Daily Text Messages Research Articles

Behavioural Economics to Improve Antihypertensive Therapy Adherence (BETA): protocol for a pilot randomised controlled trial in Los Angeles

IntroductionNon-adherence to antihypertensive therapy is one of the major barriers to reducing the risk of cardiovascular disease. Several interventions have targeted higher medication adherence, yet most do not result in...

Design and Implementation of a Culturally-Tailored Randomized Pilot Trial: Puerto Rican Optimized Mediterranean-Like Diet

BackgroundAdhering to a Mediterranean Diet (MedDiet) is associated with a healthier cardiometabolic profile. However, there are limited studies on the MedDiet benefits for non-Mediterranean racial/ethnic minorities, for whom this diet may be unfamiliar and inaccessible and who have a high risk of chronic diseases. ObjectivesTo describe the study design of a pilot trial testing the efficacy of a MedDiet-like tailored to adults in Puerto Rico (PR). MethodsThe Puerto Rican Optimized Mediterranean-like Diet (PROMED) was a single-site 4-mo parallel two-arm randomized pilot trial among a projected 50 free-living adults (25–65 y) living in PR with at least two cardiometabolic risk factors (clinicaltrials.gov registration #NCT03975556). The intervention group received 1 individual nutritional counseling session on a portion-control culturally-tailored MedDiet. Daily text messages reinforced the counseling content for 2 mo, and we supplied legumes and vegetable oils. Participants in the control group received cooking utensils and one standard portion-control nutritional counseling session that was reinforced with daily texts for 2 mo. Text messages for each group were repeated for two more months. Outcome measures were assessed at baseline, 2 and 4 m. The primary outcome was a composite cardiometabolic improvement score; secondary outcomes included individual cardiometabolic factors; dietary intake, behaviors, and satisfaction; psychosocial factors; and the gut microbiome. ResultsPROMED was designed to be culturally appropriate, acceptable, accessible, and feasible for adults in PR. Strengths of the study include applying deep-structure cultural components, easing structural barriers, and representing a real-life setting. Limitations include difficulty with blinding and with monitoring adherence, and reduced timing and sample size. The COVID-19 pandemic influenced implementation, warranting replication. ConclusionsIf PROMED is proven efficacious in improving cardiometabolic health and diet quality, the findings would strengthen the evidence on the healthfulness of a culturally-appropriate MedDiet and support its wider implementation in clinical and population-wide disease-prevention programs.

Chinese university students’ translanguaging hybrids on WeChat

The popularity of the online social media in China promotes a dynamic digital drive for both global and glocalised communications, facilitating the emergence of more connected intercultural language practices unimaginable in the past. Social media also creates a vast community where pervasive translanguaging practices take place daily. Translanguaging hybrids coined by Chinese university students on WeChat are exactly a case in point. WeChat is a free platform launched in 2011 by Tencent. Well established in China and the world over, Tencent provides multimodal instant messaging services. Open to world cultures, these students show ingenuity in translanguaging linguistic play in their daily text messages; meanwhile, their creative coinage of translanguaging hybrids influences the entire WeChat community. Written language in the WeChat community, often amounting to a new form of speech, deserves serious scholarly inquiry.

Are changes in pain associated with changes in heart rate variability in patients treated for recurrent or persistent neck pain?

BackgroundPersistent or recurrent neck pain is associated with perturbations in the autonomic nervous system balance, and nociceptive stimulation has been seen to influence this balance. However, very few prospective studies have addressed the extent to which changes in pain associate with changes in autonomic cardiac regulation. Therefore, we investigated if changes in pain vary with changes in heart rate variability in a cohort of patients treated for persistent or recurrent neck pain.MethodThis analysis is based on data from a randomized controlled trial in which participants were given home stretching exercises with or without spinal manipulative therapy for two weeks. As the effectiveness of the intervention (home stretching exercises and spinal manipulative therapy) was found to be equal to the control (home stretching exercises alone), all 127 participants were studied as one cohort in this analysis. During the intervention, pain levels were recorded using daily text messages, and heart rate variability was measured in the clinics three times over two weeks. Two approaches were used to classify patients based on changes in pain intensity: 1) Clinically important changes in pain were categorized as either "improved" or "not improved" and, 2) Pain development was measured using pain trajectories, constructed in a data driven approach. The association of pain categories and trajectories with changes in heart rate variability indices over time were then analysed using linear mixed models.ResultsHeart rate variability did not differ significantly between improved and not-improved patients, nor were there any associations with the different pain trajectories.ConclusionsIn conclusion, changes in pain after home stretching exercises with or without spinal manipulative therapy over two weeks were not significantly associated with changes in heart rate variability for patients with persistent or recurrent neck pain. Future studies should rely on more frequent measurements of HRV during longer treatment periods.Trial registrationThe trial was registered at ClinicalTrials.gov, registration number: NCT03576846.

