Papanicolaou Triage Among Women Who Performed HPV Self-collection Test: Qualitative Study. JMIR Form Res 2020; 4:e14652. [PMID: 32032940 PMCID: PMC7084289 DOI: 10.2196/14652] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/23/2020] [Accepted: 02/06/2020] [Indexed: 12/19/2022] Open
Abstract
Background SMS interventions are effective in promoting a variety of health behaviors; however, there is limited information regarding the use of SMS for cervical cancer screening and follow-up care. The Application of Communication and Information Technologies to Self-Collection study aims to evaluate a multicomponent mobile health intervention to increase triage adherence among women with human papillomavirus (HPV)–positive self-collected tests in Jujuy, Argentina. Here, we describe the formative results used to design the content of the SMS to be tested in the trial. Objective This study aimed to understand the cultural and contextual elements, women’s beliefs, and perceptions regarding the use of SMS by the health care system and women’s preferences about the message content. Methods We conducted five focus groups (FGs), stratified by rural or urban residence and age. All participants were aged 30 years or older and had performed HPV self-collection. Participatory techniques, including brainstorming, card-based classification, and discussions were used to debate the advantages and disadvantages of messages. We openly coded the discussions for agreements and preferences regarding the SMS content. Messages for both HPV-negative and HPV-positive women were validated through interviews with health authorities and 14 HPV-tested women. The final versions of the messages were pilot-tested. Results A total of 48 women participated in the FGs. Participants rejected receiving both negative and positive HPV results by SMS because, for them, the delivery of results should be done in a face-to-face interaction with health professionals. They stressed the importance of the SMS content informing them that results were available for pick up and reflecting the kind of relationship that they have with the community health workers and the nearest health center. Women considered that a personalized SMS was important, as was the use of a formal yet warm tone. Owing to confidentiality issues, not using the word “HPV” was also a key component of the desired SMS content; therefore, the final message included the term “self-collection” without the mention of HPV infection. Results from the validation stage and pilot test showed high acceptability of the final version of the message. Conclusions The results suggest that SMS is accepted when notifying women about the availability of the HPV test result, but it should not replace the delivery of results in face-to-face, doctor-patient encounters. In addition, messages must be tailored and must have a persuasive tone to motivate women to adhere to the triage.
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Affiliation(s)
| | - Racquel E Kohler
- Cancer Health Equity, Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Mariana Curotto
- Programa Nacional de Prevención de Cáncer Cervicouterino, Instituto Nacional del Cáncer, Buenos Aires, Argentina
| | - Kasisomayajula Vish Viswanath
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, United States.,McGraw-Patterson Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
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Collection of Common Knee Patient-reported Outcome Instruments by Automated Mobile Phone Text Messaging in Pediatric Sports Medicine. J Pediatr Orthop 2020; 40:e91-e95. [PMID: 31107346 DOI: 10.1097/bpo.0000000000001403] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patient-reported outcome (PRO) instruments measure health status in a variety of domains. With the proliferation of mobile phones, delivering PROs across patient-friendly platforms (eg, apps, text messaging) may increase completion rates, particularly among children. The purpose of this study was to validate the collection of common knee PROs in sports medicine with text messaging by correlating text-messaging responses with paper delivery in adolescents. METHODS Patients presenting to a hospital-based pediatric orthopaedic sports medicine clinic with a knee injury were enrolled prospectively. Paper versions of the Pediatric International Knee Documentation Committee (Pedi-IKDC) Subjective Knee Evaluation Form and the Pediatric Functional Activity Brief Scale (Pedi-Fab Scale) were completed during initial clinic visits. Over the next 72 hours, patients completed the text message delivery of the Pedi-IKDC and Pedi-Fab Scale. Correlations between paper and text message delivery of the 2 PROs were assessed. RESULTS Ninety-one patients (mean age: 16.0±2.0 y; 48% females) enrolled in the text-messaging study, with 55 (60.4%) completing the Pedi-Fab Scale, 48 (52.7%) completing the Pedi-IKDC, and 39 (42.9%) completing both PROs. The intraclass correlation coefficient between the paper and mobile phone delivery of the Pedi-Fab Scale was 0.95 (P<0.001; 95% confidence interval, 0.91-0.97). The intraclass correlation coefficient between the paper and mobile phone delivery of the Pedi-IKDC was 0.96 (P<0.001; 95% confidence interval, 0.93-0.98). Average Pedi-Fab scores on paper (M=12.7) and mobile phone (M=12.3) were not significantly different (P=0.52). Similarly, average Pedi-IKDC scores on paper (M=68.8) and mobile phone (M=67.7) were not significantly different (P=0.41). Average completion time for the text delivered Pedi-Fab and Pedi-IKDC were 102±224 and 159±155 minutes, respectively. High school enrollment (P=0.025), female sex (P=0.036), and race (P=0.002) were significantly associated with text completion of Pedi-IKDC. CONCLUSIONS Text message delivery using mobile phones permits valid assessment of Pedi-IKDC and Pedi-Fab scores in adolescents. Questionnaire delivery by automated text messaging allows asynchronous response and may increase compliance and reduce the labor cost of collecting PROs. LEVEL OF EVIDENCE Level III-prospective cohort study.
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Muroff J, Robinson W. Tools of Engagement: Practical Considerations for Utilizing Technology-Based Tools in CBT Practice. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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DeCamp LR, Godage SK, Valenzuela Araujo D, Dominguez Cortez J, Wu L, Psoter KJ, Quintanilla K, Rivera Rodríguez T, Polk S. A Texting Intervention in Latino Families to Reduce ED Use: A Randomized Trial. Pediatrics 2020; 145:peds.2019-1405. [PMID: 31879276 DOI: 10.1542/peds.2019-1405] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Latino children in immigrant families experience health care disparities. Text messaging interventions for this population may address disparities. The objective of this study was to evaluate the impact of a Spanish-language text messaging intervention on infant emergency department use and well care and vaccine adherence. METHODS The Salud al Día intervention, an educational video and interactive text messages throughout the child's first year of life, was evaluated via randomized controlled trial conducted in an urban, academic pediatric primary care practice from February 2016 to December 2017. Inclusion criteria were publicly insured singleton infant <2 months of age; parent age >18, with Spanish as the preferred health care language; and at least 1 household cellular phone. Primary outcomes were abstracted from the electronic medical record at age 15 months. Intention-to-treat analyses were used. RESULTS A total of 157 parent-child dyads were randomly assigned to Salud al Día (n = 79) or control groups (n = 78). Among all participants, mean parent age was 29.3 years (SD: 6.2 years), mean years in the United States was 7.3 (SD: 5.3 years), and 87% of parents had limited or marginal health literacy. The incidence rate ratio for emergency department use for the control versus intervention group was 1.48 (95% confidence interval: 1.04-2.12). A greater proportion of intervention infants received 2 flu vaccine doses compared with controls (81% vs 67%; P = .04). CONCLUSIONS This Spanish-language text messaging intervention reduced emergency department use and increased flu vaccine receipt among a population at high risk for health care disparities. Tailored text message interventions are a promising method for addressing disparities.
