Short Message Service Intervention Research Articles

Cost Analysis of Short Messaging Service and Peer Navigator Interventions for Linking and Retaining Adults Recently Diagnosed With HIV in Care in South Africa.

Large proportions of people living with HIV (PLHIV) in sub-Saharan Africa are not linked to or retained in HIV care. There is a critical need for cost-effective interventions to improve engagement and retention in care and inform optimal allocation of resources. We estimated costs associated with a short message service (SMS) plus peer navigation (SMS+PN) intervention; an SMS-only intervention; and standard of care (SOC), within the I-Care cluster-randomized trial to improve HIV care engagement for recently diagnosed PLHIV. We employed a uniform cost data-collection protocol to quantify resources used and associated costs for each intervention. Compared with SOC, the SMS+PN intervention cost $1284 ($828-$2859) more per additional patient linked to care within 30 days and $1904 ($1158-$5343) more per additional patient retained in care at 12 months, while improving linkage by 24% (95% CI: 11 to 36) and retention by 16% (95% CI: 6 to 26). By contrast, the SMS-only intervention cost $198 ($93-dominated) more per additional patient linked to care and $697 ($171-dominated) more per additional patient retained in care but was not significantly associated with improvements in linkage (12%; 95% CI: -1 to 25) or retention (3%; 95% CI: -7 to 14) compared with SOC. The efficiency of the SMS+PN intervention could be improved by 46%, to $690 more per additional patient linked and $1023 more per additional patient retained in care, if implemented within the Department of Health using more efficient distribution of staff resources. Findings suggest that scale-up of the SMS+PN intervention could benefit patients, improving care and health outcomes while being cost-effective.

User-Centered Design to Develop Automated Short Message Service Messaging for Patient Support of Rheumatic Heart Disease Secondary Antibiotic Prophylaxis.

The Active Community Case Management Platform is a cloud-based technology developed to facilitate rheumatic heart disease case management by health care providers. This study aimed to design and pilot an automated short message service (SMS) intervention to support secondary prophylaxis adherence. We developed a concise library of messages to support secondary antibiotic prophylaxis. The SMS intervention used TextIT, an interface that enables users to send out interactive SMS messages at scale. The message bank was piloted in a cohort of 50 patients with rheumatic heart disease randomized into 2 groups. Group 1 received standard support (nurse-led/Active Community Case Management Platform). Group 2 received standard support plus SMS intervention for 2 months in the Lira and Gulu districts of Northern Uganda. We collected qualitative data on participants' experiences and assessed treatment adherence. Using a sequential user-centered process consisting of 4 phases (phases 1-4), we developed a message bank (n=43) deployed during our pilot study. There were no between-group differences in treatment adherence or acceptance. Interviews of participants indicated that the intervention was viewed positively. A total of 75% of SMS recipients responded to the messages, and 25% called the study staff to acknowledge receipt of text messages. This study has successfully developed a bank of SMS messages to support secondary antibiotic prophylaxis adherence. We have demonstrated the feasibility and acceptability of SMS technology in rheumatic heart disease care management. Future work will include integrating automated SMS into the Active Community Case Management Platform and a larger study of integrated SMS to reduce health care worker burden for patient support and improve adherence to secondary antibiotic prophylaxis.

Determinants of medication adherence and impact of mobile telephony, pillbox interventions on compliance and glycemic control among patients with type 2 diabetes

Abstract Background: Medication adherence has been linked to improved glycemic control, fewer complications from diabetes, fewer hospitalizations, reduced health care expenses, and a decreased mortality rate. The medication adherence pattern, reason, and factors associated with poor medication adherence among patients living with type 2 diabetes mellitus were determined, and the impact of two interventions to improve medication adherence was assessed. Materials and Methods: The medication adherence patterns of 240 people living with diabetes were determined using the Morisky Green Levine Medication Adherence Scale-4 and categorized into low, medium, and high adherence patterns. Patients with poor medication adherence (low and medium pattern) scores were randomized into short message service (SMS) and pillbox interventions, and the impact of Interventions on compliance and glycemic control was determined. Results: Results demonstrate that 3% of patients living with type 2 diabetes have low, 43% medium, and 54% have high medication adherence patterns. The most common reason cited for non-adherence was (88%) followed by lack of finance (5%) and multiple medications (4%). A positive association of injectable dosage forms, number of drugs, and treatment modalities with adherence was found. SMS and pillbox intervention improved medication adherence among individuals with diabetes who had poor adherence, which translated into good glycemic control. Conclusions: The improvement in drug compliance and glycemic control was found to be equivocal among the SMS and pillbox intervention groups. The inclusion of interventions into the institutional education program and counseling by health care workers will motivate patients to adopt these interventions to improve drug compliance and glycemic control.