Effectiveness, safety and cost-effectiveness of vaporized nicotine products versus nicotine replacement therapy for tobacco smoking cessation in a low-socioeconomic status Australian population: a study protocol for a randomized controlled trial

BackgroundIn Australia, tobacco smoking rates have declined but inequalities remain with significantly higher smoking prevalence among low-socioeconomic populations. Clinical trial data suggest vaporized nicotine products (VNPs) aid smoking cessation. Most VNP trials have used refillable tank systems, but newer generation (pod) devices now comprise the largest market share yet have limited clinical trial evidence on safety and effectiveness. This study evaluates the effectiveness, safety and cost-effectiveness of VNPs (pod and tank device) compared with nicotine replacement therapy ([NRT]—gum or lozenge) for smoking cessation.MethodsThis is a two-arm, open-label, superiority, parallel group, randomized controlled trial (RCT) with allocation concealment and blinded outcome assessment. The RCT is conducted at the National Drug and Alcohol Research Centre at the University of New South Wales, Sydney, Australia. Participants are people who smoke daily, are interested in quitting and receive a government pension or allowance (N = 1058). Participants will be randomized (1:1 ratio) to receive 8 weeks of free: VNPs, with pod (40 mg/mL nicotine salt) and tank device (18 mg/mL freebase nicotine) in mixed flavours; or NRT (gum or lozenge; 4 mg). All participants will receive daily text message behavioural support for 5 weeks. Assessments will be undertaken by telephone at baseline, with three follow-up calls (two check-in calls within the first month and final follow-up at 7 months post randomization) to ascertain smoking status, treatment adherence and adverse events. The primary outcome is 6-month continuous abstinence verified by carbon monoxide breath test of ≤5ppm at 7-month follow-up. Safety and cost-effectiveness of VNPs versus NRT will also be evaluated.DiscussionFurther data are required to strengthen certainty of evidence for VNPs aiding smoking cessation, particularly for newer generation pod devices. To our knowledge, this trial is the first to offer choice of VNPs and no comparative effectiveness trial data exists for new pod devices. If effective, the findings can inform wider implementation of VNPs to aid smoking cessation in a priority group.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12621000076875. Registered on 29 January 2021. https://www.anzctr.org.au

O58 - Symptoms of depression in parents after discharge from NICU associated with family-centred care

In 2018 to 2020, a multicentre cohort study was conducted in 23 NICUs across 15 countries. The aim of this study was to examine the potential association of family-centred care as perceived by parents during a NICU stay with parents’ depressive symptoms at discharge and at 4 months corrected for infant age. Parents ( n = 635 mothers, n = 466, fathers) of infants ( n = 739) born before 35 weeks of gestation and admitted to the participating NICUs were enrolled to the study during the first weeks of their infants’ hospitalisations. Parents’ perception of family-centred care in the NICU was assessed using the Digi-FCC (parent-version) tool with daily text messages and a questionnaire at discharge. Parent’s perception of depressive symptoms was also assessed using the Edinburgh Depression Scale: first at discharge and secondly when infants reached 4-months of corrected age. After controlling for gestational age, multiple birth, parent education and relationship status: an association was found between mothers’ and fathers’ perception of family-centred care, and their depressive symptoms at and after discharge. Parent perceptions of family-centred care was influenced by their ability to participate and make decisions about infant care, by the emotional support provided by staff members, and by other factors such as parental amenities and unlimited access for parents and significant others. Our study shows that family-centred NICU care associates with parents’ depressive symptoms after a NICU stay. Depression is common in parents of preterm infants. The provision of family-centred care may protect the mental well-being of parents of preterm infants.

