Text Reminders Research Articles

Are Text Pages an Effective Nudge to Increase Attendance at Internal Medicine Morning Report Conferences? A Cluster Randomized Controlled Trial.

Despite the importance of medical educational conferences, low attendance remains an issue. The utility of reminder text pages as a behavioral nudge to increase attendance is unknown. Our objective was to determine whether reminder text pages increase daily morning report attendance. We conducted a multiple-crossover cluster randomized controlled trial among medical students and internal medicine interns and residents (learners) at the Veteran Affairs Boston Healthcare System during the 2019 to 2020 academic year. During intervention periods, all residents and interns received a text page reminder 5 minutes before the upcoming 8:00 am morning report conference; no page was sent during control periods. The primary outcome was conference attendance 10 minutes after the start of the conference. The study period included 85 morning report conferences, which 211 unique learners were eligible to attend; outcome data were available for 100% of eligible learners. On days when no page was sent, 44.4% of eligible learners attended the conference by 8:10 am ; on days when a reminder page was sent, 49.5% of eligible learners attended (P = .007). Accounting for clustering within individuals and controlling for date and team, the adjusted risk difference in morning report attendance associated with a reminder page was 4.0% (95% CI, 0.5%-7.6%) compared with no reminder page. No effect modification by overnight admissions was detected. Our results suggest that daily reminder pages may result in a small increase in conference attendance. Whether this small increase is educationally significant will vary across training programs that apply this strategy.

Telephonic intervention to combat non-adherence to oral iron-folic acid supplementation in pregnancy: A randomized controlled trial

IntroductionIron deficiency anemia is a public health problem globally attributing to high incidences of maternal and infant mortality and morbidity. Iron and folic acid supplementation (IFAS) is essential and provided free of cost by the public health sectors, however, a systematic review shows that the national-level adherence to oral Iron-Folic Acid Supplementation (IFAS) is less than half in pregnant women, and the significant obstacles to non-adherence are fear of side effects and forgetfulness. This trial was designed to mitigate the side effects and tackle forgetfulness with telephonic intervention. The objectives were to investigate the effectiveness of the telephonic intervention on oral IFAS adherence and hemoglobin and the reasons for non-adherence to oral IFAS, to find out the proportion of anemia in the study population, and to assess the effectiveness of the intervention on maternal and neonatal outcomes. MethodsHospital-based open-label multi-centric parallel-group randomized controlled trial, used block randomization and allocated treatment in a 1:1 ratio recruited 286 anemic pregnant women between 14 and 24 weeks of gestation with hemoglobin level < 11 g/dl having smartphones at a secondary hospital and a tertiary hospital in Eastern India. The experimental group received telephonic intervention for one month via structured text reminders, WhatsApp audio messages, and phone calls. The standard course of treatment was given to the control group. Results286 women (n1 =143, n2 =143) were randomized, 36 had attrition leaving 250 for analysis (n1 =123, n2 =127), the experimental group experienced a 44.9 % and the control group 13.8 % increase in adherence (P < 0.001). The leading reasons for non-adherence were forgetfulness (24 %), nausea and vomiting (23.2 %), and constipation (18.8 %). Hemoglobin level increased by 0.8 g/dl (P < 0.001) in the experimental group and 0.2 g/dl (P < 0.807) in the control group. ConclusionIn addition to improving adherence to oral IFAS, telephonic intervention mitigates side effects and enhances hemoglobin in anemic pregnant women. The increase in adherence was threefold in the experimental group compared to a marginal rise in the control group. This study recommends the implementation of a telephonic intervention to promote adherence to oral IFAS among anemic pregnant women.

