Reminder Strategies Research Articles

Construction and evaluation of an online environment to reduce off-topic messaging

ABSTRACT Online discussions have become more common as social network services have become more ubiquitous and complement various learning activities. However, studies investigating online discussions in recent years have shown that off-topic messaging has increased with the use of social network services. Thus, determining the design of a mechanism to reduce the frequency of off-topic messaging is an issue deserving attention. This study develops a Facebook-based system and employs two strategies (a filter reminder strategy and a self-reflection strategy) aiming to reduce off-topic messaging in comparative and empirical studies. The research questions are as follows: (a) Which strategy is more effective in reducing off-topic messaging? (b) What are the influences of the strategies on the patterns of students’ cognitive processes? and (c) Does this influence occur during discussions? The results indicate that the filter reminder strategy can not only reduce off-topic messaging but also elicit more diversified cognitive behaviors. Finally, based on the findings, this study provides suggestions for future research and advice regarding instruction.

Rationale and design of the regimen education and messaging in diabetes (REMinD) trial

BackgroundIndividuals with type 2 diabetes manage complex multi-drug regimens, but nearly half of all patients do not consistently take the dose prescribed for them, and therefore may not receive the full potential therapeutic benefit. Both patient and health system factors contribute to achieving and maintaining medication adherence. To determine if patients with type 2 diabetes who are concurrently managing other chronic conditions could improve their adherence, we devised and are testing a multifaceted, primary care-based strategy to provide health literacy-appropriate and language concordant regimen information, guidance and reminders. ObjectiveWe are testing the effectiveness of an electronic health record (EHR) based strategy and short message service (SMS) text reminders to help patients with type 2 diabetes adhere to their medications. MethodsWe are conducting a 3-arm, multi-site trial to test and compare the effectiveness of the EHR, and EHR + SMS text reminder strategies compared to usual care on medication adherence. Our goal is to enroll a total of 900 English or Spanish-speaking patients with type 2 diabetes and hemoglobin A1C value ≥7.5%. Enrolled participants will complete interviews at baseline and 3 and 6 months following their baseline interview. ConclusionsOur trial is evaluating practical, clinic-based, scalable, evidence-based solutions for patients with type 2 diabetes managing complex medication regimens. Our findings will evaluate strategies that can be implemented broadly in primary care practices, and programmed as defaults within EHRs to support appropriate medication adherence to allow the widespread implementation of those strategies.

Clinic Exploration of Care Processes to Promote Colorectal Cancer Screening in Rural Accountable Care Organization Clinics: A Qualitative Case Study

It is essential to have an effective care process to promote colorectal cancer (CRC) screening particularly in rural areas. Primary care health care providers may have a significant impact on improving CRC screening rates among rural residents through systematic screening processes in their clinics. In this qualitative study, we aimed to explore the whole clinic processes of recommending and referring CRC screening in the rural accountable care organization (ACO) primary care clinics. We collected qualitative data through 21 semi-structured in-depth interviews with healthcare providers in rural primary care ACO clinics in Nebraska. We audio recorded and transcribed the interviews and analyzed the data using an inductive content analysis approach. The qualitative analyses revealed that ACO clinics are promoting CRC screening through teamwork with enhanced utilization of electronic health records and various other reminder strategies for both providers and patients. Areas for improvement in ACO clinic processes were also identified.

Use of short text message reminders to improve attendance of postnatal care at a referral maternity hospital, Kenya, 2016�A randomised controlled trial

