Effectiveness of mobile phone text message reminder interventions to improve adherence to antiretroviral therapy among adolescents living with HIV: A systematic review and meta-analysis

Background Poor adherence to antiretroviral therapy in adolescents living with HIV is a global challenge. One of the key strategies to improve adherence is believed to be the use of digital adherence tools. However, evidence is limited in this area. Our objective was to investigate the effectiveness of mobile phone text message reminders in improving ART adherence for adolescents. Methods The preferred reporting item for systematic review and meta-analysis guideline was followed. A literature search was done in five databases (PubMed, Web of Science, Embase, Global Health and Cochrane) in August 2020. Additional searches for studies and grey literature were performed manually. We included studies with quantitative design exploring the effectiveness of text message reminders, targeting adolescents aged 10–19 years. Studies were excluded if the intervention involved phone calls, phone-based applications, or other complex tech services. Mean differences between intervention and standard of care were computed using a random effects model. Subgroup analyses were performed to identify sources of heterogeneity between one-way and two-way text messages. Results Of 2517 study titles screened, seven eligible studies were included in the systematic review. The total number of participants in the included studies was 987, and the study sample varied from 14 to 332. Five studies showed a positive impact of text messaging in improving adherence, while no significant difference was found between the intervention and the control (standard of care) group in the remaining two studies. The pooled mean difference between the intervention and the control group was 0.05 (95% CI: –0.08 to 0.17). There was considerable heterogeneity among the studies (I2 = 78%). Conclusion and recommendation The meta-analysis of text message reminder interventions did not show a statistically significant difference in the improvement of ART adherence among adolescents living with HIV. The included studies were heterogeneous in the reported clinical outcomes, where the effectiveness of the intervention was identified in small studies which had a short follow-up period. Studies with bigger sample size and a longer follow-up period are needed.

Oral Hygiene Maintenance Via Teledentistry in Orthodontic Patients: A Randomized Controlled Trial

OBJECTIVES: To determine the extent of improvement in oral hygiene via text message reminder in patients undergoing fixed orthodontic treatment. METHODOLOGY: The participants were from 13 to 30 years of age recruited from Department of Orthodontics, Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University, Karachi, Pakistan. The sample comprised of 70 patients (59 female and 11 male) about to have fixed orthodontic treatment, 35 in text message group and 35 in control group. Patient's plaque index was evaluated at baseline and after 30 days. RESULTS: Text message group had highly significant (P < .05) plaque index score (PostPI) than control group. CONCLUSIONS: Orthodontic patients frequently reminded to brush have better oral hygiene. KEYWORDS: Plaque index, Text message, Oral hygiene, Orthodontics. HOW TO CITE: Khan EB, Shah M, Rafi S.M.T, Rizwan S, Ahmed Z, Fatima S. Oral hygiene maintenance via teledentistry in orthodontic patients: A randomized controlled trial. J Pak Dent Assoc 2021;30(1):34-38.

The Effectiveness Of Using Text Messages Reminder On Adherence With Tuberculosis Patients: A Systematic Review

Non-adherence is a factor that inhibits the completion of TB cases globally. Some studies suggest that the use of digital technology in the form of text message reminders can reduce the risk of non-adherence. The purpose of writing this article is to analyze the effectiveness of text message reminders on adherence to tuberculosis (TB) patients. The method in preparing this Systematic review is based on literature studies from various electronic databases, including Scopus, ScienceDirect, ProQuest, and Sage by conducting a comprehensive review using the PRISMA guidelines. The keywords used are "Text Messaging" AND "medication adherence" AND "tuberculosis". There are 11 original articles with 9 articles using the Randomized Control Trials (RCTs) research method and 2 articles using the Quasy-experimental method that fits the inclusion criteria. The use of text message reminder interventions is effective and can be used as an optional method of increasing adherence to TB patients.

47 Increase Clinic Attendance Among Adolescents and Young Adults: A novel cost-effective method

Background Transition clinics have been introduced to address the unique needs of adolescent and young adult (AYA) populations, however clinic attendance continues to be an issue. Although poor clinic attendance among the AYA population has been well known, solutions to address this has been limited. Some factors that have been associated with missed appointments include forgetfulness, negative previous clinic experiences and clinic schedules. With widespread use of digital technologies among AYA, the application of digital solutions to increase attendance at healthcare appointments has been explored, but little is known on its effectiveness. Objectives To determine the effect of text messaging appointment reminders on uninformed no show rates in an AYA transition clinic. Uninformed no show rate was defined as an absence from clinic (not related to a medical emergency) without communication with the clinic. Design/Methods A pilot prospective cohort study with a retrospective control group was conducted in an AYA general hematology transition clinic. In order to establish the current no show rate at the clinic, a retrospective review of AYA patients who attended the clinic between April 2013-August 2015 was conducted. Thereafter, all patients who had an appointment scheduled between February 2016 and December 2017 were included in the study and received a text message reminder of their appointment 48 hours prior to their appointment. Monthly uninformed no show rates were collected, and a student’s t-test was conducted to determine if there was a significant difference in uninformed no show rates before and after the introduction of text message reminders. Results Eighty-six participants consented to participate in the study and received a text message reminder of their appointment. From April 2013- August 2015 a total of 51 clinic days with 236 appointments occurred. During this time the mean uninformed no show rate was 39.9%. SMS appointment reminders were sent from February 2016 to December 2017 for 48 clinic days for a total of 206 clinic appointments. The mean uninformed no show rate after the introduction of text message appointment reminders was 22.6%. The introduction of text messaging appointment reminders significantly (p&lt;0.01) decreased uninformed no show rates by 17.3%. Conclusion Text message reminders are an effective low cost method in reminding AYA patients about their appointments. By using innovative, cost effective and practical strategies like text messaging reminders to increase clinic attendance, we not only improve the care of our patients but also reduce the financial and clerical burden to the system resulting from missed appointments.