1038 Introducing a Patient-Initiated Follow Up (PIFU) Pathway to a District General Hospital’s Urology Department: A Two-Cycle Quality Improvement Project Following the First 100 Patients

Abstract Aim Outpatient appointments have almost doubled from 54 to 94 million in the last 10-years: 68% follow-up visits, costing £8 billion yearly. Patient-Initiated Follow Up (PIFU) enables patients to initiate follow up ‘as needed’ rather than attend routine follow-up. This project aims to introduce and improve a PIFU-pathway to reduce the 7% yearly increase in local follow-ups and improve patient satisfaction. Method Using Plan-Do-Study-Act (PDSA) quality improvement methodology, a PIFU-pathway for new patients under a single consultant was established in a district general hospital’s urology department. Patients in clinic were given a letter with contact number should they request review. Those within 4-to-12 months of PIFU were quantitatively evaluated through retrospective health record analysis. A further PDSA cycle sought to improve the service by acting on patient opinions collected via telephone. Results 100 patients were evaluated with an average 6-months on PIFU. Mean age 58 years, 41% were female. PIFU indications: lower urinary tract symptoms (57%), stones (12%), UTI (9%), other (22%). Only 2% utilised PIFU, 98% sought no further appointments, 97% reported preference of PIFU over routine follow-up and improved satisfaction. 43% were unaware how to utilise PIFU; 91% either forgot about PIFU or lost PIFU contact information. Subsequent interventions include development of introductory and reminder texts, an email address, and specific webpage. Conclusions The project suggests PIFU can reduce the number of unnecessary outpatient appointments in secondary care, whilst improving patient satisfaction and without compromising care across numerous chronic urological conditions. Clinicians can subsequently target active problems or waiting list control.

The effect of text message reminders on compliance with Twin Block appliances: A randomised controlled trial.

The aim of this study was to evaluate whether text reminders influence patient compliance with Twin Block appliances. The null hypothesis was that there was no statistically significant differences in Twin Block compliance between those who receive text reminders and those that do not. Single-blind parallel randomised controlled clinical trial. Health Service Executive (HSE) orthodontic outpatient clinic in Dublin, Ireland. A total of 59 patients aged 11-15 years with a 5a Index of Orthodontic Treatment Need (IOTN grade) starting treatment with Twin Block appliances. A computer-generated unstratified allocation sequence was used to randomise the participants into the control group (CG) or the text group (TG). Both groups were asked to wear their appliances full-time. In addition to the same verbal and written instruction received by the CG, the TG received text message reminders, every 3 days, to wear their appliances. The primary outcome measure was wear time reported by Theramon® sensors embedded in the appliances. Data on wear time were uploaded from the Theramon® sensors onto cloud software. Participants in both groups were asked to fill out wear diaries and submit these at each visit. Treating clinicians and the primary investigator were blinded to the allocation group. Participants were followed up for 4 months. Participants were not blinded to their treatment group. In total, 29 participants were allocated to the CG and 30 to the TG. The data for 53 participants were analysed, 24 from the CG and 29 from the TG. The median hours/day of wear recorded using the Theramon® sensors was 13.77 (interquartile range [IQR] = 10.19) for the CG and 17.72 (IQR = 5.62) for the TG. The difference in wear time recorded was not statistically significant (P = 0.16). The study concluded that text message reminders had no statistically significant influence on patient compliance with Twin Block appliances.

Emotional Availability (EA) Brief: Single Session Feedback and Coaching for Improving Fathers’ Emotional Availability for Children Across a Wide Developmental Spectrum

Fathers are a historically underrepresented population in developmental research and must be considered for their modern presentation in parenting processes. Emotional Availability (EA) is a construct that captures the parent-child relationship quality and predicts positive outcomes for children. A recently developed intervention, the EA Brief, is a program conceptualized for easy administration that may be utilized to improve father-child dyadic functioning across a range of child ages. The final sample of interested fathers was 18 fathers with children between 4-months and 13.5-years. For pretest sessions, all fathers completed surveys (demographic information, the Emotional Availability Self Report, and the Flourishing Scale) via Qualtrics, followed by a 20-minute filmed interaction via Zoom which was later coded for EA. Immediate Intervention Group (IIG) received one pretest before the intervention and one posttest after the intervention over a 3-5 week intervention delivery. The intervention involved a 2-hour interactive Zoom workshop where information about EA, attachment, and mindfulness was provided, a 1-hour individualized, Zoom EA feedback/coaching session, and two weeks of text reminders about the covered content. In contrast to the IIG, the Waitlist Control (WC) participants received two pretests (same assessments as above) separated by the 3-5 week time period corresponding to the timing of intervention delivery for the IIG. After the second pretest, they received the same intervention as the IIG. All IIG and WC fathers received posttest sessions (exact same assessments as for the pretests noted above). Across 16 target variables assessing EA, six observed variables showed post-intervention improvement (α &lt; 0.05) though no significant findings were found on self-reported measures. These findings suggest that fathers respond to programs that provide guidance for clinically informed, research-based parenting despite the program having limited effect on their self-perceptions of how they parent.