Increasing bowel cancer screening using SMS in general practice: the SMARTscreen cluster randomised trial.

Australia has one of the highest incidences of colorectal cancer (CRC) worldwide. The Australian National Bowel Cancer Screening Program (NBCSP) is a best-practice, organised screening programme, but uptake is low (40.9%) and increasing participation could reduce morbidity and mortality associated with CRC. Endorsement by GPs is strongly associated with increasing screening uptake. This study (SMARTscreen) aimed to test whether a multi-intervention short message service (SMS) sent by general practices to 50-60-year-old patients who were due to receive the NBCSP kit would increase NBCSP uptake, by comparing it with usual care. A stratified cluster randomised controlled trial was undertaken, involving 21 Australian general practices in Western Victoria, Australia. For intervention practices, people due to receive the NBCSP kit within a 6-month study period were sent an SMS just before receiving the kit. The SMS included a personalised message from the person's general practice endorsing the kit, a motivational narrative video, an instructional video, and a link to more information. Control practices continued with usual care, comprising at-home testing with a faecal immunochemical test (FIT) through the NBCSP. The primary outcome was the between-arm percentage difference in uptake of FIT screening within 12 months from randomisation, which was estimated using generalised linear model regression. In total, 39.2% (1143/2914) of people in 11 intervention practices and 23.0% (583/2537) of people in 10 control practices had a FIT result in their electronic health records - a difference of 16.5% (95% confidence interval = 2.02 to 30.9). The SMS intervention increased NBCSP kit return in 50-60-year-old patients in general practice. This finding informed a larger trial - SMARTERscreen - to test this intervention in a broader Australian population.

Characteristics of Anemic Pregnant Women Receiving SMS Intervention on Iron Supplement Consumption

The case of maternal deaths due to anemia is increasing. The high level of anemia is caused by a lack of compliance in taking iron supplements. SMS (Short Message Service) features on mobile phones can be used as reminders for patients to take iron supplements. This research aims to describe the characteristics of anemic pregnant women who receive SMS interventions regarding iron supplement consumption. This study uses a descriptive research design conducted in 7 community health centers in the city of Makassar. The sampling technique uses purposive sampling and a total of 68 pregnant women were included (33 received SMS intervention and 35 did not receive SMS intervention). The research involving 33 anemic pregnant women shows that 48.5% are between 17 and 25 years old, and 51.5% have completed high school. Most are unemployed (81.8%), with sufficient husband support (45.5%). Most of them are in the second trimester (57.6%), with the highest parity being multiparous (45.5%) with only one ANC visit (42.4%), and have moderate anemia (51.5%). This study concludes that the respondents are classified as having moderate anemia, multipara, and having only one ANC visit. Regarding socioeconomic status, most of them have completed high school, unemployed, and receive sufficient support from their husbands.
 Keywords: Anemia, Iron Supplement, SMS Intervention

Smartphone-based interventions in the secondary prevention of cardiovascular disease: A meta-analysis.

A variety of reviews have indicated the effectiveness of smartphone-based interventions in preventing secondary cardiovascular disease (CVD). However, few studies have focused on clinical outcomes. This meta-analysis aimed to evaluate the potential benefits of application interventions and short message service (SMS) interventions on CVD outcomes. Electronic databases were searched to identify randomized controlled trials (RCT) investigating an application or SMS intervention for secondary CVD prevention. Primary outcomes included major adverse cardiovascular events (MACE), cardiovascular death, and cardiac hospitalization. Secondary outcomes were cardiovascular risk factors (BMI, blood pressure, and cholesterol). A total of 26 RCTs were included, with 16 investigating applications and 10 assessing SMS. Overall, there was no significant difference in MACE, cardiovascular death, and cardiac hospitalization when comparing application interventions with usual care, as well as comparing SMS with usual care. Subgroup analysis revealed that patients who received applications without a medical interface had a significantly lower incidence of MACE (OR = 0.56; 95% CI: 0.33, 0.98). Participants who received applications with a medical interface showed a tendency towards higher rates of cardiac hospitalization (OR = 2.03; 95% CI: 0.85, 4.87). Significant reduction in waist circumference (SMD =-0.80; 95% CI: -1.58, -0.03) was found in application interventions compared to usual care; while significant reductions in SBP (SMD =-0.08; 95% CI: -0.15, -0.01) and TC (SMD =-0.31; 95% CI: -0.57, -0.08) were found in SMS interventions compared to usual care. Smartphone-based interventions, including applications and SMS, have the potential to benefit the secondary prevention of CVD. Applications may reduce the incidence of cardiovascular-related adverse events, while SMS interventions may improve cardiovascular risk factors.