INTRODUCTION: Globally about 830 women die daily due to complications of pregnancy and child birth out of which 550 occur in Sub-Saharan Africa, with about 8,000 maternal deaths occurring annually in Kenya. 66% of maternal deaths occur within the first week and 85% of maternal deaths occur within two weeks post-delivery. Attendance of postnatal services during this time could significantly reduce morbidity and mortality. We determined effectiveness of short text message (SMS) in reducing failure-to-attend rates (FTA) of postnatal clinic at the largest maternity hospital in Nairobi, Kenya. METHODS: We conducted a hospital-based randomised controlled trial. Women who delivered between March and May 2016 at Pumwani Maternity Hospital were recruited, enrolled and randomised into SMS (intervention) or no SMS (control) arms. Women were masked to which arm they belonged during randomisation but were unmasked during the appointments as the intervention had been sent. The investigators were not masked. Reminders were sent three days prior to and on the morning of the appointment. Relative Risk (RR) at 95% Confidence Interval were calculated to estimate the effectiveness of intervention at two and six-weeks. RESULTS: We enrolled 754 women, with 377 randomly assigned into each arm. There were no differences in socio-demographic characteristics between the study arms at baseline. After two-weeks, women in the intervention arm had an 80% reduction in FTA risk (RR=0.2, 95% CI 0.1–0.3). After six weeks, women in the intervention arm had a 60% reduction in FTA risk (RR=0.4, 95% CI 0.2–0.6). Among participants, 80 (42.1%) women at two-weeks and 30 (41.7%) women at six-weeks cited forgetting appointment as the most common reason for failing to attend postnatal clinic. CONCLUSION: SMS reminders were effective in reducing failure-to-attend clinic appointments. We recommend the use of SMS reminder strategy for postnatal care.

Understanding 'missed appointments' for pills and injectables: a mixed methods study in Senegal.

IntroductionHigh discontinuation rates of contraceptive methods have been documented in sub-Saharan Africa. However, little is known about gaps within individual episodes of method use, despite their implications for unintended pregnancies. The objective of this mixed methods study was to examine the prevalence of, and explore the factors contributing to, delays in repeat appointments for pills and injectables in Senegal.MethodsFirst, we constructed a longitudinal data set of women’s contraceptive consultations using routine records from 67 facilities in Senegal. Consultations for pills and injectables were classified as on time, delayed or with unknown delay status based on time since previous appointment. We described the prevalence of delayed appointments and used backward stepwise regression to build a mixed-effects model to investigate risk factors for delay. Second, we conducted workshops with family planning (FP) providers, and indepth interviews and focus group discussions with women of reproductive age, to explore factors contributing to delays.ResultsAlmost one-third (30%) of appointments for pills and injectables were delayed, resulting in risk of pregnancy. Previous delay, pill use, lower educational level, higher parity, third and subsequent visits, and Islamic faith were independently predictive of delays (p<0.04 for all). Although women’s ‘forgetfulness’ was initially mentioned as the main reason for delays by women and providers, examining the routines around appointment attendance revealed broader contextual barriers to timely refills—particularly widespread covert use, illiteracy, financial cost of FP services and limited availability of FP services.ConclusionDelays in obtaining repeat pills and injections are common among contraceptive users in Senegal, exposing women to unintended pregnancies. Strategies to reduce such delays should move beyond a narrow focus on individual women to consider contraceptive behaviour within the broader socioeconomic and health systems context. In particular, effective interventions addressing low acceptability of contraception and appointment reminder strategies in high illiteracy contexts are needed.

Integrating Calcium Supplementation into Facility-Based Antenatal Care Services in Western Kenya: A Qualitative Process Evaluation to Identify Implementation Barriers and Facilitators