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Affiliation(s)
- Lisa Ross DeCamp
- Center for Salud/Health and Opportunity for Latinos and .,Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sashini K Godage
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | - Linxuan Wu
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Kevin J Psoter
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Sarah Polk
- Center for Salud/Health and Opportunity for Latinos and.,Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Cassidy C, Steenbeek A, Langille D, Martin-Misener R, Curran J. Designing an intervention to improve sexual health service use among university undergraduate students: a mixed methods study guided by the behaviour change wheel. BMC Public Health 2019; 19:1734. [PMID: 31878901 PMCID: PMC6933635 DOI: 10.1186/s12889-019-8059-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 12/11/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction University undergraduate students are within the population at highest risk for acquiring sexually transmitted infections, unplanned pregnancy, and other negative health outcomes. Despite the availability of sexual health services at university health centres, many students delay or avoid seeking care. In this study, we describe how the Behaviour Change Wheel was used as a systematic approach to design an intervention to improve sexual health service use among university undergraduate students. Methods This paper describes the intervention development phase of a three-phased, sequential explanatory mixed methods study. Phases one and two included a quantitative and qualitative study that aimed to better understand students’ use of sexual health services. In phase three, we followed the Behaviour Change Wheel to integrate the quantitative and qualitative findings and conduct stakeholder consultation meetings to select intervention strategies, including intervention functions and behaviour change techniques. Results Key linkages between opportunity and motivation were found to influence students’ access of sexual health services. Stakeholders identified six intervention functions (education, environmental restructuring, enablement, modelling, persuasion, and incentivization) and 15 behaviour change techniques (information about health consequences, information about social and environmental consequences, feedback on behaviour, feedback on outcomes of behaviour, prompts/cues, self-monitoring of behaviour, adding objects to the environment, goal setting, problem solving, action planning, restructuring the social environment, restructuring the physical environment, demonstration of the behaviour, social support, credible source) as relevant to include in a toolbox of intervention strategies to improve sexual health service use. Conclusions This study details the use of the Behaviour Change Wheel to develop an intervention aimed at improving university students’ use of sexual health services. The Behaviour Change Wheel provided a comprehensive framework for integrating multiple sources of data to inform the selection of intervention strategies. Stakeholders can use these strategies to design and implement sexual health service interventions that are feasible within the context of their health centre. Future research is needed to test the effectiveness of the strategies at changing university students’ sexual health behaviour.
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Affiliation(s)
- Christine Cassidy
- Dalhousie University, School of Nursing, 5869 University Avenue, PO BOX 15000, Halifax, NS, B3H 4R2, Canada.
| | - Audrey Steenbeek
- Dalhousie University, School of Nursing, 5869 University Avenue, PO BOX 15000, Halifax, NS, B3H 4R2, Canada
| | - Donald Langille
- Dalhousie University, Department of Community Health and Epidemiology, Halifax, NS, Canada
| | - Ruth Martin-Misener
- Dalhousie University, School of Nursing, 5869 University Avenue, PO BOX 15000, Halifax, NS, B3H 4R2, Canada
| | - Janet Curran
- Dalhousie University, School of Nursing, 5869 University Avenue, PO BOX 15000, Halifax, NS, B3H 4R2, Canada
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Gong E, Gu W, Luo E, Tan L, Donovan J, Sun C, Yang Y, Zang L, Bao P, Yan LL. Development and Local Contextualization of Mobile Health Messages for Enhancing Disease Management Among Community-Dwelling Stroke Patients in Rural China: Multimethod Study. JMIR Mhealth Uhealth 2019; 7:e15758. [PMID: 31845901 PMCID: PMC6938591 DOI: 10.2196/15758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Rural China has experienced an increasing health burden because of stroke. Stroke patients in rural communities have relatively poor awareness of and adherence to evidence-based secondary prevention and self-management of stroke. Mobile technology represents an innovative way to influence patient behaviors and improve their self-management. OBJECTIVE This study is part of the System-Integrated Technology-Enabled Model of Care (the SINEMA trial) to improve the health of stroke patients in resource-poor settings in China. This study aimed to develop and pilot-test a mobile phone message-based package, as a component of the SINEMA intervention. METHODS The SINEMA trial was conducted in Nanhe County, Hebei Province, China. A total of 4 villages were selected for pretrial contextual research and pilot study. The 5 stages for developing the mobile phone messages were as follows: (1) conducting literature review on existing message banks and analyzing the characteristics of these banks; (2) interviewing stroke patients and caregivers to identify their needs; (3) drafting message contents and designing dispatching algorithms for a 3-month pilot testing; (4) collecting feedback from pilot participants through questionnaire survey and in-depth interviews on facilitators and barriers related to their acceptance and understanding of messages; and (5) finalizing the message-based intervention based on participants' feedback for the SINEMA trial. RESULTS On the basis of 5 existing message banks screened out of 120 papers and patients' needs identified from 32 in-depth interviews among stroke patients and caregivers, we developed a message bank containing 224 messages for a pilot study among 54 community-dwelling stroke patients from 4 villages. Of 54 participants, 51 (response rate: 94.4%) completed the feedback survey after receiving daily messages for 3 months. Participants' mean age was 68 years (SD 9.2), and about half had never been to school. We observed a higher proportion of participants who were in favor of voice messages (23/42, 54%) than text messages (14/40, 35%). Among participants who received voice messages (n=43) and text messages (n=40), 41 and 30, respectively, self-reported a full or partial understanding of the contents, and 39 (39/43, 91%) and 32 (32/40, 80%), respectively, rated the messages as helpful. Analyses of the 32 interviews further revealed that voice messages containing simple and single-theme content, in plain language, with a repeated structure, a slow playback speed, and recorded in local dialect, were preferred by rural stroke patients. In addition, the dispatching algorithm and tools may also influence the acceptance of message-based interventions. CONCLUSIONS By applying multiple methodologies and conducting a pilot study, we designed and fine-tuned a voice message-based intervention package for promoting secondary prevention among community-dwelling stroke patients in rural China. Design of the content and dispatching algorithm should engage both experts and end users and adequately consider the needs and preferences of recipients.