Twelve-month effectiveness of telephone and SMS support to mothers with children aged 2 years in reducing children’s BMI: a randomized controlled trial

Background/objectivesFew quality intervention studies have assessed whether a combined telephone and short message service (SMS) intervention to mothers is effective in reducing BMI and obesity risk behaviors of children at 3 years of age. This study aimed to assess effectiveness of telephone and SMS support in reducing children’s body mass index (BMI) and obesity risk behaviors.Subjects/MethodsA randomized controlled trial (RCT) with 662 women of 2-year-old children (with the proportion of overweight and obesity being similar to the general population) was conducted in Sydney, Australia, March 2019–October 2020. The mothers in the intervention group received three telephone support sessions plus SMS messages and mailed-intervention-booklets over a 12 months period i.e., 24–26, 28–30, and 32–34 months of the child’s age. Mothers in the control group received usual care and two mailed booklets on information not related to the intervention. The primary outcome was child’s BMI at 3 years of age. Secondary outcomes were children’s dietary and activity behaviors. All outcome measures were based on mothers’ self-report using standardized tools due to COVID-19 pandemic restrictions.Results537 (81%) mothers completed the post-intervention assessment at 3 years with only 470 (71%) children having weight and height measures. Multiple imputation analysis showed no statistically significant difference in mean BMI between the groups. Children in the intervention group were more likely not to eat in front of the TV [AOR 1.79 (95% CI 1.17–2.73), P = 0.008], more likely to meet the dietary recommendations [AOR 1.73 (95% CI 0.99–3.02), P = 0.054] and meet the activity recommendations [AOR 1.72 (95% CI 1.11–2.67), P = 0.015] than those in the control group respectively. Among those with an annual household income (<AUD$80,000), the intervention was significantly associated with a lower mean BMI [16.26 (SD 2.22) kg.m−2] in the intervention group than [16.84 (SD 2.37)] in the control, a difference of −0.59 kg/m2 (95% CI: −1.15 to −0.03, P = 0.040).ConclusionsA staged telephone and SMS support intervention to mothers with children aged 2 years was associated with improved dietary and activity behaviors. The intervention was also associated with reduced children’s BMI at age 3 years only for those from lower income households.Trial registrationThe trial is registered with the Australian Clinical Trial Registry (ACTRN12618001571268)

Outcomes of a Caregiver-Focused Short Message Service (SMS) Intervention to Reduce Intake of Sugar-Sweetened Beverages in Rural Caregivers and Adolescents.

This study examined enrollment, retention, engagement, and behavior changes from a caregiver short message service (SMS) component of a larger school-based sugar-sweetened beverage (SSB) reduction intervention. Over 22 weeks, caregivers of seventh graders in 10 Appalachian middle schools received a two-way SMS Baseline Assessment and four monthly follow-up assessments to report their and their child's SSB intake and select a personalized strategy topic. Between assessments, caregivers received two weekly one-way messages: one information or infographic message and one strategy message. Of 1873 caregivers, 542 (29%) enrolled by completing the SMS Baseline Assessment. Three-quarters completed Assessments 2-5, with 84% retained at Assessment 5. Reminders, used to encourage adherence, improved completion by 19-40%, with 18-33% completing after the first two reminders. Most caregivers (72-93%) selected a personalized strategy and an average of 28% viewed infographic messages. Between Baseline and Assessment 5, daily SSB intake frequency significantly (p < 0.01) declined for caregivers (-0.32 (0.03), effect size (ES) = 0.51) and children (-0.26 (0.01), ES = 0.53). Effect sizes increased when limited to participants who consumed SSB twice or more per week (caregivers ES = 0.65, children ES = 0.67). Findings indicate that an SMS-delivered intervention is promising for engaging rural caregivers of middle school students and improving SSB behaviors.