BackgroundIn countries with low calcium intake, the WHO recommends integrating calcium supplementation into antenatal care (ANC) to reduce the risk of preeclampsia, a leading cause of maternal mortality. Current WHO guidelines recommend women take 3–4 calcium supplements plus 1 iron-folic acid supplement at separate times daily. There is limited evidence about implementing these guidelines through routine ANC. Through the Micronutrient Initiative-Cornell University Calcium (MICa) trial, we examined the effect of regimen on supplement consumption among ANC clients in western Kenya. A nested process evaluation examined factors that influence calcium supplementation delivery and uptake. ObjectivesThis process evaluation assessed ANC providers’, pregnant women’s, and family members’ experiences with calcium supplementation, and investigated the feasibility and acceptability of engaging family members to support adherence. MethodsWe conducted semistructured interviews with 7 ANC providers, 32 pregnant women, and 20 adherence partners (family members who provide reminders and support), and 200 observations of ANC consultations. Interviews were transcribed, translated, and analyzed thematically. Observational data were summarized. ResultsANC providers reported positive feelings about calcium supplementation, the training received, and counseling materials, but reported increased workloads. Women reported that providers counseled them on supplement benefits and managing side effects, offered reminder strategies, and provided supplements and behavior change materials. Women explained that reminder materials and adherence partners improved adherence. Most adherence partners reported providing reminders and other instrumental support to help with pill taking, which women confirmed and appreciated. Some women reported that comorbidities, concerns about being perceived as HIV positive, pill burden, unfavorable organoleptic properties, and lack of food were adherence barriers. ConclusionsAlthough integrating calcium into antenatal iron-folic acid supplementation was generally acceptable to ANC providers, pregnant women, and their families, calcium supplementation presents unique challenges that must be considered to successfully implement these guidelines. This trial was registered at clinicaltrials.gov as NCT02238704. Curr Dev Nutr 2018;2:nzy068.

Effectiveness of reminder strategies on cancer screening adherence: a randomised controlled trial.

Few randomised controlled trials (RCTs) have evaluated the different recalling approaches for enhancing adherence to faecal immunochemical test (FIT)-based screening. The authors evaluated the effectiveness of two telecommunication strategies on improving adherence to yearly FIT screening. A randomised, parallel group trial was performed in a primary care screening practice. The authors recruited 629 asymptomatic individuals aged 40-70 years with a negative FIT in 2015 to a population-based screening programme. On participation, they were invited to repeat their second round of FIT in 2016, 12 months after the first test. Each participant was randomly assigned to either interactive telephone reminder (n = 207), short message service reminder (SMS, n = 212), or control, where no additional interventions were delivered after the findings of their first FIT was communicated to the participants (n = 210). Reminders in the intervention groups were delivered 1 month before subjects' expected return. Additional telephone reminders were delivered 2 months after the expected return date to all subjects who defaulted specimen return. The outcomes included rates of FIT collection and specimen return up to 6 months after their expected return. At 6 months, the cumulative FIT collection rate was 95.1%, 90.4%, and 86.5%, respectively, for the telephone, SMS, and control groups (P = 0.010). The corresponding specimen return rate was 94.1%, 90.0%, and 86.0% (P = 0.022). When compared with the control, only subjects in the telephone group were significantly more likely to collect FIT tubes (adjusted odds ratio [AOR] 3.18, 95% confidence interval [CI] = 1.50 to 6.75, P = 0.003) and return completed specimens (AOR = 2.73, 95% CI = 1.35 to 5.53, P = 0.005). Interactive telephone reminders are effective at securing previously screened subjects to repeat screening 1 year after a negative finding.

Post-discharge malaria chemoprevention (PMC) in Malawi: caregivers` acceptance and preferences with regard to delivery methods

BackgroundIn malaria endemic countries of sub-Saharan Africa, many children develop severe anaemia due to previous and current malaria infections. After blood transfusions and antimalarial treatment at the hospital they are usually discharged without any follow-up. In the post-discharge period, these children may contract new malaria infections and develop rebound severe anaemia. A randomised placebo-controlled trial in Malawi showed 31% reduction in malaria- and anaemia-related deaths or hospital readmissions among children under 5 years of age given antimalarial drugs for 3 months post-discharge. Thus, post-discharge malaria chemoprevention (PMC) may provide substantial protection against malaria and anaemia in young children living in areas of high malaria transmission. A delivery implementation trial is currently being conducted in Malawi to determine the optimal strategy for PMC delivery. In the trial, PMC is delivered through community- or facility-based methods with or without the use of reminders via phone text message or visit from a Health Surveillance Assistant. This paper describes the acceptance of PMC among caregivers.MethodsFrom October to December 2016, 30 in-depth interviews and 5 focus group discussions were conducted with caregivers of children who recently completed the last treatment course in the trial. Views on the feasibility of various delivery methods and reminder strategies were collected. The interviews were transcribed verbatim, translated to English, and coded using the software programme NVivo.ResultsCommunity-based delivery was perceived as more favourable than facility-based delivery due to easy home access to drugs and fewer financial concerns. Many caregivers reported lack of visits from Health Surveillance Assistants and preferred text message reminders sent directly to their phones rather than waiting on these visits. Positive attitudes towards active use of health cards for remembering treatment dates were especially evident. Additionally, caregivers shared positive experiences from participation in the programme and described dihydroartemisinin-piperaquine as a safe and effective antimalarial drug that improved the health and well-being of their children.ConclusionsPost-discharge malaria chemoprevention given to children under the age of 5 previously treated for severe anaemia is highly accepted among caregivers. Caregivers prefer community-based delivery with use of health cards as their primary tool of reference.Trial registrationNCT02721420 (February 13, 2016).