Text Message Reminders for Long-Acting Injectable Antipsychotics in Patients with Schizophrenia Spectrum Disorders.

Individuals with schizophrenia spectrum disorders have a chronic disease process that is difficult to manage. Medication nonadherence increases the risk for relapse and subsequent rehospitalization. Long-acting injectable (LAI) antipsychotics have greater effectiveness in promoting medication adherence. To determine whether text message reminders for LAI antipsychotic administration improve medication adherence. The setting is a community mental health clinic in the west Texas region. Reminders deliver upon scheduling the appointment 3 weeks, 3 days, and 3 hr before the medication is due. This project aimed to determine the effectiveness of text reminders for LAI compliance in patients with schizophrenia spectrum disorders. Primary outcome measures include compliance percentage and target day variability. After exclusion criteria, there was a sample size of 49 patients. This pre- and post-intervention study utilized descriptive statistics and nonparametric analysis. Pre-intervention metrics outline 84.39% compliance with 3.55 target day variability. Post-intervention data resulted in a significant increase in compliance percentage to 91.24% (p = .014) and a decrease in target day variability to 1.33 days (p < .05). Text message reminders may be an effective intervention in increasing LAI compliance for individuals with schizophrenia spectrum disorders.

Effectiveness of Caregiver Intervention for Improving Medication Adherence on Level of Medication Adherence and Attitude toward Medications among Nonadherent Patients with Mental Illness

Abstract Background: Nonadherence to medication is the major challenge in treating mental illness, resulting in worsening symptoms and prolonging the course of the illness. Caregivers spend a considerable amount of time with the patients. Therefore, proper training and education for caregivers help to improve treatment outcomes. Aim: This study aims to evaluate the effectiveness of caregiver intervention for improving medication adherence (CIIMA) on level of medication adherence and attitude toward medications among nonadherent patients with mental illness. Methods: This study was an experimental study using a randomized pretest posttest control group design. The study was conducted in the psychiatric outpatient department of tertiary care hospital in the eastern India. Eighty nonadherent patients with mental illness and their primary caregivers were randomly allocated to the experimental and control group using the concealment allocation method. Patients were assessed for their level of medication adherence using medication adherence rating scale, their attitude toward medication were assessed using drug attitude inventory and reasons for medication nonadherence were assessed using the Rating of Medication Influence. CIIMA consisted of individual psycho-education, pill card monitoring, weekly telephonic and text reminders provided to the experimental group, and routine treatment was provided to the control group. The level of medication adherence and attitude toward medication were reassessed for both groups after 1 month of the initial assessment. Results: After 1 month of CIIMA, 87.2% of patients in the experimental group were adherent to medication as compared 18.4% in the control group (P &lt; 0.001), significant improvement in their attitude toward medication and treatment in the experimental group as compared to the control group (P = 0.001). Conclusion: CIIMA is an effective, low-cost, nurse-led intervention can be delivered in the inpatient and outpatient units for improving medication adherence thereby preventing future relapse of their mental illness.