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Affiliation(s)
- Enying Gong
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Wanbing Gu
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Erdan Luo
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, China
| | - Liwei Tan
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- School of Public Health, Fudan University, Shanghai, China
| | - Julian Donovan
- Northumbria Healthcare National Health Service Foundation Trust, Wallsend, United Kingdom
| | - Cheng Sun
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Ying Yang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Longkai Zang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Second School of Clinical Medicine, Wuhan University, Wuhan, China
| | - Peng Bao
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Ningxia Medical University, Yinchuan, China
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Duke Global Health Institute, Durham, NC, United States
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84
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Kompf J. The Use of Text Messages for Exercise Behavior Change Techniques. Strength Cond J 2019. [DOI: 10.1519/ssc.0000000000000483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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85
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Karim AM, Guichon D, Yihun BY, Zemichael NF, Lorenzana K, Barofsky J, Betemariam W. Application of behavioral economics principles to reduce injectable contraceptive discontinuation in rural Ethiopia: A stratified-pair, cluster-randomized field trial. Gates Open Res 2019; 3:1494. [PMID: 32803127 PMCID: PMC7416084 DOI: 10.12688/gatesopenres.12987.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Contraceptive prevalence in Ethiopia jumped from 6% in 2000 to 36% in 2016, mainly due to increased injectable method use. However, discontinuation rates among injectable users were high (38%). Given that the public sector is the major source for injectable contraceptives, John Snow Inc. (JSI) in collaboration with ideas42 worked with Ethiopia's flagship Health Extension Program to apply behavioral design to mitigate discontinuation of injectable contraceptives. Methods: We applied behavioral economics insights to mitigate the discontinuation of injectable contraceptives. This process created an intervention package, consisting of a health worker planning calendar, a client counseling job aid, and client appointment cards. A stratified-pair cluster-randomized field trial tested the effectiveness of the intervention. The study area included two districts from the four regions where JSI was implementing a family planning program. One district from each region was randomly allocated to the intervention arm. Women visiting health posts to use injectable contraceptives were enrolled in the study. Regression methods, adjusted for study design, participants' backgrounds, and contextual factors, estimated the intervention's effect on discontinuation rates. Results: A behavioral design methodology was feasibly implemented in a rural, low-resource setting in Ethiopia. The resultant intervention package was successfully delivered in 19 satellite health posts in four districts. Intervention adherence was high for the appointment cards and counseling job aid, but not for the planning calendar. The injectable discontinuation rate was 10.8 % (95% confidence interval: 2.2, 19.3) points lower in the intervention area compared to the control area during the post-intervention follow-up survey. Conclusion: The use of two tools informed by behavioral economics -the appointment card and counseling job aid-effectively decreased injectable discontinuation even with the presence of other health system bottlenecks. Behavioral economics insights and the behavioral design methodology have the potential to enhance family planning programs in Ethiopia and elsewhere.
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Affiliation(s)
- Ali Mehryar Karim
- Global Development, Bill & Melinda Gates Foundation, Addis Ababa, Ethiopia
| | | | - Bantalem Yeshanew Yihun
- The Last Ten Kilometers Project 2020, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
| | - Nebreed Fesseha Zemichael
- The Last Ten Kilometers Project 2020, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
| | | | | | - Wuleta Betemariam
- The Last Ten Kilometers Project 2020, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
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86
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Lepère P, Touré Y, Bitty-Anderson AM, Boni SP, Anago G, Tchounga B, Touré P, Minga A, Messou E, Kanga G, Koule S, Poda A, Calmy A, Ekouevi DK, Coffie PA. Exploring the Patterns of Use and Acceptability of Mobile Phones Among People Living With HIV to Improve Care and Treatment: Cross-Sectional Study in Three Francophone West African Countries. JMIR Mhealth Uhealth 2019; 7:e13741. [PMID: 31719023 PMCID: PMC6881784 DOI: 10.2196/13741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/07/2019] [Accepted: 06/19/2019] [Indexed: 01/16/2023] Open
Abstract
Background The use of mobile technology in health care (mobile health [mHealth]) could be an innovative way to improve health care, especially for increasing retention in HIV care and adherence to treatment. However, there is a scarcity of studies on mHealth among people living with HIV (PLHIV) in West and Central Africa. Objective The aim of this study was to assess the acceptability of an mHealth intervention among PLHIV in three countries of West Africa. Methods A cross-sectional study among PLHIV was conducted in 2017 in three francophone West African countries: Côte d’Ivoire, Burkina Faso, and Togo. PLHIV followed in the six preselected HIV treatment and care centers, completed a standardized questionnaire on mobile phone possession, acceptability of mobile phone for HIV care and treatment, preference of mobile phone services, and phone sharing. Descriptive statistics and logistic regression were used to describe variables and assess factors associated with mHealth acceptability. Results A total of 1131 PLHIV—643 from Côte d’Ivoire, 239 from Togo, and 249 from Burkina Faso—participated in the study. Median age was 44 years, and 76.1% were women (n=861). Almost all participants owned a mobile phone (n=1107, 97.9%), and 12.6% (n=140) shared phones with a third party. Acceptability of mHealth was 98.8%, with the majority indicating their preference for both phone calls and text messages. Factors associated with mHealth acceptability were having a primary school education or no education (adjusted odds ratio=7.15, 95% CI 5.05-10.12; P<.001) and waiting over one hour before meeting a medical doctor on appointment day (adjusted odds ratio=1.84, 95% CI 1.30-2.62; P=.01). Conclusions The use of mHealth in HIV treatment and care is highly acceptable among PLHIV and should be considered a viable tool to allow West and Central African countries to achieve the Joint United Nations Programme on HIV/AIDS 90-90-90 goals.