Reach and Acceptability of a Mobile Reminder Strategy and Facebook Group Intervention for Weight Management in Less Advantaged Adolescents: Insights From the PRALIMAP-INÈS Trial.

BackgroundAlthough information and communication technology interventions appear to be a promising means of reducing the health inequality gap in overweight and obesity prevention, research on information and communication technology interventions is lacking outside the Anglo-Saxon world.ObjectiveThe aim of this study was to assess the reach and acceptability of 2 information and communication technology interventions delivered as part of a French nutritional program: an SMS text messaging (short message service, SMS) attendance-reminder for collective sessions strategy and a Facebook challenge group.MethodsThis study sample comprised 262 socially less advantaged overweight adolescents aged between 13 and 18 years. The information and communication technology interventions were carried out during the 2013-2014 academic year in 33 French state-run schools. For the SMS attendance-reminder for collective sessions strategy, at the start of the academic year, adolescents were asked to give their mobile number. SMS attendance-reminders were sent shortly before each of the 5 collective sessions. For the Facebook challenge group, adolescents were invited to join a closed Facebook group in which challenges on physical activity and on diet were posted weekly. Process data and 2 sets of face-to-face interviews were also used to interpret participation rates and access to Facebook. Appreciation for both interventions was evaluated by a questionnaire at the end of the academic year.ResultsOf the recruited adolescents, 79.0% (207/262) gave their mobile number, reflecting high access to a mobile phone. Giving a number was significantly more likely for girls (odds ratio [OR] 2.1, 95% CI 1.1-3.9; P=.02) and adolescents in a vocational or general high school as opposed to middle school (OR 1.0, 95% CI 0.4-2.7; OR 0.2, 95% CI 0.1-0.5; P<.001). Indicating a mobile number at the start of the year was not significantly associated with participation in collective sessions. Of the adolescents seen at the start-of-year face-to-face interviews, 78.1% (153/196) declared an interest in the Facebook challenge group, which implies having a Facebook account or being able to have access to one. However, only 21 adolescents went through the process of joining the group. Although there was satisfaction with the Facebook group among the participants, the low participation rate in the Facebook group does not allow conclusions to be drawn with confidence.ConclusionsThe results are in line with the claim that using information and communication technologies in health programs is unlikely to widen health inequalities. However, in this population of French adolescents, mobile phone strategies seem more adapted to a high school context, and caution should be exercised with a younger audience. Although there is positive appreciation of the SMS attendance-reminders and a Facebook intervention is initially highly appealing to less advantaged adolescents, no evidence of impact could be demonstrated. These results highlight the difficulty in assessing the impact of specific interventions in complex health programs.Trial RegistrationClinicaltrials.gov NCT01688453; https://clinicaltrials.gov/ct2/show/NCT01688453 (Archived by WebCite at http://www.webcitation.org/6yy6EQ0SM)

Is lithium monitoring NICE? Lithium monitoring in a UK secondary care setting.