Non-attendance of appointments at the orthodontic clinic

Abstract Aims To investigate the non-attendance of patients at orthodontic appointments and to determine related reasons. Methods Appointment data were collected from the Faculty of Dentistry, University of Otago between August and October in 2013 (paper-appointment system using post letters) and 2019 (digital-appointment system using automatically generated short message service (SMS) texts before the Covid-19 pandemic). The demographic and time characteristics of patients who attended and failed their appointments were collected for statistical analysis. Results The total number of appointments was 5810, including 2761 by 1901 patients in 2013 and 3049 by 2009 patients in 2019. The overall fail to attend (FTA) rates were 16.1% in 2013 and 12.9% in 2019. Morning appointments showed a higher failure rate (16.0% in 2013 and 14.2% in 2019) than the afternoon appointments (12.1% in 2013 and 11.1% in 2019) (p &lt; 0.05). Bonding appointments had a significantly lower failure rate (6.2%) compared with other treatment procedures with an attendance rate of 93.8% (p &lt; 0.05). People living between the 901 and 950 (higher socioeconomic status, SES) suburb index were 1.5 times less likely to fail compared with people living in other categories (p &lt; 0.05). Conclusion The fail to attend (FTA) of orthodontic appointments was approximately 15% in the Otago University Orthodontic Clinic, New Zealand. Patients from lower SES, Māori and Pasifika peoples, and morning appointments had higher FTA rates. Bonding appointments had the lowest FTA rate. FTA significantly decreased after the introduction of a SMS text reminder system. An effort is still required to improve the orthodontic attendance rate, and future studies could consider investigating the digital reminder systems, such as smart phone apps, to enhance clinical attendance in the electronic age.

Description of patient questions received by clinical pharmacists in the Nudge Study.

The Nudge Study is a patient level-randomized trial testing different text message medication refill reminders sent to patients assigned to 4 arms: (1) usual care, (2) generic text, (3) optimized text, and (4) optimized text plus chatbot. This report describes the frequency and types of patient questions sent to clinical pharmacists (CPs) following text reminders. Patients were enrolled from Denver Health and Hospital Authority (DHHA) and Veterans Affairs Eastern Colorado Health Care System (VA ECHCS) from October 1, 2019, through May 30, 2021. Included patients responded to at least 1 text or interactive voice response (IVR) message. Patients were dichotomized as those who posed at least 1 question to a CP and those who posed no questions. Of the 6,325 patients enrolled in an intervention arm, 3,323 (52.5%) responded to at least 1 text or IVR message, and among those responding, 305 (9.2%) responded with a pharmacist question. Patient factors associated with submitting a CP question included age (45-74 years), enrollment from DHHA, and receipt of the optimized text or optimized text plus chatbot message versus the generic text. Questions to CP were in the following categories: medication related (48.2%), refill logistics (38.4%), cost (9.2%), and other (17.7%). In a text messaging intervention focused on medication refills, there were few questions directed to the CP. Patients assigned to receive optimized texts were more likely to have questions. We hypothesize that this may suggest greater patient engagement regarding their condition, resulting in more questions.

The outcome of Reminder Text Messages Intervention on Completion of Routine Immunisation in Rural Areas, Nigeria

The outcome of Reminder Text Messages Intervention on Completion of Routine Immunisation in Rural Areas, Nigeria

Patient engagement with prescription refill text reminders across time and major societal events

Patient engagement with prescription refill text reminders across time and major societal events

A randomized controlled trial of a mobile app and tailored messages to improve outcomes among women with breast cancer receiving adjuvant endocrine therapy.

512 Background: Adjuvant endocrine therapy (AET) use among women with early-stage, hormone receptor-positive breast cancer reduces the risk of cancer recurrence, but adverse symptoms contribute to lower adherence. We evaluated the effectiveness of an app that integrates patient-reported outcomes with electronic health records and tailored messages. Methods: Women with early-stage breast cancer initiating AET (November 2018-June 2021) were randomized into three arms: (1) an “App” group that received instructions and access to the study app and weekly text reminders to use it; (2) an “App+Feedback (AF)” group received additional weekly tailored messages about managing symptoms, adherence, and communication; or (3) a “Usual Care (UC)” group without access to the app. The intervention lasted 6-months and participants completed surveys at enrollment, 6-, and 12-months. Increasing/severe symptoms and missed doses triggered alerts that prompted follow-ups from the oncology team. Outcomes included AET adherence, captured using an electronically monitored pillbox and self-reported adherence, symptom burden (FACT-ES), mental and physical health quality of life (SF-12), self-efficacy for managing symptoms (PROMIS 1.0), and 6-month count of emergency department visits/urgent care/hospitalizations [higher cost encounters] and office visits. Results: Overall, 300 women were randomized (102 UC, 96 App, and 102 AF). Median age was 60 years (range: 31–83), 34% identified as Black, 21% had incomes below 200% of the federal poverty level, and 20% had a high school degree or less education. Retention at 12-months was 88% ( N=264). Mean app logins were 14.4 among intervention participants, which resulted in 4.2 mean alerts, with 58.0% having at least one alert during the 6-month intervention. AET adherence over 12-months measured using the pillbox was similar across groups: 76% for UC, 73% for App, and 71% for AF ( p=0.57). At 12-months, AF participants had fewer higher cost care encounters over the previous 6 months (0.30, 95%CI: 0.15 to 0.45, p=0.01) compared to UC (0.71, 95%CI: 0.44 to 0.97) but not for App only vs. UC (0.46, 95% CI: 0.25 to 0.66, p=0.15). Mean mental health scores were 2.0 points better (95% CI: 0.21 to 3.84) at 6-months for AF (43.0) compared to UC (41.0). There were no statistically significant differences by group in self-reported adherence, symptom burden, physical health, self-efficacy for managing symptoms, and office visits at 6- or 12-months. Conclusions: While the intervention did not improve AET adherence, the app combined with tailored messages resulted in better self-reported mental health during the intervention and fewer higher cost care encounters at 12-months without increasing office visits. Symptom monitoring apps with tailored messages may be scalable and effective strategies for improving outcomes for patients with breast cancer. Clinical trial information: NCT03592771 .