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Affiliation(s)
- Phillipe Lepère
- Institut de Santé Globale, Université de Genève, Suisse, Genève, Switzerland
| | | | | | | | | | | | | | - Albert Minga
- Centre Médical de Suivi des donneurs de sang, Abidjan, Cote D'Ivoire
| | - Eugène Messou
- Entre de Prise en charge et de Formation à Yopougon-Attié, Abidjan, Cote D'Ivoire
| | - Guillaume Kanga
- Centre Intégré de Recherches Biocliniques d'Abidjan, Abidjan, Cote D'Ivoire
| | - Serge Koule
- Unité de soins ambulatoires et de conseils, Abidjan, Cote D'Ivoire
| | - Armel Poda
- Hôpital de Jour, Service des Maladies Infectieuses et Tropicales, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Alexandra Calmy
- Unité Virus de L'immunodéficience Humaine, Service des maladies infectieuses, Hôpital Universitaire de Genève, Genève, Switzerland
| | - Didier K Ekouevi
- Programme PACCI, Abidjan, Cote D'Ivoire.,Centre Africain de Recherche en Epidémiologie et en Santé Publique, Lomé, Togo.,Département Santé Publique, Université de Lomé, Lomé, Togo.,Centre Inserm - 1219, Université de Bordeaux, Bordeaux, France
| | - Patrick A Coffie
- Programme PACCI, Abidjan, Cote D'Ivoire.,Département de Dermatologie et d'Infectiologie, Unités de Formation et de Recherche des Sciences Médicales, Université Félix Houphouët Boigny,, Abidjan, Cote D'Ivoire.,Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Cote D'Ivoire
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87
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Mwansa-Kambafwile JRM, Chasela C, Ismail N, Menezes C. Initial loss to follow up among tuberculosis patients: the role of Ward-Based Outreach Teams and short message service (SMS) technology (research proposal). BMC Res Notes 2019; 12:737. [PMID: 31703722 PMCID: PMC6842212 DOI: 10.1186/s13104-019-4757-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/18/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction Tuberculosis (TB) is a problem in South Africa. Initial loss to follow up (LTFU) among TB patients is high varying between 14.9 and 18%. Some of the reasons for this are: lack of proper communication between patient and staff on next steps after testing, not aware that results are ready; and other competing priorities. Receiving reminder messages that result is ready is an intervention that can be explored to reduce initial LTFU. This can be through either receiving a note from the Ward-Based Outreach Teams (WBOTs) or via short message service (SMS) advising the patient to collect test result at the facility. This proposal aims to assess the effectiveness of WBOTs or SMS technology in reducing TB initial LTFU. Methods This will be a mixed methods approach. In depth interviews with WBOT Managers and TB Program Managers will be conducted. Focus group discussions with WBOT members will also be conducted. Two interventions (enhanced WBOTs/SMS technology) will be tested using a 3 arm randomized controlled trial (standard of care, SMS technology or enhanced WBOTs). The WBOTs will deliver paper note reminders while SMS intervention will entail sending reminder SMS messages to patients as soon as TB results are ready.
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Affiliation(s)
- Judith R M Mwansa-Kambafwile
- Department of Public Health, University of Witwatersrand, Johannesburg, South Africa. .,Centre for Tuberculosis, National Institute of Communicable Diseases, Johannesburg, South Africa. .,Consortium for Advanced Research Training in Africa (CARTA), Nairobi, Kenya.
| | - Charles Chasela
- Department of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Nazir Ismail
- Centre for Tuberculosis, National Institute of Communicable Diseases, Johannesburg, South Africa.,Department of Microbiology, University of Pretoria, Pretoria, South Africa.,Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Colin Menezes
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
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88
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Mbuthia F, Reid M, Fichardt A. mHealth communication to strengthen postnatal care in rural areas: a systematic review. BMC Pregnancy Childbirth 2019; 19:406. [PMID: 31694578 PMCID: PMC6836428 DOI: 10.1186/s12884-019-2531-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 09/23/2019] [Indexed: 11/13/2022] Open
Abstract
Background Postnatal care (PNC) in rural areas is characterised by low uptake, with possible effect on maternal and neonatal mortality rates. Mobile health (mHealth) communication has been proposed to promote the uptake of health services; however, there is limited information on how mHealth can strengthen PNC in rural areas. The objective of this review was to gather the best available evidence regarding mHealth communication to strengthen PNC in rural areas. Methods Studies published between 1 January 2008 and 31 August 2018 were searched in electronic databases hosted by EBSCO Host. Reference list checking and contact with authors were also done. Critical appraisal of the eligible studies was also done. Results The results of 11 articles were synthesised to report the determinants of PNC uptake. Determinants were aligned to the Integrative Model of Behaviural Prediction (IMBP). One-way mobile phone messaging was the most common type of mHealth communication used. mHealth communication influenced mothers’ intentions, skills, and environmental constraints associated with uptake of PNC. Intentions were influenced by attitudes, perceived norms and self-efficacy. Positive attitudes, as well as changed attitudes toward PNC practices were observed. Perceived norms that were enhanced were delivery at a health facility with immediate PNC, seeking of reinforcement and professional health support of newborn care practices, and male partner support. Improved self-efficacy was demonstrated by mothers who attended scheduled appointments and they were confident with regard to newborn care practices. Skills for PNC that were improved included cord care, thermal care, appropriate breastfeeding and problem-solving. The environmental constraints faced and which were addressed in the studies included inaccessibility, unavailability and unaffordability of PNC services in rural areas. Conclusions Results from the literature included in this study show that one-way mobile phone messaging is the common type of mHealth communication used to strengthen PNC in rural areas. mHealth communication can influence intentions, skills and environmental constraints as determinants of PNC uptake. mHealth communication is recommended to strengthen PNC in rural areas. To widen the evidence, more studies in the field of mHealth communication that report a variety of both maternal and neonatal outcomes are needed.
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Affiliation(s)
- Florence Mbuthia
- Dedan Kimathi University of Technology, Kenya, PO Box 657-10100, Nyeri, Kenya.