Effect of messaging content on engagement with a short messaging service for perioperative smoking cessation.

We determined whether a tobacco cessation intervention targeting brief perioperative abstinence ("quit for a bit") increased engagement of surgical patients with treatment compared with an intervention targeting long-term postoperative abstinence ("quit for good"). Surgical patients who smoke were stratified according to intended duration of postoperative abstinence, and then randomized within strata to receive either a "quit for a bit" or a "quit for good" intervention. Both employed initial brief counseling and short message service (SMS) to deliver treatment up to 30 days after surgery. The primary outcome of treatment engagement was defined as the rate at which subjects actively responded to system requests delivered via SMS. The engagement index did not differ between intervention groups (median [25th, 75th] of 23.7% [8.8, 46.0] for "quit for a bit" group (n=48) and 22.2% [4.8, 46.0] for "quit for good" group (n=50), p=0.74), nor did the proportion of patients continuing SMS use after study completion (33% and 28%, respectively). Exploratory abstinence outcomes at morning of surgery and 7 and 30 days after surgery did not differ between groups. Program satisfaction was high in both groups and did not differ. There was no significant interaction between intended abstinence duration and any outcome, i.e., alignment of intent with intervention did not affect engagement. Tobacco cessation treatment delivered via SMS was well-accepted by surgical patients. Tailoring an SMS intervention to focus on the benefits of short-term abstinence for surgical patients did not increase engagement in treatment or perioperative abstinence rates. Treatment of surgical patients for tobacco use is efficacious and reduces postoperative complications. However, implementation in clinical practice has proved challenging, and new methods of engaging these patients in cessation treatment are needed. We found that tobacco use treatment delivered via short message service (SMS) was feasible and well-utilized by surgical patients. Tailoring an SMS intervention to focus on the benefits of short-term abstinence for surgical patients did not increase engagement in treatment or perioperative abstinence rates.

Short Message Service Reminder Nudge for Parents and Influenza Vaccination Uptake in Children and Adolescents With Special Risk Medical Conditions

Children with chronic medical conditions are at increased risk of severe influenza. Uptake of influenza vaccination in children and adolescents with these identified special risk medical conditions (SRMCs) is suboptimal. To assess the effectiveness of Flutext-4U, a parent short message service (SMS) reminder nudge intervention, in increasing influenza immunization in children and adolescents with SRMCs. This randomized clinical trial was conducted at a tertiary pediatric hospital in Adelaide, South Australia, from April 15 to September 30, 2021. Children and adolescents aged 6 months to younger than 18 years with SRMCs and a subspecialist outpatient appointment over a 5-month period during the Australian seasonal influenza vaccination season (April-August 2021) were eligible to participate. Follow-up was until September 30, 2021. Participants were randomly assigned (1:1 ratio) to control: clinician nudges (hospital vaccine availability, ease of access, and recommendation from hospital subspecialists) or SMS intervention (control conditions plus an additional SMS reminder nudge to parents), with randomization stratified by age group (<5 years, 5-14 years, or >14 to <18 years). The primary outcome was influenza vaccination, as confirmed by the Australian Immunisation Register. A total of 600 participants (intervention group: 298 [49.7%]; mean [SD] age, 11.5 [4.6] years; 162 female participants [54.4%]; control group: 302 [50.3%]; mean [SD] age, 11.4 [4.7] years; 155 female participants [51.3%]) were included. Influenza vaccination was 38.6% (113 of 293) in the SMS intervention group compared with 26.2% (79 of 302) in the control group (adjusted odds ratio [aOR], 1.79; 95% CI, 1.27-2.55; P = .001). Time to vaccine receipt was significantly lower among SMS participants (adjusted hazard ratio, 1.67; 95% CI, 1.25-2.22; P < .001). For participants randomly assigned by June 15, a significantly greater proportion receiving the SMS intervention were vaccinated during the optimal delivery period April to June 30 (SMS group: 40.0% [76 of 190] vs 25.4% [50 of 197]; aOR, 1.97; 95% CI, 1.28-3.06; P = .002). Results of this randomized clinical trial suggest that an additional SMS reminder nudge for parents delivered in the tertiary care hospital setting to children and adolescents with SMRCs resulted in higher influenza vaccine uptake compared with clinician nudges alone. ANZCTR Identifier: ACTRN12621000463875.