A Financial Incentives Program to Promote Smoking Cessation Among Recently Hospitalized Individuals: Feasibility and Acceptability Study

Hospitalization is an opportunity to engage underserved individuals in tobacco treatment who may not otherwise have access to it. Tobacco treatment interventions that begin during hospitalization and continue for at least 1 postdischarge month are effective in promoting smoking cessation. However, there is low usage of postdischarge tobacco treatment services. Financial incentives for smoking cessation are an intervention in which participants receive incentives, such as cash payments or vouchers for goods, to encourage individuals to stop smoking or to reward individuals for maintaining abstinence. We sought to determine the feasibility and acceptability of a novel postdischarge financial incentive intervention that uses a smartphone application paired to measurements of exhaled carbon monoxide (CO) concentration levels to promote smoking cessation in individuals who smoke cigarettes. We collaborated with Vincere Health, Inc. to tailor their mobile application that uses facial recognition features, a portable breath test CO monitor, and smartphone technology to deliver financial incentives to a participant's digital wallet after the completion of each CO test. The program includes 3 racks. Track 1: Noncontingent incentives for conducting CO tests. Track 2: Combination of noncontingent and contingent incentives for CO levels <10 parts per million (ppm). Track 3: Contingent incentives only for CO levels <10 ppm. After obtaining informed consent, we pilot-tested the program from September to November 2020 with a convenience sample of 33 hospitalized individuals at Boston Medical Center, a large safety-net hospital in New England. Participants received text reminders to conduct CO tests twice daily for 30 days postdischarge. We collected data on engagement, CO levels, and incentives earned. We measured feasibility and acceptability quantitatively and qualitatively at 2 and 4 weeks. Seventy-six percent (25/33) completed the program and 61% (20/33) conducted at least 1 breath test each week. Seven patients had consecutive CO levels <10 ppm during the last 7 days of the program. Engagement with the financial incentive intervention as well as in-treatment abstinence was highest in Track 3 that delivered financial incentives contingent on CO levels <10 ppm. Participants reported high program satisfaction and that the intervention helped motivate smoking cessation. Participants suggested increasing program duration to at least 3 months and adding supplemental text messaging to increase motivation to stop smoking. Financial incentives paired to measurements of exhaled CO concentration levels is a novel smartphone-based tobacco cessation approach that is feasible and acceptable. Future studies should examine the efficacy of the intervention after it is refined to add a counseling or text-messaging component.