| | - Marianne Reid
- University of the Free State, PO Box 339, Bloemfontein, 9300, Republic of South Africa
| | - Annali Fichardt
- University of the Free State, PO Box 339, Bloemfontein, 9300, Republic of South Africa
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89
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Nelligan RK, Hinman RS, Atkins L, Bennell KL. A Short Message Service Intervention to Support Adherence to Home-Based Strengthening Exercise for People With Knee Osteoarthritis: Intervention Design Applying the Behavior Change Wheel. JMIR Mhealth Uhealth 2019; 7:e14619. [PMID: 31628786 PMCID: PMC7012505 DOI: 10.2196/14619] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/24/2019] [Accepted: 07/27/2019] [Indexed: 01/12/2023] Open
Abstract
Background Knee osteoarthritis is a chronic condition with no known cure. Treatment focuses on symptom management, with exercise recommended as a core component by all clinical practice guidelines. However, long-term adherence to exercise is poor among many people with knee osteoarthritis, which limits its capacity to provide sustained symptom relief. To improve exercise outcomes, scalable interventions that facilitate exercise adherence are needed. SMS (short message service) interventions show promise in health behavior change. The Behavior Change Wheel (BCW) is a widely used framework that provides a structured approach to designing behavior change interventions and has been used extensively in health behavior change intervention design. Objective The study aimed to describe the development of, and rationale for, an SMS program to support exercise adherence in people with knee osteoarthritis using the BCW framework. Methods The intervention was developed in two phases. Phase 1 involved using the BCW to select the target behavior and associated barriers, facilitators, and behavior change techniques (BCTs). Phase 2 involved design of the program functionality and message library. Messages arranged into a 24-week schedule were provided to an external company to be developed into an automated SMS program. Results The target behavior was identified as participation in self-directed home-based strengthening exercise 3 times a week for 24 weeks. A total of 13 barriers and 9 facilitators of the behavior and 20 BCTs were selected to use in the intervention. In addition, 198 SMS text messages were developed and organized into a 24-week automated program that functions by prompting users to self-report the number of home exercise sessions completed each week. Users who reported ≥3 exercise sessions/week (adherent) received positive reinforcement messages. Users who reported <3 exercise sessions/week (nonadherent) were asked to select a barrier (from a list of standardized response options) that best explains why they found performing the exercises challenging in the previous week. This automatically triggers an SMS containing a BCT suggestion relevant to overcoming the selected barrier. Users also received BCT messages to facilitate exercise adherence, irrespective of self-reported adherence. Conclusions This study demonstrates application of the BCW to guide development of an automated SMS intervention to support exercise adherence in knee osteoarthritis. Future research is needed to assess whether the intervention improves adherence to the prescribed home-based strengthening exercise.
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Affiliation(s)
- Rachel K Nelligan
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Parkville, Australia
| | - Rana S Hinman
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Parkville, Australia
| | - Lou Atkins
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Kim L Bennell
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Parkville, Australia
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90
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Singh N, Varshney U. Medication adherence: A method for designing context-aware reminders. Int J Med Inform 2019; 132:103980. [PMID: 31586826 DOI: 10.1016/j.ijmedinf.2019.103980] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/30/2019] [Accepted: 09/24/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Several interventions have been proposed to improve medication adherence including those using reminders. Context-aware reminders can be effective because they operate when the dose is due, has not been taken, and is still safe to take. Although very promising, we find that there is no method to design context-aware reminders. To address these, we focus on proposing a method to design context-aware reminders. METHODS We conducted a systematic review of context-aware reminders for medication adherence using PRISMA approach. The analysis of literature leads to several interesting observations including the need for a method to design context-aware reminders. In this study, we present Method to Design Context-Aware Reminders (MDCAR) that can also meet special requirements. We used domain experts reasoning to evaluate the designed Context-Aware Reminders for Medication Adherence (CARS-MA). Further, we used analytical model to evaluate reliability, side effects, and cost of intervention. RESULTS This is the first paper that addresses "how to" design context-aware reminders. The proposed design method can lead to range of context-aware reminders including CARS-MA. The verification, validation, and evaluation of CARS-MA indicate that the context-aware reminders perform better than simple reminders in improving medication adherence. CONCLUSIONS The proposed method for context-aware reminders will help healthcare professionals and researchers to implement and select a suitable intervention to improve medication adherence. Further, it can lead to decision support systems for patients, healthcare professionals, researchers and policy makers for medication adherence. The design method can be extended for complex scenarios of multiple medications, persistent-reminders, and composite interventions.
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Affiliation(s)
- Neetu Singh
- University of Illinois at Springfield, Springfield, IL, 62703, USA.
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91
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Adler D, Abar B, Wood N, Bonham A. An Intervention to Increase Uptake of Cervical Cancer Screening Among Emergency Department Patients: Results of a Randomized Pilot Study. J Emerg Med 2019; 57:836-843. [PMID: 31594738 DOI: 10.1016/j.jemermed.2019.07.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/16/2019] [Accepted: 07/29/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Emergency departments (EDs) have the potential to promote critical public and preventive health interventions. Cervical cancer (CC) screening has been a cornerstone of preventive health efforts for decades. Approximately 20% of U.S. women are not adherent with CC screening guidelines-considerably below the U.S. Federal Government's target. ED patients are disproportionately nonadherent with CC screening guidelines. The ED, therefore, is an optimal setting to target women with an intervention that promotes CC screening. OBJECTIVES To assess the feasibility and potential efficacy of an intervention, grounded in behavioral change theory, to promote uptake of CC screening among ED patients. METHODS Design: Randomized clinical trial pilot study; Patients: Women aged 21-65 years that were identified in the ED to be nonadherent with CC screening recommendations; Setting: Single center urban academic ED. RESULTS Among enrolled participants, 355 (79%) were determined to be adherent with screening recommendations and 95 (21%) were determined to be either nonadherent or have uncertain adherence. Among the nonadherent/uncertain group, 47 were randomized to the control condition (referral only) and 48 were randomized to the intervention condition. Thirty-six percent of participants in the control condition received or scheduled screening during the follow-up period. In the intervention condition, 43% received or scheduled screening during the follow-up period-a 19% relative improvement over the control condition. CONCLUSION This pilot study demonstrates feasibility and preliminary efficacy of a behavioral intervention to increase uptake of CC screening among ED patients.