Feasibility of a Novel COVID-19 Telehealth Care Management Program Among Individuals Receiving Treatment for Opioid Use Disorder: Analysis of a Pilot Program.

BackgroundThe emergence of COVID-19 exacerbated the existing epidemic of opioid use disorder (OUD) across the United States due to the disruption of in-person treatment and support services. Increased use of technology including telehealth and the development of new partnerships may facilitate coordinated treatment interventions that comprehensively address the health and well-being of individuals with OUD.ObjectiveThe analysis of this pilot program aimed to determine the feasibility of delivering a COVID-19 telehealth care management program using SMS text messages for patients receiving OUD treatment.MethodsEligible individuals were identified from a statewide opioid treatment program (OTP) network. Those who screened positive for COVID-19 symptoms were invited to connect to care management through a secure SMS text message that was compliant with Health Insurance Portability and Accountability Act standards. Care management monitoring for COVID-19 was provided for a period of up to 14 days. Monitoring services consisted of daily SMS text messages from the care manager inquiring about the participant’s physical health in relation to COVID-19 symptoms by confirming their temperature, if the participant was feeling worse since the prior day, and if the participant was experiencing symptoms such as coughing or shortness of breath. If COVID-19 symptoms worsened during this observation period, the care manager was instructed to refer participants to the hospital for acute care services. The feasibility of the telehealth care management intervention was assessed by the rates of adoption in terms of program enrollment, engagement as measured by the number of SMS text message responses per participant, and retention in terms of the number of days participants remained in the program.ResultsBetween January and April 2021, OTP staff members referred 21 patients with COVID-19 symptoms, and 18 (82%) agreed to be contacted by a care manager. Participants ranged in age from 27 to 65 years and primarily identified as female (n=12, 67%) and White (n=15, 83%). The majority of participants were Medicaid recipients (n=14, 78%). There were no statistically significant differences in the demographic characteristics between those enrolled and not enrolled in the program. A total of 12 (67%) patients were enrolled in the program, with 2 (11%) opting out of SMS text message communication and choosing instead to speak with a care manager verbally by telephone. The remaining 10 participants answered a median of 7 (IQR 4-10) SMS text messages and were enrolled in the program for a median of 9 (IQR 7.5-12) days. No participants were referred for acute care services or hospitalized during program enrollment.ConclusionsThese results demonstrate the feasibility of a novel telehealth intervention to monitor COVID-19 symptoms among OTP patients in treatment for OUD. Further research is needed to determine the applicability of this intervention to monitor patients with comorbid chronic conditions in addition to the acceptability among patients and providers using the SMS text messaging modality.

Daily self-report of substance use via text message corresponds to retrospective assessment in people with HIV who use methamphetamine

Methamphetamine use is highly prevalent among people with HIV (PWH). Substance use is difficult to assess accurately and is often evaluated using a timeline follow-back interview (TLFB). One significant limitation of the TLFB is its long retrospective recall period (e.g. remembering use over a 30-day period). Self-report via text messaging offers a remote and potentially efficacious method of assessing methamphetamine use at a time closer to actual use. The aim of this secondary analysis is to evaluate the concordance between TLFB- and text message-reported methamphetamine use in a sample of 57 PWH; and by neurocognitive impairment status. Daily text messages evaluated methamphetamine use in the previous 24 h. Participants completed a TLFB covering the past 30 days to assess methamphetamine use frequency. There was a significant correlation between TLFB and daily text message reports (ρ = 0.617, p < .001). Results of matched paired t-tests showed comparability in mean reports of methamphetamine use between assessment methods (text-based frequency = 28%, TLFB frequency = 31%; p = .328). Although results approached significance, there were no differences in the neurocognitively impaired group between assessment methods (text message reported frequency = 28%, TLFB reported frequency = 39%; p = .062). Results reveal strong correspondence between TLFB and text message assessment of methamphetamine use. There may be benefits to using text messaging for substance use assessment and opportunities for interventions to improve important health behaviors (e.g. antiretroviral therapy adherence) that are strongly linked to substance use behaviors.