0215 Targeting the Knowledge-Behavior Gap in Sleep: The Impact of Augmenting Sleep Education with Implementation Intentions

Abstract Introduction Sleep education programs are increasingly utilized in high schools and universities to address late bedtimes and poor sleep quality in students. While these programs successfully improve sleep knowledge, they often do not change sleep behaviors (e.g., bedtimes), especially during academically demanding/stressful periods. A potential method for bridging the knowledge-behavior gap in sleep is to augment sleep education with implementation intention formation (Education+II), an established goal-fulfillment strategy. We tested this intervention in a highly demanding context: students enrolled in organic chemistry classes. Methods Undergraduate students (N=101) completed baseline questionnaires and actigraphy monitoring before completing a standardized sleep education program (Sleep 101). Afterward, participants were randomly assigned to an Education-Only condition or an Education+II condition. In the Education+II condition, using standardized if-then verbalization and visualization techniques, participants formed specific plans to go to bed earlier for the next five school nights. Participants were sent text reminders to implement their specific plans; nightly texts were also sent to Education-Only participants, but they were asked to reply with an interesting fact about sleep they learned during the education program. Participants completed questionnaires at the end of the intervention period as well as during 1-month and 7-month follow-up periods. Results There were significant time-dependent improvements in total sleep time, global sleep quality, mood, and perceived stress across groups, suggesting benefits of receiving sleep education. Participants in the Education+II condition demonstrated earlier bedtimes than those in the Education-Only condition during the intervention phase (both actigraphy and self-report) and at least one month later. Forming an implementation intention did not improve organic chemistry grades on a group-level, but grades in non-chemistry courses were higher in Education+II participants who maintained earlier bedtimes (a correlational pattern specific to this condition). Conclusion Augmenting sleep education with implementation intentions successfully advanced bedtimes during a rigorous organic chemistry course. Implementation intentions are a no-cost technique that is easy to build into sleep education programs. Doing so will encourage individuals to turn their general intentions to get better sleep into actualizable steps that facilitate behavioral change. Support (if any) National Science Foundation CAREER grant (1943323).

The Impact of Behavioral Economics-Based Counseling and Mobile Phone Text Educational and Reminder Messages on the Use of Modern Family Planning in Jordan: A Cluster Randomized Controlled Trial.

Favorable attitudes toward modern family planning methods (MFPMs) among Jordanian and Syrian women do not always translate into behavioral changes, and the availability and cost of MFPMs do not appear to be related to either prior stalls in fertility rates in Jordan or to the current and likely temporary decline in fertility rates. This study aimed to determine whether behavioral economics (BE)-based family planning interventions influence the use of any family planning method, MFPMs use, continuation of MFPMs use, and pregnancy rates among women in Jordan. The BE-based family planning interventions included personalized text messaging and augmented counseling based on framing and identity-priming BE principles, with their effects tested over a 9-month period in the postpartum period following the birth of a child. A parallel-group cluster randomized controlled trial was conducted to compare two interventions, augmented counseling based on framing and identity-priming BE principles and personalized mobile phone text messages reminders, aiming to improve the utilization of MFPMs among postpartum women over status quo family planning services in comprehensive health centers in the north of Jordan. In total, 1032 participated in the study: 295 women in the control group; 326 women in Intervention Group 1, which received only augmented counseling; and 411 women in intervention Group 2, which received augmented counseling and monthly text messages. The rates of using MFPMs in the counseling group and the counseling and messages group 3 months (54.7% and 57.1%, respectively), 6 months (50.0% and 51.7%, respectively), and 9 months (49.5% and 52.0%, respectively) were significantly higher than the rates among women in the control group (40.6% at 3 months, 37.6% at 6 months, and 34.3% at 9 months). Overall, 26.8% of women in the control group, 42.1% of women in the counseling-only group, and 45.2% of women in the counseling and messages group used MFPMs continuously for all 9 months. At 9 months, the pregnancy rate was significantly much higher in the control group (13.7%) compared to women in the counseling-only group (7.0%) and to women in the counseling and messages group (7.4%). Simple BE-based interventions can be effective methods for enhancing the use of MFPMs and maintaining the anticipated decline in Jordan's total fertility rate.

Feasibility and Acceptability of At-Home Routine Pregnancy Testing in the United States: A Pilot Study.