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Affiliation(s)
- David Adler
- Department of Emergency Medicine, University of Rochester, Rochester, New York
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester, Rochester, New York
| | - Nancy Wood
- Department of Emergency Medicine, University of Rochester, Rochester, New York
| | - Adrienne Bonham
- Department of Obstetrics & Gynecology, University of Rochester, Rochester, New York
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92
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Udoko AN, Graff J, Ransone S, Coday M, Gatwood JD, Bailey JE. Characteristics of Health-related Text Messages Preferred by Medically Underserved African-American Patients with Diabetes. Cureus 2019; 11:e5743. [PMID: 31723504 PMCID: PMC6825447 DOI: 10.7759/cureus.5743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Introduction Text messaging (TM) is increasingly used by the U.S. medical practices and healthcare delivery systems, but little is known about preferences of medically underserved minority patients for TM supporting improved self-care decisions. We sought to determine the characteristics of text messages and TM programs preferred by African-American patients with diabetes in medically underserved areas. Methods This convergent mixed methods study employed a self-administered survey and focus group interviews. Quantitative and qualitative data were collected simultaneously, analyzed separately, and merged to provide a holistic view of the TM characteristics patients preferred. Participants (N = 36) were recruited from a medically underserved area in Memphis, Tennessee. Focus group data were uploaded into the NVivo qualitative data analysis software program, and main themes were identified. Standard frequencies were calculated for survey responses. Results Participants ranged in the age of 22-74 years (M = 54.1; SD = 14.6) were predominantly female (77.8%), African-Americans (88.9%), and had at least a high school education (91.7%). A majority used mobile phones for sending (69.4%) and receiving (72.2%) text messages. Participants wanted to receive daily (44.4%) or weekly (47.2%) text messages from their healthcare provider (61.1%), or a motivational message program (33.3%). They preferred actionable messages with a positive tone and wanted options to customize message type, content, and frequency according to their preferences, goals, and needs. Discussion Medically underserved African-American diabetes patients want customized text messages that are practical, actionable, encouraging, and from their doctor. Healthcare providers seeking to develop patient-centered TM programs for medically underserved minority patients should personalize and tailor messages according to patient preferences, health goals, and self-care needs.
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Affiliation(s)
- Aniekan N Udoko
- Pediatrics, University of Tennessee Health Science Center, Memphis, USA
| | - Joyce Graff
- Pediatrics, University of Tennessee Health Science Center, Memphis, USA
| | | | - Mace Coday
- Preventive Medicine, University of Tennessee Health Science Center, Memphis, USA
| | - Justin D Gatwood
- Pharmacy, University of Tennessee Health Science Center, Nashville, USA
| | - James E Bailey
- Internal Medicine, University of Tennessee Health Science Center, Memphis, USA
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93
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Xiao M, Lei X, Zhang F, Sun Z, Harris VC, Tang X, Yan L. Home Blood Pressure Monitoring by a Mobile-Based Model in Chongqing, China: A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183325. [PMID: 31509950 PMCID: PMC6765873 DOI: 10.3390/ijerph16183325] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/27/2022]
Abstract
Purpose: Increasing attention is being paid to the role of the intelligent self-management of hypertension under the context of increasing prevalence but limited medical resources. However, heterogeneity in interventions and outcome measures has hindered the interpretation of research evaluating mobile health technologies for hypertension control, and little study of such technology has been performed in China. Objective: This was a feasibility study aimed to understand patient and medical practitioners’ acceptance and experience of a mobile-phone based platform for the management of hypertensive patients. Methods: The model used behavioral incentives for daily blood pressure measurement and physician-facing prioritization of patients based on level of blood-pressure control. Patients were enrolled by purposive sampling. The platform was used for two-week blood pressure monitoring through WeChat, which simulated our future app. Qualitative interviews with patients and providers were conducted in time. Results: Twenty hypertensive patients and two providers were enrolled and used the platform throughout the two weeks. Patients reported daily home blood pressure monitoring to be simple, feasible and increased their health awareness. Specifically, patients self-reported that reminders, the daily frequency and time of monitoring, and positive reinforcement were important for maintaining adherence. Providers reported that they could manage patients more quickly and accurately, but reasonable feedback information was needed to avoid excessive increases in workload. Conclusion: The adoption of mobile-based technology to monitor patient’s blood pressure may provide a practical solution for managing patients in Chongqing, China. Patient health education and enhanced app functionality could improve patient compliance and satisfaction while reducing provider workload.
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Affiliation(s)
- Meng Xiao
- School of Public Health and Management, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Xun Lei
- School of Public Health and Management, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Fan Zhang
- School of Public Health and Management, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Zhenxing Sun
- Yuzhong Center for Disease Control and Prevention, Chongqing 400010, China.
| | - Vanessa Catherine Harris
- Amsterdam Institute for Global Health and Development and Department of Global Health University Medical Center, location AMC, University of Amsterdam, 1105 Amsterdam, The Netherlands.
| | - Xiaojun Tang
- School of Public Health and Management, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Lijing Yan
- Global Health Research Center, Duke Kunshan University, Kunshan 215316, China.
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94
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Nigerian rural mothers' knowledge of routine childhood immunizations and attitudes about use of reminder text messages for promoting timely completion. J Public Health Policy 2019; 40:459-477. [PMID: 31427672 PMCID: PMC7771534 DOI: 10.1057/s41271-019-00180-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Mothers' poor knowledge and attitudes about routine immunization impede childhood immunization completion. This study assessed mothers' knowledge in rural communities about routine immunization and acceptability of mobile phone reminder text messages as an intervention for improving uptake and timely completion of routine immunization. The study adopted a descriptive cross-sectional design among 3440 consenting mothers of infants in six randomly selected Nigerian states and in the Federal Capital Territory (FCT). We used a Focus Group Discussion guide and validated questionnaire to collect data; we analysed data using a thematic approach and descriptive statistics. Respondents' ages were 26.7 ± 5.5 years. Knowledge of routine immunization was poor; attitudinal disposition was positive. Most (90.5%) indicated willingness to accept reminder text messages for routine immunization and 91.5% opined that mobile phones can be effective in providing such information. Mothers' willingness to accept the use of SMS reminder text messages for promoting routine immunization completion requires well-designed and culture-sensitive persuasive messages.