Lithium is widely used for the treatment of bipolar disorder. Owing to its narrow therapeutic index and side-effect profile, regular monitoring of serum levels, renal and thyroid function has been recommended by all major guidelines on lithium use. We investigated whether lithium monitoring during maintenance phase treatment in clinical practice meets the latest recommendation by the National Institute for Health and Clinical excellence (i.e. lithium levels between 0.6 and 1.0 mmol/L and lithium level, thyroid and renal function tests every 6 months) in one of the largest mental health organizations in Europe, the South London and Maudsley (SLaM) NHS Foundation Trust. Retrospective data were extracted from SLaM's Clinical Record Interactive Search (CRIS) system. Adult patients with a psychiatric disorder who were on lithium at any point during the period January 2012-January 2016 and had at least one lithium level test result in the system were included in the analyses. A total of 2639 lithium level tests results were retrieved for 412 patients. Overall, the serum level was within the recommended range in 50.7% of all tests, below the range in 42.4% and above in 6.9%. Lithium level, renal and thyroid function tests were performed at the recommended frequency of 6 months (or less) in 76.2%, 72.7% and 60.2% of patients, respectively. These data demonstrate that there is a gap between the NICE 2014 recommendation and lithium monitoring practice in secondary care, with a high number of lithium level results below the therapeutic minimum. Reminder strategies for secondary care practitioners, shared care agreements or a central registry for lithium users could improve monitoring performance.

HybridLab Learning Method. III. Residual Value of Gynecological Clinical Skills [35I

INTRODUCTION: The aim was to evaluate the retention of clinical skills over time with or without the use of a checklist reminder strategy. METHODS: The 5th year students in OB/GYN rotation gain gynecological patient investigation skills (gynecologic history collection, breast examination, gynecological exam, Pap smear taking) by HybridLab method. The 1st structured standardized assessment was performed during rotation. After 4-12 months, 50 students randomly took part in the 2nd control investigation without checklist reminder (group A) or with (group B) in an identical clinical task. RESULTS: Initial evaluation of the results between the two groups (99.34 and 99.36%) and the average time interval between assessments (7.64 ± 2.8 and 1.6 ± 9:36) did not differ in both groups (P&gt; 0.05). The mean evaluation of practical skills of 2nd assessment was 75.6% (SD 17.0) of students in group A and 88.6% (SD 14.0) in group B (p=0,005). The total valuation change (with and without a reminder) was 17.1% (SD 16.7). Group A demonstrated reduced performance by 23.4% (16.8), group B — by 10.8% (SD 14.2) (p=0,006). The duration between assessments had no influence on the performance results. Based on ROC test, we determined that the ratio of chances OR [95%C.I] for gynecological skills evaluation change less 15% in group B (after reminding) was 6.729 [1.939-23.356]; the ratio of chances OR [95%C.I] for gynecological history taking evaluation change less 5% was 11.0 [2.587-46.779]. CONCLUSION: HybridLab method ensures achievement of necessary clinical skills, reminder significantly boosters their retention.

Secondary prevention for screening detected rheumatic heart disease: opportunities to improve adherence.

Secondary prevention is an effective treatment for rheumatic heart disease (RHD), but ensuring high adherence to prophylaxis over many years is challenging and requires understanding of local factors. Participants were young people diagnosed with RHD through echocardiographic screening in Fiji. We used a structured interview to evaluate the following: health seeking behaviours; attitudes, practice, barriers and potential improvement strategies for adherence to antibiotic prophylaxis; and adolescent-friendly qualities of the health service. One hundred and one participants were interviewed (median age, 17.2 years). Adherence was very low overall (adequate in 6%). Sore throat and fever with sore joints were experienced in the preceding year by 42% and 28%, respectively. Barriers to receiving treatment included taking alternate treatments and the perception that symptoms were benign and self-limiting. Reasons for missing prophylaxis injections included lack of awareness, feeling well, transport cost and access, and medication unavailability (>40% of participants each). The injection health service had many perceived strengths, but inclusion of adolescents in decision making, and quality of educational materials were deficiencies. Reminder strategies, particularly phone-based reminders, were considered helpful by 94%. We identified several factors influencing secondary prevention that may be used to develop interventions to improve adherence.

