Development of a text-messaging intervention to improve treatment adherence and post-treatment review of children with uncomplicated malaria in western Kenya.

Sophie Githinji,Dejan Zurovac,Robert W Snow,Caroline Jones,Josephine Malinga,Ambrose Talisuna

doi:10.1186/s12936-015-0825-x

Abstract

BackgroundPatients’ low adherence to artemisinin-based combination therapy has been reported in areas of Kenya bordering the Lake Victoria region, where the burden of malaria remains high. A randomized controlled trial is underway to determine the efficacy of short message service (SMS) text reminders on adherence to artemether-lumefantrine and post-treatment review of children under the age of five. This paper reports on the iterative process of intervention and delivery system development.MethodsAn intervention development workshop involving the research team and other stakeholders was held to determine the content of the text messages. Three focus group discussions were conducted to test caregivers’ understanding of the messages developed during the workshop. The tested messages were refined and incorporated into an automated SMS distribution system and piloted with 20 caregivers drawn from facilities neighbouring the study sites. The automated SMS distribution system was repeatedly refined following the pilot and implemented at the start of the trial.ResultsThe content of SMS messages underwent major revisions following the focus group discussions. Technical terms and abbreviations were replaced with simplified general terms. Message sign-off was modified to reflect the name of health facility, removing references to health workers. Day 3 post-treatment review visit reminder was modified to state the purpose of the visit while wording ‘day 28’ was added to the last post-treatment review visit reminder to help the caregiver recall the appointment date. The unscheduled visit prompt was modified to reflect flexibility and practicality of taking the child back to the facility if unwell. Reception of SMS reminders during the pilot was low with only 169/240 (70%) of scheduled messages delivered to the caregivers. The automated distribution system underwent major refinement and repeated testing following the pilot until effective delivery of all scheduled messages was achieved and sustained over a period of 3 months.ConclusionsText 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. SMS distribution systems should be rigorously tested to ensure efficient delivery of the messages before they are deployed.

Highlights

Patients’ low adherence to artemisinin-based combination therapy has been reported in areas of Kenya bordering the Lake Victoria region, where the burden of malaria remains high
With the rapid growth of mobile phone subscriptions, reaching 6.9 billion in 2014, and 90% penetration in developing countries [13], use of short message service (SMS) text messaging is presenting a new type of intervention to facilitate patient communication and potentially improve adherence to treatment dosing schedules [14]
Testing understanding of the messages Dose reminders Only dose-two reminders were discussed since all dose reminders had the same content, except for the dose number

Summary

Introduction

Patients’ low adherence to artemisinin-based combination therapy has been reported in areas of Kenya bordering the Lake Victoria region, where the burden of malaria remains high. The World Health Organization (WHO) has recommended adoption of artemisinin combination therapy (ACT) for the treatment of uncomplicated falciparum malaria in 2006. Interventions already applied include the use of packaging aids, visual media, verbal information, convenient regimen with either once daily or short treatment duration, community education, and medication supervision [12]. With the rapid growth of mobile phone subscriptions, reaching 6.9 billion in 2014, and 90% penetration in developing countries [13], use of short message service (SMS) text messaging is presenting a new type of intervention to facilitate patient communication and potentially improve adherence to treatment dosing schedules [14]

Methods

Results

Discussion

Conclusion