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95
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Yakovchenko V, Hogan TP, Houston TK, Richardson L, Lipschitz J, Petrakis BA, Gillespie C, McInnes DK. Automated Text Messaging With Patients in Department of Veterans Affairs Specialty Clinics: Cluster Randomized Trial. J Med Internet Res 2019; 21:e14750. [PMID: 31444872 PMCID: PMC6729116 DOI: 10.2196/14750] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 01/26/2023] Open
Abstract
Background Acceptability of mobile phone text messaging as a means of asynchronous communication between health care systems and patients is growing. The US Department of Veterans Affairs (VA) has adopted an automated texting system (aTS) for national rollout. The aTS allows providers to develop clinical texting protocols to promote patient self-management and allows clinical teams to monitor patient progress between in-person visits. Texting-supported hepatitis C virus (HCV) treatment has not been previously tested. Objective Guided by the Practical, Robust Implementation and Sustainability Model (PRISM), we developed an aTS HCV protocol and conducted a mixed methods, hybrid type 2 effectiveness implementation study comparing two programs supporting implementation of the aTS HCV protocol for medication adherence in patients with HCV. Methods Seven VA HCV specialty clinics were randomized to usual aTS implementation versus an augmented implementation facilitation program. Implementation process measures included facilitation metrics, usability, and usefulness. Implementation outcomes included provider and patient use of the aTS HCV protocol, and effectiveness outcomes included medication adherence, health perceptions and behaviors, and sustained virologic response (SVR). Results Across the seven randomized clinics, there were 293 facilitation events using a core set of nine implementation strategies (157 events in augmented implementation facilitation, 136 events in usual implementation). Providers found the aTS appropriate with high potential for scale-up but not without difficulties in startup, patient selection and recruitment, and clinic workflow integration. Patients largely found the aTS easy to use and helpful; however, low perceived need for self-management support contributed to high declination. Reach and use was modest with 197 patients approached, 71 (36%) enrolled, 50 (25%) authenticated, and 32 (16%) using the aTS. In augmented implementation facilitation clinics, more patients actively used the aTS HCV protocol compared with usual clinic patients (20% vs 12%). Patients who texted reported lower distress about failing HCV treatment (13/15, 87%, vs 8/15, 53%; P=.05) and better adherence to HCV medication (11/15, 73%, reporting excellent adherence vs 6/15, 40%; P=.06), although SVR did not differ by group. Conclusions The aTS is a promising intervention for improving patient self-management; however, augmented approaches to implementation may be needed to support clinician buy-in and patient engagement. Considering the behavioral, social, organizational, and technical scale-up challenges that we documented, successful and sustained implementation of the aTS may require implementation strategies that operate at the clinic, provider, and patient levels. Trial Registration Retrospectively registered at ClinicalTrials.gov NCT03898349; https://clinicaltrials.gov/ct2/show/NCT03898349
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Affiliation(s)
- Vera Yakovchenko
- Center for Healthcare Organization and Implementation Research, Bedford Department of Veterans Affairs Medical Center, Department of Veterans Affairs, Bedford, MA, United States
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Bedford Department of Veterans Affairs Medical Center, Department of Veterans Affairs, Bedford, MA, United States.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Thomas K Houston
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Amherst, MA, United States
| | - Lorilei Richardson
- Center for Healthcare Organization and Implementation Research, Bedford Department of Veterans Affairs Medical Center, Department of Veterans Affairs, Bedford, MA, United States
| | - Jessica Lipschitz
- Brigham and Women's Hospital Department of Psychiatry, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research, Bedford Department of Veterans Affairs Medical Center, Department of Veterans Affairs, Bedford, MA, United States
| | - Chris Gillespie
- Center for Healthcare Organization and Implementation Research, Bedford Department of Veterans Affairs Medical Center, Department of Veterans Affairs, Bedford, MA, United States
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research, Bedford Department of Veterans Affairs Medical Center, Department of Veterans Affairs, Bedford, MA, United States.,Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, United States
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96
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Zoellner JM, Porter KJ, You W, Chow PI, Ritterband LM, Yuhas M, Loyd A, McCormick BA, Brock DJP. Kids SIPsmartER, a cluster randomized controlled trial and multi-level intervention to improve sugar-sweetened beverages behaviors among Appalachian middle-school students: Rationale, design & methods. Contemp Clin Trials 2019; 83:64-80. [PMID: 31233859 PMCID: PMC6713199 DOI: 10.1016/j.cct.2019.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/07/2019] [Accepted: 06/19/2019] [Indexed: 01/15/2023]
Abstract
The intake of sugar-sweetened beverages (SSB) is disproportionately high in Appalachia, including among adolescents whose intake is more than double the national average and more than four times the recommended daily amount. Unfortunately, there is insufficient evidence for effective strategies targeting SSB behaviors among Appalachian youth in real-world settings, including rural schools. Kids SIPsmartER is a 6-month, school-based, behavior and health literacy program aimed at improving SSB behaviors among middle school students. The program also integrates a two-way short message service (SMS) strategy to engage caregivers in SSB role modeling and supporting home SSB environment changes. Kids SIPsmartER is grounded by the Theory of Planned Behavior and health literacy, media literacy, numeracy, and public health literacy concepts. Guided by the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance), this type 1 hybrid design and cluster randomized controlled trial targets 12 Appalachian middle schools in southwest Virginia. The primary aim evaluates changes in SSB behaviors at 7-months among 7th grade students at schools receiving Kids SIPsmartER, as compared to control schools. Secondary outcomes include other changes in students (e.g., BMI, quality of life, theory-related variables) and caregivers (e.g., SSB behaviors, home SSB environment), and 19-month maintenance of these outcomes. Reach is assessed, along with mixed-methods strategies (e.g., interviews, surveys, observation) to determine how teachers implement Kids SIPsmartER and the potential for institutionalization within schools. This paper discusses the rationale for implementing and evaluating a type 1 hybrid design and multi-level intervention addressing pervasive SSB behaviors in Appalachia. Clincialtrials.gov: NCT03740113.
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Affiliation(s)
- Jamie M Zoellner
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA.