Burnout and Associated Psychological Problems Among Teachers and the Impact of the Wellness4Teachers Supportive Text Messaging Program: Protocol for a Cross-sectional and Program Evaluation Study.

BackgroundStress, burnout, anxiety, and depression continue to be a problem among teachers worldwide. It is not presently known what the prevalence and correlates for these psychological problems are among teachers in Alberta and Nova Scotia. It is also not known if a supportive text message program (Wellness4Teachers) would be effective in reducing stress, burnout, anxiety, or depression symptoms among teachers.ObjectiveThe goal of this study is to evaluate the prevalence and correlates of stress, burnout, symptoms of anxiety, depression, and low resilience among elementary and high school teachers in Alberta and Nova Scotia, Canada. It also aims to determine if daily supportive text messages can help reduce the prevalence of these psychological problems in teachers.MethodsThis is a cross-sessional mixed methods study with data to be collected from subscribers of Wellness4Teachers using a web-based survey at baseline (onset of text messaging), 6 weeks, the program’s midpoint (3 months), and end point (6 months). Teachers can subscribe to the Wellness4Teachers program by texting the keyword “TeachWell” to the program phone number. Outcome measures will be assessed using standardized rating scales and key informant interviews. Data will be analyzed with descriptive and inferential statistics using SPSS and thematic analysis using NVivo.ResultsThe results of this study are expected 24 months after program launch. It is expected that the prevalence of stress, burnout, anxiety, depression, and low resilience among teachers in Alberta and Nova Scotia would be comparable to those reported in other jurisdictions. It is also expected that factors such as gender, number of years teaching, grade of teaching, and school type (elementary vs high school) will have an association with burnout and other psychological disorders among teachers. Furthermore, it is expected that Wellness4Teachers will reduce the prevalence and severity of psychological problems in teachers, and subscriber satisfaction will be high.ConclusionsThe Wellness4Teachers project will provide key information regarding prevalence and correlates of common mental health conditions in teachers in Alberta and Nova Scotia, as well as the impact of daily supportive text messages on these mental health parameters. Information from this study will be useful for informing policy and decision-making concerning psychological interventions for schoolteachers.

Trajectories of Pain Severity and Interference Among Adolescent and Young Adults With Cancer: A Microlongitudinal Study.

Cancer-related pain is a pervasive concern among adolescent and young adults (AYA) with cancer and is an emerging long-term health concern. Few studies have examined the complex contributions to pain among AYA. We aimed to fill a gap by (1) identifying subgroups of AYA with distinct patterns of pain severity and interference over time and (2) explore possible predictors of these patterns. Daily text messages over a 9-week period were used to model group-based trajectory analyses of pain severity and interference by identifying subgroups of AYA who experience common patterns of changes in pain. Demographic, medical, physical symptom burden, and psychological distress were examined as possible predictors of these patterns. AYA were on average 16.93 years old and 2.5 years since diagnosis. Subgroups of AYA were identified for pain severity and interference over time: high variability (37.7%; 37.7%, respectively), consistent high pain (35.8%; 18.9%, respectively), and consistent low pain (26.4%; 43.4%, respectively). AYA with greater psychological distress were more likely to belong to the high consistent pain severity and interference groups. AYA with greater physical symptoms were more likely to belong to the high consistent pain interference group. No significant associations between demographic/medical characteristics and trajectory subgroups were found. AYA with elevated physical and psychological symptoms were more likely to experience high consistent pain severity and pain interreference over time. Interventions aimed at reducing pain through focusing on teaching AYA how to alleviate physical symptoms and teaching coping skills to manage psychological distress may be beneficial.

Can Automated Text Messaging Successfully Monitor Antibiotic Adherence for Urban Adolescents and Young Women Managed for Pelvic Inflammatory Disease in the Outpatient Setting.