Mobile-phone text messaging to promote ideal cardiovascular health in women

ObjectiveIdeal cardiovascular health (CVH) was developed to promote CVH as a key component of primordial prevention. Mobile short message service (SMS) is useful for improving health behaviours. We aim to...

Retention and engagement of rural caregivers of adolescents in a short message service intervention to reduce sugar-sweetened beverage intake.

This study investigates a 6-month short message service (SMS) intervention to reduce adolescent sugar-sweetened beverage (SSB) intake. The objectives are to describe caregiver retention and SMS engagement as well as explore differences by caregiver characteristics. Caregivers completed a baseline survey then messages were sent two times per week. Message types included the following: SSB intake assessments, educational information, infographic URLs, and strategies. Engagement was measured through interaction with these messages and included: assessment completion, reminders needed, number of strategies chosen, and URLs clicked. Caregivers (n = 357) had an average baseline SSB intake of 23.9 (SD = 26.8) oz/day. Of those, 89% were retained. Caregivers with a greater income and education were retained at a higher rate. Average engagement included: 4.1 (SD = 1.3) of 5 assessments completed with few reminders needed [4.1 (SD = 3.7) of 14 possible], 3.2 (SD = 1.1) of 4 strategies selected, and 1.2 (SD = 1.6) of 5 URLs clicked. Overall, average engagement was relatively high, even where disparities were found. Demographic characteristics that were statistically related to lower engagement included younger age, lower income, lower educational attainment, single caregivers, lower health literacy. Furthermore, caregivers with a reduced intention to change SSB behaviors completed fewer assessments and needed more reminders. Higher baseline SSB intake was associated with lower engagement across all indicators except URL clicks. Results can be used to develop targeted retention and engagement strategies (e.g., just-in-time and/or adaptive interventions) in rural SMS interventions for identified demographic subsets. Clincialtrials.gov: NCT03740113.

S-28-3: COMPARATIVE EFFECTIVENESS AND IMPLEMENTATION OF DIGITAL HEALTH INTERVENTIONS FOR PEOPLE WITH HYPERTENSION: SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS

Background: Digital health interventions are effective for hypertension self-management, but a comparison of the effectiveness and implementation of the different modes is lacking. This study aimed to compare the effectiveness of short message service (SMS), smartphone application and website interventions on improving blood pressure in people with hypertension, and to report on their reach, uptake and feasibility. Methods: CINAHL, Cochrane Central, Embase, Medline and PsychInfo were searched on 25th May 2022 for randomised controlled trials (RCTs) published in English from 1st January 2009 that examined the effectiveness of digital health interventions on reducing blood pressure in adults with hypertension. Risk of Bias was assessed using Cochrane Risk of Bias 2 (RoB 2). Data on systolic and diastolic blood pressure reduction were synthesised in a meta-analysis, and data on reach, uptake and feasibility were summarised narratively. The level of evidence was evaluated using GRADE. Results: Of 3,235 records identified, 29 RCTs from 12 countries (n = 7,592 participants) were included. Eleven studies used SMS as the primary mode of delivery of the digital health intervention, 13 employed smartphone applications, and five implemented the interventions via websites. Overall, digital health intervention group participants achieved a -3.62 [-5.22, -2.02] mm Hg greater reduction in systolic blood pressure compared to control group participants. All three different modes of delivery of the intervention resulted in statistically significant reductions in systolic blood pressure compared to the control group, with no statistically significant differences between the three different modes of delivery (p = 0.73). Due to considerable heterogeneity between included studies and the high risk of bias overall, the level of evidence was assigned a low overall score. SMS intervention studies reported higher reach compared to smartphone application and website-based intervention studies, but smartphone application studies reported higher uptake compared to the other two. Conclusion: Digital health interventions were associated with improved blood pressure control, compared to usual care, regardless of the mode of delivery. Considering that at least 92% of the global population has access to a digital telecommunication medium and that numerous digital health tools are available for hypertension management, clinicians should familiarise themselves with this modality of program delivery and encourage people with hypertension to use evidence-based digital health tools for improving their self-management of hypertension. Digital health interventions now have the option of several modes of delivery and choice should be made based on context, feasibility, economics, and patients preference, emphasising the importance of study co-design.