Evaluating a Personalized, Automated Caregiver Mobile Phone Delivered Text Message Reminder Intervention to Reduce Infant Vaccination Drop-out in Arua, Uganda: Protocol for a Randomized Controlled Trial (Preprint)

BACKGROUND Globally, suboptimal vaccine coverage is a major public health concern. According to Uganda’s 2016 Demographic and Health Survey, only 49% of 12-23 month olds had received all recommended vaccinations by 12 months of age. Innovative ways are needed to increase coverage and reduce drop-out, including increasing awareness of caregivers to bring children for timely vaccination. OBJECTIVE To evaluate a personalized, automated caregiver mobile phone delivered text message reminder intervention to reduce the proportion of children who start but do not complete the vaccination series for children 12 months of age and younger in select health facilities in Arua District. METHODS A two arm, multi-center, parallel groups randomized controlled trial was conducted in four health facilities providing vaccination services in and around the town of Arua. Caregivers of children between six weeks and six months of age at the time of their first dose of pentavalent vaccine (Penta1; containing diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b antigens) were recruited and interviewed. All participants received the standard of care, defined as the health worker providing child vaccination home-based records to caregivers, as available, and providing verbal instruction of when to return for the next visit. At the end of each day, caregivers and their children were randomized by computer either to receive or not to receive personalized, automated text message reminders for their subsequent vaccination visits according to the national schedule. SMS reminders for Penta2 were sent two days before, on the day of, and two days after the scheduled vaccination visit. Reminders for Penta3 and measles-containing vaccine (MCV) were sent on the day of and five and seven days after the visit. Study personnel conducted post-intervention follow-up interviews with participants at the health facilities during the children’s MCV visit. In addition, focus group discussions were conducted to assess caregiver acceptability of the intervention; economic data was collected to evaluate the incremental costs and the cost-effectiveness of the intervention; and health facility records review forms were completed to capture service delivery process indicators. RESULTS Of 3485 screened participants, 1961 were enrolled from the sample size of 1962. Enrollment concluded in August 2016. Follow-up interviews of study participants, including data extraction from the children’s vaccination cards; data extraction from the health facility immunization registers; completion of the health facility records review forms; and focus group discussions were completed by December 2017. Results are expected to be released in 2021. CONCLUSIONS Prompting of health seeking behavior with reminders has been shown to improve health intervention uptake. Mobile phone ownership continues to grow in Uganda, so their use in vaccination interventions like this study is logical and should be evaluated with scientifically rigorous study designs. CLINICALTRIAL Clinicaltrials.gov NCT04177485; https://clinicaltrials.gov/ct2/show/NCT04177485.

Development of automated text-message reminder system to improve uptake of childhood vaccination in North-West, Ethiopia

Introduction: Non-attendance and delay for vaccination schedules remains a big challenge to healthcare workers. Among the frequently mentioned reasons for missed vaccination in children is the lack of communication between child caretakers and health workers. This necessitates developing an appropriate and uninterrupted vaccine delivery strategy with more focus on demand side interventions like forgetfulness.Objectives: This paper aimed to develop and test an automated mobile text message reminder system in the local context.Methods: Before development of the system, interview and document reviews were used for requirement gathering. This system is developed using iterative development process through phases of requirement analysis, design, development, testing and refinement. Front end application was developed using Java technologies while back end applications were developed with Oracle database. Finally, pilot testing was done on 30 participants before actual implementation.Results: The automated system has been developed based on requirements. The text message reminder system has two components: 1. Web based application for client registration and automatic reminder scheduling; 2.SMS application for automatic SMS text messaging. In the final testing, all the messages (100%) were delivered to the piloted mothers. Message speeds for each individual client ranged on average from 5 second to 30 seconds.Conclusion: Text message reminder system has been developed for routine childhood immunization program in Ethiopian context. Text message interventions should be carefully developed, tested and refined before implementation to ensure they are written in the most appropriate way for their target population.

Offering an app to book cervical screening appointments: A service evaluation

Objective To assess the feasibility of offering women who are overdue for cervical screening the use of a smartphone app to book their appointment. Methods Women who were at least six months overdue for cervical screening in three general practice surgeries in a deprived East London borough were identified from practice records. Staff sent batches of text messages informing women that they were overdue for screening, and inviting them to download an app to book their appointment. Results Across the three practices, 2632 eligible women were identified. Valid mobile phone numbers were available for 1465 women. One woman had opted out of receiving text messages, so messages were sent to 1464 women. Of these, 158 (11%) booked a screening appointment within five months. The majority of these women booked without using the app (72%; 113/158); just over a quarter booked via the app (28%; 45/158). Conclusions Just over 10% of cervical screening non-attenders booked an appointment in response to a text message with a link to a downloadable app; however, only one in four of these women booked using the app. This suggests that the text message reminder was likely to have been the key ‘active ingredient’ for most women, rather than the app itself. Future research could explore the optimal message for a text reminder in this context and evaluate the inclusion of a link to existing online booking systems.