This study evaluates patient responsiveness to an automated text messaging system for pelvic inflammatory disease (PID) self-care support, and measures the reliability of text-reported adherence. Patients aged 13-25-years with mild to moderate PID were recruited from urban, academic outpatient settings. Enrolled patients received antibiotics and were randomized into a standard of care or intervention group. During a 14-day treatment period, participants in the intervention arm received a community-based nursing visit and daily text message medication reminders with evening prompts to report the number of doses taken. Of the 97 participants randomized into the intervention arm, 91 (94%) were eligible for analysis. Most were African American and low income, with a mean age of 18.3 (SD=2.2) years. Participants responded to ~53% (SD=34%) of all dosage inquiry messages. Responsiveness attenuated at approximately 2.2% per day over the treatment period. Ninety-three percent (n=85) of the analyzed intervention arm returned for the two-week follow-up. Despite overall adherence and general responsiveness, text-reported and self-reported medication adherence were not well correlated (r=0.37, p<0.001). Our findings show that text messaging is a feasible strategy for reaching urban adolescents being managed for complicated sexually transmitted infections in outpatient settings. However, patient responsiveness to self-care text messages do vary, limiting the adherence monitoring capacity of this technology. Given the number of unanswered text messages and incomplete text-reported adherence data, additional measures to assess adolescents' adherence to PID medications are needed in clinical trials.

Using mHealth to improve adherence and reduce blood pressure in individuals with hypertension and bipolar disorder (iTAB-CV): study protocol for a 2-stage randomized clinical trial

BackgroundCardiovascular disease in individuals with mental health conditions such as bipolar disorder is highly prevalent and often poorly managed. Individuals with bipolar disorder face significant medication adherence barriers, especially when they are prescribed multiple medications for other health conditions including hypertension. Poor adherence puts them at a disproportionate risk for poor health outcomes. As such, there is a need for effective interventions to improve hypertension medication adherence, particularly in patients that struggle with adherence due to mental health comorbidity.MethodsThis 5-year project uses a 2-stage randomized controlled trial design to evaluate a brief, practical adherence intervention delivered via interactive text messaging (iTAB-CV) along with self-monitoring of medication taking, mood, and home blood pressure (N = 100) compared to self-monitoring alone (N = 100). Prior to randomization, all participants will view an educational video that emphasizes the importance of medication for the treatment of hypertension and bipolar disorder. Those randomized to the texting intervention will receive daily text messages with predetermined content to address 11 salient domains as well as targeted customized messages for 2 months. This group will then be re-randomized to receive either a high (gradual taper from daily to weekly texts) or low booster (weekly texts) phase for an additional 2 months. All participants will be monitored for 52 weeks. The primary outcomes are systolic blood pressure and adherence to antihypertensive medication as determined by a self-reported questionnaire and validated with an automated pill-monitoring device. Secondary outcomes include adherence to bipolar disorder medications, psychiatric symptoms, health status, self-efficacy for medication-taking behavior, illness beliefs, medication attitudes, and habit strength.DiscussionThis study specifically targets blood pressure and mental health symptom control in people with bipolar and includes implementation elements in the study design intended to inform future scale-up. Promising pilot data and a theoretical model, which views sustained medication-taking behavior in the context of habit formation, suggests that this remotely delivered intervention may help advance care for this high-risk population and is amenable to both scale up and easy adaptation for other groups with poor medication adherence.Trial registrationThe study was registered at ClinicalTrials.gov (NCT04675593) on December 19, 2020.

DPPFit: Developing and Testing a Technology-Based Adaptation of the Diabetes Prevention Program (DPP) to Address Prediabetes in a Primary Care Setting.

The objective of this study was to adapt the National Diabetes Prevention Program (N-DPP) into a pragmatic tool for primary care settings by using daily text messaging to deliver all N-DPP content, supplemented by Fitbit technology to provide behavioral strategies typically delivered by personnel in traditional programs. Test the mobile health (mHealth), technology-based N-DPP adaptation (DPPFit) in primary care patients with prediabetes using a remote intervention based on the traditional 16 core sessions of the DPP. A pilot study with pre/post survey analysis of aggregate data were used to determine changes in weight, physical activity, sedentary behavior, and associated diabetes risk outcomes among study participants (n = 33). In this study, participants were issued Fitbit devices and provided the remote intervention over 16 weeks via automated text messaging technology, which followed the content of the DPP core education sessions. Data analysis from baseline to 6-month follow-up demonstrate mean weight loss of 3.3 kg (95% CI: -6.2 to -0.5; P = .026), reduction in body mass index by 1.25 points (95% CI: -2.1 to -0.4; P = .005), a significant average increase of 2 days in self-reported physical activity per week (95% CI: 0.4 to 3.6; P = .015) and an average 10% decrease in sedentary time (P = .007). The remote DPPFit intervention demonstrates a promising and practical approach to the management of prediabetes in a primary care setting. The results support the use of the DPPFit program and application to achieve meaningful outcomes in a population with prediabetes. A randomized controlled trial with a larger sample is warranted.