We aimed to investigate the acceptability of regular self-testing among people with increased risk for delayed pregnancy recognition when provided with free at-home pregnancy tests and to explore the feasibility of this intervention among a larger sample. In 2019-2020, we recruited participants across the United States by using flyers posted online and in community settings and abortion clinics. We purposively sampled people with pregnancy capacity who were 18 to 24years old, had irregular menses, or had a recent second-trimester abortion. Participants were mailed pregnancy tests and instructions. Participants received text message reminders to test monthly over a 3-month period and were asked to text back results. Participants also completed online surveys at baseline, after 1 month, and after 3 months. A purposive subsample of participants was selected to participate in semi-structured interviews. Interviews were analyzed using thematic analysis of interview guide topics and emergent themes. 61 participants were enrolled. Fifty-four participants (90%) responded to the text reminders and 52 (85%) reported testing in all 3 months. Fifty-eight (95%) said tests were easy to use, 59 (97%) said the results were clear, and all participants found it convenient to text their results. Fourteen participants completed qualitative interviews. All described continuing to test after the study and indicated high acceptability for text reminders. Interviewees described convenience and cost as primary benefits for preferring at-home pregnancy testing. Regular self-testing and texting results is feasible and acceptable to participants provided with free at-home urine pregnancy tests. These results can inform future studies designed to investigate the effect of regular self-testing on timing of pregnancy detection to facilitate early entry to prenatal care or early abortion.

A Randomized Clinical Trial of Technology-Enhanced Family-Focused Therapy for Youth in the Early Stages of Mood Disorders

Family-focused therapy (FFT) is associated with enhanced outcomes in youth with bipolar and depressive disorders, but has not been evaluated in conjunction with mobile health tools. In symptomatic adolescents whose parents had histories of mood disorders, we examined whether the effects of telehealth-based FFT were augmented by mobile health apps that emphasized mood tracking and family coping skills. Participants (aged 13-19 years) had active mood symptoms and a parent with major depressive or bipolar disorder. Participants received 12 sessions in 18 weeks of telehealth FFT, with random assignment to (1) a mobile app (MyCoachConnect, MCC) that enabled mood tracking, reviews of session content, and text reminders to practice mood management and family communication skills (FFT-MCC); or (2) a mobile app that enabled mood tracking only (FFT-Track). Independent evaluators assessed youth every 9 weeks over 6 months on depressive symptoms (primary outcome), anxiety, and psychosocial functioning. Participants (N = 65; mean age 15.8 ± 1.6 years) significantly improved in depressive symptoms over 6 months (F1,170 = 45.02, p < .0001; ή2 = 0.21, 95% CI = 0.11-0.31), but there were no effects of treatment condition or treatment by time interactions on depression scores. When secondary outcome measures were considered, the subgroup of youth with bipolar spectrum disorders showed greater improvements in anxiety and global functioning in FFT-MCC compared with FFT-Track. Youth in the early stages of mood disorder may benefit from FFT enhanced by mobile health apps. Collaborations between researchers and information technologists on mobile app design and user experience may lead to increases in engagement among adolescents. Technology Enhanced Family Treatment; https://clinicaltrials.gov/; NCT03913013.

Effect of a customized digital adherence tool on retention in care and adherence to antiretroviral treatment in breastfeeding women, children and adolescents living with HIV in Tanzania: a mixed-methods study followed by clinical trials

BackgroundAdherence to antiretroviral (ARV) treatment for HIV infection is challenging because of many factors. The World Health Organization (WHO) has recommended using digital adherence technologies (DATs). However, there is limited evidence on how DATs improve adherence. Wisepill® is an internet-enabled medication dispenser found feasible and acceptable in several studies. However, limited evidence is available on its effectiveness in improving ART adherence, specifically among children and adolescents. Furthermore, DATs are often developed without involving the target groups. We propose a two-stage project consisting of a formative study to customize an existing Wisepill DAT intervention and a randomized clinical trial to investigate the effectiveness of DAT combined with reminder cues and tailored feedback on adherence to ARV treatment among children and adolescents living with HIV and retention in care among breastfeeding women living with HIV in Kilimanjaro and Arusha Region, Tanzania.MethodsWe will conduct a formative mixed-methods study and three sub-trials in Kilimanjaro and Arusha Regions among (1) children aged 0–14 years and their caregivers, (2) adolescents aged 15–19 years and (3) breastfeeding women and their HIV-negative infants. In the formative study, we will collect and analyse data on needs and contents for DATs, including the contents of short message service (SMS) texts and tailored feedback. The results will inform the customization of the DAT to be tested in the sub-trials. In the trials, participants will be randomized in the intervention arm, where the DAT will be implemented or the control arm, where standard care will be followed. Participants in the intervention arm will take their medication from the Wisepill box and receive daily reminder texts and tailored feedback during clinic visits.DiscussionIf the intervention improves adherence to ART and the devices are acceptable, accurate and sustainable, the intervention can be scaled up within the National Aids Control Programmes.Trial registrationPACTR202301844164954, date 27 January 2023.