Effectiveness of Short Message Service (SMS) based Glycaemic Control

Objective: To find out the effectiveness of short message service (SMS) on glycaemic control among patients with diabetes at a tertiary care hospital in Rawalpindi.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Department of Endocrinology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Jul 2020.&#x0D; Methodology: A total of 218 patients with diabetes were included in the study. Patients were randomized into two groups by lottery method. Group-A received a tailored SMS package daily for six months along with printed dietary instructions, while Group-B was given only printed dietary instructions. After six months, HbA1c levels and other sociodemographic factors were compared among the two Groups A and B.&#x0D; Results: In Group-A (SMS-Group) mean HbA1c levels reduced from 9.3±2.0 to 7.0±0.4 compared to Group-B (non-SMSGroup) with mean HbA1c levels from 9.7±1.8 to 8.8 ±1.4. Before SMS intervention, all variables, including HbA1c levels between the two groups, were insignificant. However, the use of structured SMS-based intervention in Group-A showed a statistically significant reduction in HbA1c levels compared to Group-B (p-value &lt;0.05). The mean difference was 1.77(95% CI:-2.44 to -1.10).&#x0D; Conclusion: This study showed Short Message Service (SMS) effectiveness by significantly reducing glycaemic levels (HbA1c)among people with diabetes compared to conventional methods of diabetic education for glycaemic control.

Effect of a short message service (SMS) intervention on the attendance to the prenatal education program: True experimental study pilot (Preprint)

Effect of a short message service (SMS) intervention on the attendance to the prenatal education program: True experimental study pilot (Preprint)

Effect of a Short Messaging Service (SMS) intervention delivered to caregivers on energy, nutrients, and food groups intake in infant participants of the WIC program.

ObjectivesTo test the effect of a weekly test message (SMS) intervention for improving feeding practices on infant intake of energy, nutrients, and specific food groups.MethodsThis study was a multi-site, randomized clinical trial, in 202 caregivers of healthy term infants participating in either the Puerto Rico or Hawaii WIC program. Participants were randomized to receive weekly SMS about either infant's general health issues (control) or SMS for improving feeding practices (intervention) to complement WIC messages for 4 months. Anthropometrics and demographics were assessed at baseline. A validated infant food frequency questionnaire was assessed at the four-month visit to assess intake of general food groups. Data was summarized as median (25th and 75th percentiles) or percentage and differences between study arms was compared using Mann Whitney or chi-square.ResultsA total of 163 participants completed the study (n = 84 control and n = 79 intervention). Baseline characteristics were similar between both groups. At 4–6 months of age, compared to the control group, the intervention group had a significantly higher intake of total grains (0.28 oz; 0.00, 0.60; P = 0.033), protein (13.5 g, 10.5, 18.3; P = 0.022), calcium (472 mg; 418, 667; P = 0.012), and zinc (4.39 mg; 2.61, 6.51; P = 0.028). No differences were seen in the other food groups, including breastmilk.Conclusions for practiceFeeding SMS to complement WIC messages led to higher intakes of some key nutrients but did not have an overall improvement in the intake of food groups. Messaging also did not delay the introduction of complimentary foods or improve breastfeeding rates. Future studies should evaluate the use of more intensive SMS interventions for continued care between WIC visits.

A Systematic Review of Digital Interventions to Improve ART Adherence among Youth Living with HIV in sub-Saharan Africa.

An estimated 3.4 million youth aged 15–24 years live with human immunodeficiency virus (HIV), a majority of whom reside in sub-Saharan Africa (SSA). Youth living with HIV (YLHIV) generally maintain lower levels of antiretroviral therapy (ART) adherence compared to other age groups, which has negative impacts on long-term clinical outcomes. Given expanding mobile phone and Internet usage among youth in SSA, and a need for strategies to increase ART adherence, this review systematically assessed whether digital interventions could be used to improve YLHIV ART adherence in SSA. PRISMA 2020 guidelines were followed, and PubMed and Scopus databases were searched using terms to reflect the population of interest and different digital intervention strategies to improve ART adherence. Experimental or quasi-experimental studies in SSA evaluating the quantitative effect of digital interventions on YLHIV ART adherence were included. 3849 articles and abstracts, and 122 full texts were screened by two researchers (KG and RM). A third researcher (AC) resolved conflicts. Data were extracted from six eligible articles published between 2017 and 2021. Interventions from included studies lasted 13–96 weeks and took place in Kenya, Nigeria, Uganda, and Zimbabwe. Two of the six studies found significant intervention-related improvements in viral suppression. Of these two studies, one used short message service (SMS) for appointment and daily adherence reminders, and the other combined weekly SMS reminders with phone calls, support groups, home visits, and clinic-based counseling. The four remaining studies, using SMS and Internet-based interventions, did not find any significant adherence-related improvements. This review provides mixed evidence for using digital interventions to improve ART adherence among YLHIV in SSA. Given the relative novelty of using digital interventions in this context, further research is required to evaluate their effectiveness in improving youth ART adherence.