Clinical Outcomes in Routine Evaluation Measures for Patients Discharged from Acute Psychiatric Care: Four-Arm Peer and Text Messaging Support Controlled Observational Study.

Background: Peer support workers (PSW) and text messaging services (TxM) are supportive health services that are frequently examined in the field of mental health. Both interventions have positive outcomes, with TxM demonstrating clinical and economic effectiveness and PSW showing its utility within the recovery-oriented model. Objective: To evaluate the effectiveness of PSW and TxM in reducing psychological distress of recently discharged patients receiving psychiatric care. Methods: This is a prospective, rater-blinded, pilot-controlled observational study consisting of 181 patients discharged from acute psychiatric care. Patients were randomized into one of four conditions: daily supportive text messages only, peer support only, peer support plus daily text messages, or treatment as usual. Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM), a standardized measure of mental distress, was administered at four time points: baseline, six weeks, three months, and six months. MANCOVA was used to assess the impact of the interventions on participants’ scores on four CORE-OM subscales across the three follow-up time points. Recovery, clinical change, and reliable change in CORE-OM all-item analysis were examined across the four groups, and the prevalence of risk symptoms was measured. Results: A total of 63 patients completed assessments at each time point. The interaction between PSW and TxM was predictive of differences in scores on the CORE-OM functioning subscale with a medium effect size (F1,63 = 4.19; p = 0.045; ηp2 = 0.07). The PSW + TxM group consistently achieved higher rates of recovery and clinical and reliable improvement compared to the other study groups. Additionally, the text message group and the PSW + TxM group significantly reduced the prevalence of risk of self/other harm symptoms after six months of intervention, with 27.59% (χ2(1) = 4.42, p = 0.04) and 50% (χ2(1) = 9.03, p < 0.01) prevalence reduction, respectively. Conclusions: The combination of peer support and supportive text messaging is an impactful intervention with positive clinical outcomes for acute care patients. Adding the two interventions into routine psychiatric care for patients after discharge is highly recommended.

A Health Behavior and Lifestyle Intervention Pilot Trial for Childbearing Adolescents

We pilot tested a multiple health behavior change (MHBC) intervention to improve breastfeeding rates, healthy eating/active living, and depression prevention among pregnant and parenting adolescent mothers. We also assessed utility of the MHBC mHealth approach by examining health behavior coaction and intervention acceptability. We used a longitudinal randomized controlled trial to compare the tablet-delivered momHealth to a control condition (usual care). Delivered between 32 weeks of pregnancy and one month postpartum, momHealth included nine multi-media education modules, simultaneous daily educational text messaging, and weekly videoconferences for individual and group support. Main outcomes included “any” and “exclusive” breastfeeding initiation and continuation for 5 weeks and 3 months postpartum; number of fruit and vegetable servings; minutes of moderate/vigorous physical activity per day; and depressive symptoms. Sixty-two adolescents aged 16–19 having their first baby were randomized. Compared to Control, more momHealth participants were still breastfeeding at 5 weeks (chi-square = 3.91, df = 1, P = .048). Mothers who breastfed for 3 months were more likely to eat adequate daily fruits/vegetables. Participants positively rated the intervention. momHealth positively affected early breastfeeding continuation and trended toward positive outcomes in healthy living and depressive symptoms. A fully powered trial is planned to test the intervention more effectively.