| | - Kathleen J Porter
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Wen You
- Virginia Tech, Department of Agricultural and Applied Economics, 321A Hutcheson Hall, 24060, USA
| | - Phillip I Chow
- University of Virginia, Department of Psychiatry and Neurobehavioral Sciences, 560 Ray C Hunt Drive, Charlottesville, Virginia 22908, USA
| | - Lee M Ritterband
- University of Virginia, Department of Psychiatry and Neurobehavioral Sciences, 560 Ray C Hunt Drive, Charlottesville, Virginia 22908, USA
| | - Maryam Yuhas
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Annie Loyd
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Brittany A McCormick
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Donna-Jean P Brock
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
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97
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Esteban-Vasallo M, Domínguez-Berjón M, García-Riolobos C, Zoni A, Aréjula Torres J, Sánchez-Perruca L, Astray-Mochales J. Effect of mobile phone text messaging for improving the uptake of influenza vaccination in patients with rare diseases. Vaccine 2019; 37:5257-5264. [DOI: 10.1016/j.vaccine.2019.07.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 12/01/2022]
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98
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Hansen WB, Scheier LM. Specialized Smartphone Intervention Apps: Review of 2014 to 2018 NIH Funded Grants. JMIR Mhealth Uhealth 2019; 7:e14655. [PMID: 31359866 PMCID: PMC6690163 DOI: 10.2196/14655] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 12/28/2022] Open
Abstract
Background The widespread adoption of smartphones provides researchers with expanded opportunities for developing, testing and implementing interventions. National Institutes of Health (NIH) funds competitive, investigator-initiated grant applications. Funded grants represent the state of the science and therefore are expected to anticipate the progression of research in the near future. Objective The objective of this paper is to provide an analysis of the kinds of smartphone-based intervention apps funded in NIH research grants during the five-year period between 2014 and 2018. Methods We queried NIH Reporter to identify candidate funded grants that addressed mHealth and the use of smartphones. From 1524 potential grants, we identified 397 that met the requisites of including an intervention app. Each grant’s abstract was analyzed to understand the focus of intervention. The year of funding, type of activity (eg, R01, R34, and so on) and funding were noted. Results We identified 13 categories of strategies employed in funded smartphone intervention apps. Most grants included either one (35.0%) or two (39.0%) intervention approaches. These included artificial intelligence (57 apps), bionic adaptation (33 apps), cognitive and behavioral therapies (68 apps), contingency management (24 apps), education and information (85 apps), enhanced motivation (50 apps), facilitating, reminding and referring (60 apps), gaming and gamification (52 apps), mindfulness training (18 apps), monitoring and feedback (192 apps), norm setting (7 apps), skills training (85 apps) and social support and social networking (59 apps). The most frequently observed grant types included Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) grants (40.8%) and Research Project Grants (R01s) (26.2%). The number of grants funded increased through the five-year period from 60 in 2014 to 112 in 2018. Conclusions Smartphone intervention apps are increasingly competitive for NIH funding. They reflect a wide diversity of approaches that have significant potential for use in applied settings.
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99
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Mekonnen ZA, Gelaye KA, Were MC, Gashu KD, Tilahun BC. Effect of mobile text message reminders on routine childhood vaccination: a systematic review and meta-analysis. Syst Rev 2019; 8:154. [PMID: 31253186 PMCID: PMC6598255 DOI: 10.1186/s13643-019-1054-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/26/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The World Health Organization estimates that 29% of under-five mortality could be prevented with existing vaccines. However, non-consistent attendance for immunization appointments remains a global challenge to healthcare providers. Thus, innovative strategies are required to reach the last mile where technology could be effectively utilized to achieve better compliance with children immunization schedules. Therefore, the aim of the review was to systematically collect and summarize the available evidence on the effectiveness of text message reminders on childhood vaccination. METHODS This review was conducted according to a priori published protocol on PROSPERO. A systematic literature search of databases (PubMed/MEDLINE, EMBASE, Cochrane/Wiley library, and Science direct) was conducted. Eligibility and risk of bias assessments were performed independently by two reviewers. PRISMA flow diagrams were used to summarize the study selection process. Taking into account the level of heterogeneity, a random effects model was used and risk ratios with their 95% CI were used to present the pooled estimates. To investigate the sources of heterogeneity, subgroup analysis and meta-regression analysis were also considered. In this review, publication bias was assessed statistically using Harbord test. RESULTS A total of 1771 articles were searched. Out of those 1771 articles, 558 duplicated articles were removed. About 1213 articles were further screened, and finally, ten articles met the inclusion criteria. The meta-analysis showed that there is a significant effect of text message reminders on childhood vaccination coverage (RR = 1.11; 95% CI 1.05-1.17) with a moderate level of heterogeneity (I2 = 64.3%, P = 0.003). The results from the Harbord test suggested that there is no evidence for publication bias (P = 0.340). CONCLUSION This review highlights the potential benefits of incorporating mobile text message reminders into the standard management of childhood immunizations, especially in low- and middle-income countries. The frequency and timing of the text message reminders are also crucial in determining the effectiveness of text message reminders. Hence, mHealth interventions deserve more attention as a potential innovation to improve healthcare programs. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017074230.
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Affiliation(s)
- Zeleke Abebaw Mekonnen
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Martin C Were
- Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Kassahun Dessie Gashu
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Binyam Chakilu Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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100
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Karim AM, Guichon D, Yihun BY, Zemichael NF, Lorenzana K, Barofsky J, Betemariam W. Application of behavioral economics principles to reduce injectable contraceptive discontinuation in rural Ethiopia: A stratified-pair, cluster-randomized field trial. Gates Open Res 2019; 3:1494. [PMID: 32803127 PMCID: PMC7416084 DOI: 10.12688/gatesopenres.12987.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2019] [Indexed: 11/12/2023] Open
Abstract
Background: Contraceptive prevalence in Ethiopia jumped from 6% in 2000 to 36% in 2016, mainly due to increased injectable method use. However, discontinuation rates among injectable users were high (38%). Given that the public sector is the major source for injectable contraceptives, John Snow Inc. (JSI) in collaboration with ideas42 worked with Ethiopia's flagship Health Extension Program to apply behavioral economics informed approaches to mitigate discontinuation of injectable contraceptives. Methods: Behavioral diagnosis was conducted to identify the primary drivers of discontinuation of injectable contraceptives. Using these insights, a user-centered behavioral design approach was implemented to create an intervention package, consisting of a health worker planning calendar, a client counseling job aid, and client appointment cards. The study area included two districts from the four regions where JSI was implementing a family planning program. One district from each region was randomly allocated to the intervention arm. Women visiting health posts to use injectable contraceptives were enrolled in the study. Regression methods adjusted for study design, participants' backgrounds, and contextual factors, were used to estimate the intervention's effect on discontinuation rates. Results: Intervention adherence was high for the appointment cards and counseling job aid, but not for the planning calendar. This was not surprising as using appointment cards and the job aid was within the routine workflow of health extension workers, but using the planner was not. The injectable discontinuation rate was 10.8 % points lower in the intervention area compared to the control area during the post intervention follow-up survey. Conclusion: The use of two behavioral economics informed tools-the appointment card and counseling job aid-effectively decreased injectable discontinuation even with the presence of other health system bottlenecks. Behavioral economics approaches have the potential to enhance family planning programs in Ethiopia and elsewhere. Trial registration: ISRCTN ISRCTN17390653 (10/04/2019).
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Affiliation(s)
- Ali Mehryar Karim
- Global Development, Bill & Melinda Gates Foundation, Addis Ababa, Ethiopia
| | | | - Bantalem Yeshanew Yihun
- The Last Ten Kilometers Project 2020, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
| | - Nebreed Fesseha Zemichael
- The Last Ten Kilometers Project 2020, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
| | | | | | - Wuleta Betemariam
- The Last Ten Kilometers Project 2020, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
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