Incorporating Calcium Supplementation into Antenatal Care Services is Acceptable to Providers, Pregnant Women, and Families in Western Kenya

The World Health Organization recommends providing calcium supplements to pregnant women through antenatal care (ANC) along with iron‐folic acid (IFA) supplements to reduce maternal mortality. Although the efficacy of calcium supplementation to reduce the risk of preeclampsia is well established, evidence on the effective implementation of these guidelines through health systems is needed; current guidelines recommend women take 3 calcium pills plus 1 IFA pill at separate times daily. The objectives of this implementation research were to assess providers' experiences delivering calcium supplementation to pregnant women during routine ANC visits, and to explore the experience of women and their families with calcium and IFA supplements. Women were recruited from participants in a trial integrating calcium supplementation into 16 health facilities in western Kenya. For the larger trial, the study team trained ANC providers on calcium and IFA supplementation and counseling, provided behavior change materials, and ensured adequate supplement supplies at each facility. We purposively sampled participants to reflect diversity in facility level, adherence levels, and social support. Semi‐structured interviews were conducted with 7 ANC providers, 32 women, and 20 family members. Interviews were transcribed, translated, and analyzed qualitatively using principles of grounded theory. ANC providers reported feeling positively about the calcium supplements, training they received, and behavior change materials, but reported increased workloads. Women reported that providers counseled them on supplement benefits and managing side effects, introduced reminder strategies, and provided supplements and behavior change materials. Overall, women listed experienced and perceived benefits of calcium and IFA supplements as facilitators for supplement adherence, and they reported that behavior change materials for women and family members were helpful reminders. Most family members reported providing reminders and other instrumental support to help with pill taking, which women confirmed. Some women reported that co‐morbidities, concerns about being perceived as HIV infected, pill burden, unfavorable organoleptic properties, and food insecurity were barriers to adherence, which was consistent with providers' reports. Women also requested visits from community health workers to provide additional support. While integrating calcium into prenatal IFA supplementation was generally acceptable to ANC providers, pregnant women, and their families, calcium supplementation presents unique challenges that must be addressed for the successful implementation of these guidelines.Support or Funding InformationMicronutrient Initiative and the Sackler Institute for Nutrition Science at the New York Academy of Sciences funded this research

Antiretroviral Treatment Adherence: Knowledge and Experiences among Adolescents and Young Adults in Soweto, South Africa.

Human immunodeficiency virus (HIV) management of adolescents and young adults (AYAs) is particularly pertinent to sub-Saharan Africa, where the pediatric HIV burden is marked. Antiretroviral treatment (ART) adherence is a major challenge for AYAs. This qualitative study explored knowledge and experiences of adherence amongst AYAs attending treatment at the Perinatal HIV Research Unit (PHRU), Soweto, South Africa. Four focus group discussions (FGDs) and eight in-depth interviews (IDIs) were conducted with HIV-infected 15–25-year-old ART recipients. Transcripts were coded thematically. Participants (n = 26) were aged median 18.5 years, 59.1% female and 69.2% virally suppressed <400 cp/ml. Three main themes emerged during FGDs and IDIs: (i) correct knowledge about how to be adherent, benefits, and nonadherence consequences, (ii) social, personal, and medication-related barriers to adherence, and (iii) reminder, concealment, and motivational strategies to optimize adherence. Interventions to improve AYA adherence could focus on practical strategies, including status disclosure and medication concealment.

Incentive and Reminder Strategies to Improve Response Rate for Internet-Based Physician Surveys: A Randomized Experiment.