Evaluation of FixaSpine and Mckenzie Exercises In Comparison with Postural Text Reminders on Neck Pain among Office Workers: A Pilot Study

Background: Neck pain is a public health issue and the world's fourth-biggest cause of disability. Office workers are more affected by poor posture and different weight loads on the neck leading to the development of neck pain. FixaSpine is a wearable device allowing proper sitting or standing posture when using the computer. McKenzie exercises are inter alia used for decreasing neck pain, there are no studies on the combination of FixaSpine and McKenzie exercises. Objective: to evaluate the change in perceived neck pain before and after the combination of training with FixaSpine and performing McKenzie exercises among office workers in comparison to postural text reminders. Materials and methodology: a pre-post-interventional pilot study was carried out in Southern Sweden with 39 participants. The intervention group received training with FixaSpine and McKenzie exercises and the control group received postural text reminders for the duration of four weeks. The participants performed five days a week during working hours. The data was collected by Neck Pain and Disability Scale. Paired samples t-test and independent t-test were used for analysis. Results: a total of 39 participants (intervention group (n = 25) and control group (n = 14)) were included in the study. The intervention group showed a statistically significant difference in neck pain (p = 0.000) and in the control group, there was no significant difference in neck pain (p = 0.57). There was a significant difference in post-total NPDS scores across the groups (p = 0.002). The magnitude of the mean differences was very large (mean difference = -26.21, 95 % confidence interval: -42.12 to -10.3; Glass’delta = 1.23). Conclusion: There was a significant decrease in perceived neck pain measured before and after an intervention by a combination of training with FixaSpine and performing McKenzie exercises among office workers in comparison to postural text reminders. Further research is needed involving control groups (FixaSpine /McKenzie exercises). KEYWORDS: FixaSpine, McKenzie exercises, Neck load, Neck pain, Office workers, Posture.

Using a medication event monitoring system to evaluate self-report and pill count for determining treatment completion with self-administered, once-weekly isoniazid and rifapentine

BackgroundTreatment completion is essential for the effectiveness of any latent tuberculosis infection (LTBI) regimen. The Tuberculosis Trials Consortium (TBTC) Study 33 (iAdhere) combined self-report and pill counts – standard of care (SOC) with a medication event monitoring system (MEMS) to determine treatment completion for 12-dose once-weekly isoniazid and rifapentine (3HP). Understanding the performance of SOC relative to MEMS can inform providers and suggest when interventions may be applied to optimize LTBI treatment completion. MethodiAdhere randomized participants to directly observed therapy (DOT), SAT, or SAT with text reminders in Hong Kong, South Africa, Spain and the United States (U.S.). This post-hoc secondary analysis evaluated treatment completion in both SAT arms, and compared completion based on SOC with MEMS to completion based on SOC only. Treatment completion proportions were compared. Characteristics associated with discordance between SOC and SOC with MEMS were identified. ResultsOverall 80.8% of 665 participants completed treatment per SOC, compared to 74.7% per SOC with MEMS, a difference of 6.1% (95%CI: 4.2%, 7.8%). Among U.S. participants only, this difference was 3.3% (95% CI: 1.8%, 4.9%). Differences in completion was 3.1% (95% CI: −1.1%, 7.3%) in Spain, and 36.8% (95% CI: 24.3%, 49.4%) in South Africa. There was no difference in Hong Kong. ConclusionWhen used for monitoring 3HP, SOC significantly overestimated treatment completion in U.S. and South Africa. However, SOC still provides a reasonable estimate of treatment completion of the 3HP regimen, in U.S., Spain, and Hong Kong.