Reducing readmission rates for individuals discharged from acute psychiatric care in Alberta using peer and text message support: Protocol for an innovative supportive program

BackgroundIndividuals discharged from inpatient psychiatry units have the highest readmission rates of all hospitalized patients. These readmissions are often due to unmet need for mental health care compounded by limited human resources. Reducing the need for hospital admissions by providing alternative effective care will mitigate the strain on the healthcare system and for people with mental illnesses and their relatives. We propose implementation and evaluation of an innovative program which augments Mental Health Peer Support with an evidence-based supportive text messaging program developed using the principles of cognitive behavioral therapy.MethodsA pragmatic stepped-wedge cluster-randomized trial, where daily supportive text messages (Text4Support) and mental health peer support are the interventions, will be employed. We anticipate recruiting 10,000 participants at the point of their discharge from 9 acute care psychiatry sites and day hospitals across four cities in Alberta. The primary outcome measure will be the number of psychiatric readmissions within 30 days of discharge. We will also evaluate implementation outcomes such as reach, acceptability, fidelity, and sustainability. Our study will be guided by the Consolidated Framework for Implementation Research, and the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. Data will be extracted from administrative data, surveys, and qualitative methods. Quantitative data will be analysed using machine learning. Qualitative interviews will be transcribed and analyzed thematically using both inductive and deductive approaches.ConclusionsTo our knowledge, this will be the first large-scale clinical trial to assess the impact of a daily supportive text message program with and without mental health peer support for individuals discharged from acute psychiatric care. We anticipate that the interventions will generate significant cost-savings by reducing readmissions, while improving access to quality community mental healthcare and reducing demand for acute care. It is envisaged that the results will shed light on the effectiveness, as well as contextual barriers and facilitators to implementation of automated supportive text message and mental health peer support interventions to reduce the psychological treatment and support gap for patients who have been discharged from acute psychiatric care.Trial registrationclinicaltrials.gov, NCT05133726. Registered 24 November 2021

On the Road Again: Return to Driving Following Minor Hand Surgery.

Patient return-to-driving following minor hand surgery is unknown. Through daily text message surveys, we sought to determine return-to-driving after minor hand surgery and the factors that influence return-to-driving. One hundred five subjects undergoing minor hand surgery received daily text messaging surveys postoperatively to assess: (1) if they drove the day before and if so; (2) whether they wore a cast, sling, or splint. Additional patient-, procedure-, and driving-related data were collected. More than half of subjects, 54 out of 105, returned to driving by the end of postoperative day #1. While patient-related factors had no effect on return-to-driving, significant differences were seen in anesthesia type, procedure laterality, driving assistance, and distance. Return-to-driving was significantly later for subjects who had general anesthetic compared to wide awake local anesthetic with no tourniquet (4 ± 4 days vs 1 ± 3 days, P = 0.020), as well as for bilateral procedures versus unilateral procedures (5 ± 5 days vs 1 ± 3 days, P = 0.046). Lack of another driver and driving on highways led to earlier return-to-driving (P = 0.040 and, P = 0.005, respectively). Most patients rapidly return to driving after minor hand surgery. Use of general anesthetic and bilateral procedures may delay return-to-driving. Confidential real-time text-based surveys can provide valuable information on postoperative return-to-driving and other patient behaviors.

Quality of life of colorectal cancer survivors participating in a pilot randomized controlled trial of physical activity trackers and daily text messages

PurposeThere are over 1.3 million colorectal cancer (CRC) survivors in the USA, many of whom report lower health-related quality of life (HRQoL) years after treatment. This study aimed to explore the effect of digital health tools on HRQoL in CRC survivors.MethodsWe conducted a two-arm, randomized controlled trial of 42 subjects who had completed treatment for CRC. Participants in the intervention arm received a Fitbit Flex™ and daily text messages for 12 weeks. HRQoL was assessed as a secondary endpoint in both arms at enrollment and 12 weeks using the Medical Outcomes Study Short Form Survey (SF-36) and the Functional Assessment of Cancer Therapy–Colorectal (FACT-C). Survey score changes from enrollment to 12 weeks were compared between the two arms using independent t tests, and scores at enrollment and 12 weeks were compared using paired t tests.ResultsAn increase in the FACT-C functional well-being subscale was observed in individuals in the intervention arm pre- to post-intervention (median difference, 2; interquartile range (IQR), 1, 4; P = .02). Although the between-group comparison was not statistically significant, no change in the functional well-being subscale was observed in the control arm (median difference, 0; IQR, 1, 1; P = .71). No other measures of HRQoL appeared to differ within arm across time points or between arms.ConclusionA 12-week digital physical activity intervention may improve functional well-being among CRC survivors. Larger randomized studies are needed to determine if digital health tools improve functional well-being among CRC survivors and if this improvement can be sustained over time.Trial registrationNCT02966054; registration date, November 17, 2016

Quality of life among colorectal cancer (CRC) survivors participating in a pilot trial of a web-based dietary intervention with text messages.