BackgroundMost research on how to enhance response rates in physician surveys has been done using paper surveys. Uncertainties remain regarding how to enhance response rates in Internet-based surveys.ObjectiveTo evaluate the impact of a low-cost nonmonetary incentive and paper mail reminders (formal letter and postcard) on response rates in Internet-based physician surveys.MethodsWe executed a factorial-design randomized experiment while conducting a nationally representative Internet-based physician survey. We invited 3966 physicians (randomly selected from a commercial database of all licensed US physicians) via email to complete an Internet-based survey. We used 2 randomly assigned email messages: one message offered a book upon survey completion, whereas the other did not mention the book but was otherwise identical. All nonrespondents received several email reminders. Some physicians were further assigned at random to receive 1 reminder via paper mail (either a postcard or a letter) or no paper reminder. The primary outcome of this study was the survey response rate.ResultsOf the 3966 physicians who were invited, 451 (11.4%) responded to at least one survey question and 336 (8.5%) completed the entire survey. Of those who were offered a book, 345/2973 (11.6%) responded compared with 106/993 (10.7%) who were not offered a book (odds ratio 1.10, 95% CI 0.87-1.38, P=.42). Regarding the paper mail reminder, 168/1572 (10.7%) letter recipients, 148/1561 (9.5%) postcard recipients, and 69/767 (9.0%) email-only recipients responded (P=.35). The response rate for those receiving letters or postcards was similar (odds ratio 1.14, 95% CI 0.91-1.44, P=.26).ConclusionsOffering a modest nonmonetary incentive and sending a paper reminder did not improve survey response rate. Further research on how to enhance response rates in Internet-based physician surveys is needed.

P128 Human papillomavirus (HPV) vaccination in young men who have sex with men (MSM) in the UK. An online survey of attitudes, intentions and opinions among MSM offered vaccination within integrated sexual health services: Abstract P128 Table 1

Background We have offered quadrivalent HPV vaccine (HPV4) to MSM under 27 years since 2012. We have observed a 60% 3 dose completion rate within 1 year. Aims (1) To identify motivating factors or barriers influencing HPV4 completion in a cohort of MSM receiving at least one dose of HPV vaccine. (2) To identify factors influencing survey response rates. Methods An email and reminder and an SMS text weblink to an online survey was sent to all MSM who received at least 1 dose of HPV4 vaccine. Results Of 893 eligible, 688 (77%) had an email address, 257 (29%) opened the survey, and 228 (26%) completed the survey. 89% respondents learned of the vaccine at offer. 87% were happy with the information received and 97% with their decision to accept vaccine. A reminder strategy utilising SMS text for 1 year was preferred. Prevention of genital warts and anogenital cancers were equally highly important in motivation. Trusted healthcare workers were important influences in decision making Survey respondents were more likely to be older (>21 yrs), HIV positive, homosexual and of non-white british ethnicity than the cohort of vaccine recipients. Discussion MSM HPV vaccine recipients express high levels of satisfaction with vaccination despite little a priori awareness. Trusted public service providers & friends are influential. Completion should be supported through a multifaceted approach involving a range of agencies and media and expansion of access to vaccine.

Adolescent Vaccination Strategies: Interventions to Increase Coverage.

While vaccines have decreased the burden of disease, many adolescents still remain under-immunized, particularly for human papillomavirus (HPV) and influenza. We review the most current data regarding adolescent immunizations in the United States and discuss proven strategies that work for increasing vaccination rates. Strategies that have been shown to improve rates include provider feedback, immunization information systems (or registries), and enhanced access outside of provider offices, such as school-based immunization programs. Overall, practices may want to consider multimodal quality improvement approaches to enhance practice vaccination rates. The public health and cost benefits of immunizing adolescents are well known, yet recent measles outbreaks in the United States have highlighted issues with state immunization laws and vaccine refusals. Providers should be clear in their advice regarding vaccines and use effective reminder strategies as parents commonly cite not having enough information or knowledge that a vaccine was needed for their adolescent. Additional research is needed regarding adolescent consent for vaccines, as well as adolescent and parental refusal, in order to design systems that will help inform families and allow for widespread vaccine availability.

Efficacy of Baduanjin Exercise and Feasibility of Mobile Text Reminders on Follow-up Participation in People With Severe Mental Illness: An Exploratory Study.