42 Background: Diet may be associated with survival and health-related quality of life (HRQOL) among CRC survivors. Behavioral interventions using web and mobile technology are feasible and acceptable approaches to modify dietary behavior. Little is known about the effect of web-based dietary interventions on HRQOL among CRC survivors. Methods: The Survivor Choices for Eating and Drinking study (SUCCEED) was a pilot randomized wait-list controlled trial designed to determine the feasibility and acceptability of a 12-week (wk) web-based dietary intervention with daily text messages. In this secondary analysis, we estimated the effect of the intervention on HRQOL. Between 2017-2018, 50 CRC survivors were randomized (1:1) to intervention or control. Participants in the intervention arm received the intervention in wk 1-12 and were followed from wks 12-24. Participants assigned to the control arm for 1-12 wks had the option to receive the intervention in wks 13-24. In both arms, HRQOL and sleep quality were assessed using the EORTC QLQ–C30 and CR29 and the Pittsburgh Sleep Quality Index at 0, 12, and 24 wks. Within- and between-group mean changes in HRQOL from enrollment to 12 and 24 wks were evaluated using independent t-test and paired t-test. Results: Follow-up was 88% complete at 12 and 24 wks in the intervention arm and 92% and 80% complete at 12 and 24 wks in controls. Participants mean age was 56 ± 9 y; 34% were men, 70% identified as non-Latinx White, 12% identified as Latinx, and 70% had stage III cancer. Between 0 and 12 wks, an increase in emotional functioning was observed in the intervention arm [mean change: 9.1; 95% confidence interval (CI): 2.2,16.0], while a decrease in emotional functioning was observed in controls (mean change: -5.1; 95%CI: -14.5,4.1; between-group mean difference: 14.3; 95%CI: 3.0,25.6). Between 0 and 24 wks, an increase in social functioning (mean change in intervention: 12.1; 95%CI: 2.1,22.1; between-group mean difference: 13.8; 95%CI: 2.1,25.5) and a decrease in fatigue (mean change in intervention: -9.1; 95%CI: -17.1,-1.1; between-group mean difference: -4.1; 95% CI: -15.8,7.6) was observed in the intervention arm. No other measures of HRQOL or sleep quality differed within or between arms. Conclusions: A web-based dietary intervention with daily text messages may improve emotional and social functioning among CRC survivors. Further study to evaluate the effect of web-based interventions on HRQOL among CRC survivors in larger studies may be merited. Clinical trial information: NCT02965521.

Effect of a Text-Messaging Intervention on Oral Self-Care Practices in Antenatal Women in Delhi, India: A Pilot Randomized Control Trial.

Objective:This study aimed to determine the effect of a mHealth (text message) intervention compared with a structured health educational session on the oral care and hygiene practices of pregnant women.Materials and Methods:We conducted a pilot randomized control trial, parallel design superiority trial, with a 1:1 allocation ratio. A total of 76 pregnant women up to 20 weeks of gestational age and capable of reading mobile phone text messages were recruited during August–October 2020 from the antenatal clinic of a primary health center in a low-income urban agglomeration in Delhi, India. The mHealth intervention arm participants were sent a daily text message for 30 days, while all participants were provided a one-time, face-face, brief didactic structured educational session toward oral health promotion.Results:The baseline characteristics of both groups were comparable in terms of age structure, education, parity, and oral hygiene but differed in terms of oral health problems. Postintervention, although the twice-brushing frequency increased in both arms, only the mHealth arm revealed a statistically significant reduction in the incidence of missed twice-daily brushing episodes (P = 0.016).Conclusions:A mHealth-based daily text-message intervention for 1 month was not superior to a one-time brief didactic structured educational intervention for oral health promotion in antenatal women.