People with severe mental illness (SMI) frequently have poor physical health, which can in part be related to a low level of physical activity. The goal of this exploratory study was to examine the efficacy of a group participating in Baduanjin (a type of traditional Chinese exercise) on the health of individuals with SMI and the feasibility/acceptability of using short message service (SMS) reminder strategies to prompt continued exercise during a follow-up period. Participants (N=11) participated in a Baduanjin group session for 8 weeks and then maintained home-based Baduanjin with SMS reminders for another 8 weeks. Physical and psychological tests were administered to participants. Significant improvements were found in balance and processing speed and in some domains of the 36-Item Short Form Health Survey (SF-36) after the Baduanjin program. Participants were able to maintain engagement in 80% of the expected practice time during the follow-up period. The acceptability of strategies to support home-based exercise, including SMS reminders, was high. This preliminary study suggested the efficacy of Baduanjin and the feasibility of SMS reminders in maintaining follow-up participation in people with SMI. Future studies using a larger sample size and a control group are needed to confirm the findings.

Practice- and Community-Based Interventions to Increase Human Papillomavirus Vaccine Coverage: A Systematic Review.

Vaccines against human papillomavirus (HPV) are recommended for routine use in adolescents aged 11 to 12 years in the United States, but uptake remains suboptimal. Educational interventions focused on parents and patients to increase coverage have not generally demonstrated effectiveness. To systematically review the literature on effectiveness of interventions conducted at the practice or community level to increase uptake of HPV vaccines in the United States. Keyword searches of the PubMed, Web of Science, and MEDLINE databases identified studies of adolescents that included the outcome of HPV vaccination published through July 2014. References of identified articles were also reviewed. A total of 366 records were screened, 38 full-text articles were reviewed, and 14 published studies were included. Results were summarized by different intervention approaches. Practice- and community-based intervention approaches included reminder and recall (n = 7), physician-focused interventions (eg, audit and feedback) (n = 6), school-based programs (n = 2), and social marketing (n = 2) (2 interventions tested multiple approaches). Seven studies used a randomized design, and 8 used quasiexperimental approaches (one used both). Thirteen studies included girls, and 2 studies included boys. Studies were conducted in a variety of populations and geographic locations. Twelve studies reported significant increases in at least one HPV vaccination outcome, one reported a nonsignificant increase, and one reported mixed effects. Most practice- and community-based interventions significantly increased HPV vaccination rates using varied approaches across diverse populations. This finding is in stark contrast to a recent review that did not find effects to warrant widespread implementation for any educational intervention. To address the current suboptimal rates of HPV vaccination in the United States, future efforts should focus on programs that can be implemented within health care settings, such as reminder and recall strategies and physician-focused efforts, as well as the use of alternative community-based locations, such as schools.

Retention in care and medication adherence: current challenges to antiretroviral therapy success.

Health behaviors such as retention in HIV medical care and adherence to antiretroviral therapy (ART) pose major challenges to reducing new HIV infections, addressing health disparities, and improving health outcomes. Andersen's Behavioral Model of Health Service Use provides a conceptual framework for understanding how patient and environmental factors affect health behaviors and outcomes, which can inform the design of intervention strategies. Factors affecting retention and adherence among persons with HIV include patient predisposing factors (e.g., mental illness, substance abuse), patient-enabling factors (e.g., social support, reminder strategies, medication characteristics, transportation, housing, insurance), and healthcare environment factors (e.g., pharmacy services, clinic experiences, provider characteristics). Evidence-based recommendations for improving retention and adherence include (1) systematic monitoring of clinic attendance and ART adherence; (2) use of peer or paraprofessional navigators to re-engage patients in care and help them remain in care; (3) optimization of ART regimens and pharmaceutical supply chain management systems; (4) provision of reminder devices and tools; (5) general education and counseling; (6) engagement of peer, family, and community support groups; (7) case management; and (8) targeting patients with substance abuse and mental illness. Further research is needed on effective monitoring strategies and interventions that focus on improving retention and adherence, with specific attention to the healthcare environment.