Developing a culturally tailored short message service (SMS) intervention for improving the uptake of cervical cancer screening among Ghanaian women in urban communities

BackgroundThere has been extensive research across the globe to understand the barriers and facilitators of cervical cancer (CC) screening. However, few studies have focused on how such information has been used to develop text messages for mHealth screening programs, especially in resource-poor countries. This study elicited information on barriers and facilitators, the preferences of women regarding the modalities for delivery of health SMS messages on screening for cervical cancer, and demonstrates how this information was used to create a health screening program among women in the Greater Accra Region of Ghana.MethodsFour main activities were carried out, including (1) a total of five focus group discussions, (2) a baseline survey involving 62 female bankers and 68 women from the communities, (3) a stakeholder meeting involving experts in cervical cancer research and clinical care, and (4) pilot testing of the text messages. Focus group discussions and the baseline survey data were collected concurrently between February and May 2017 and the results were used to develop 5 specific communication objectives during the stakeholder engagements held in June 2017.ResultsIn all, 32 text messages were developed and pretested in July 2017(13 addressed knowledge on CC; 6 highlighted the importance of early detection; 5 allayed fear as a barrier to CC screening; 5 encouraged women to have time for their health, and 3 messages contained information on where to go for screening and the cost involved). Although awareness about the disease was high, knowledge of CC screening was low. For two-thirds of respondents (22/33), perceived lack of time, high cost, and fear (of cc, screening procedure, and potential for negative outcome) accounted for the reasons why respondents will not go for screening, while education on CC, especially from health workers and the mass media enabled uptake of CC screening.ConclusionSeveral factors prevent women from accessing screening services for CC, however, barriers such as low levels of education on CC, lack of time, and fear can be targeted in SMS messaging programs.

Preferences for a Game-Based SMS Adherence Intervention Among Young People Living with HIV in Ghana: A Qualitative Study.

Young people living with HIV (YPLH) are at risk for poor treatment adherence. Short message service (SMS) interventions can improve adherence, yet few exist for YPLH. Our study investigated preferences for a game-based SMS intervention among YPLH in Ghana. Thirty-two YPLH, ages 18 to 24, were recruited from an HIV clinic to complete in-depth interviews. Content analysis of interview data revealed areas of technology use relevant to intervention implementation, including mobile communication preferences, internet access, and mobile game use. Participants reported high perceived utility towards intervention features: treatment reminders, gamification components, and involvement of supportive individuals (e.g., providers). Issues with privacy, literacy, and cultural/developmental appropriateness were among concerns raised. Suggestions were made for strengthening basic SMS features (e.g., using code words to protect privacy) and incorporating advanced features (e.g., simplifying game interactions). This novel approach may help engage YPLH in HIV care if carefully developed with attention towards its mechanisms and user preferences.

Participant perspectives of automated short messaging service interventions to promote physical activity: A systematic review and thematic synthesis.

IntroductionShort messaging service has the potential to improve participation in physical activity in individuals with long-term health conditions. However, successful implementation relies on participant engagement with such programmes. The aim of this study was to undertake a systematic review of qualitative literature exploring participant perspectives of short messaging service-based interventions designed to promote physical activity for people with long-term health conditions.MethodsCINHAL, MEDLINE, SPORTSDiscus, Scopus and Web of Science were searched up to 15 February 2021 looking for participants’ perspectives on short messaging service programmes designed to promote physical activity in people with long-term health conditions. Included studies were analysed using thematic synthesis.ResultsEight studies involving 533 participants were included and analysed using the principles of thematic analysis and 10 descriptive themes were identified. These descriptive themes were further refined to develop five final analytical themes: taking control of my own health, from information to action, relationship with the programme, perfection required for success and increased expectations.DiscussionThe findings agree with published work on the factors which influence behaviour. The findings from this synthesis demonstrate that automated short messaging service programmes to increase physical activity are generally acceptable. People report that these interventions support and encourage physical activity. The novel finding of this study was that having more regular and long-lasting contact has the potential to increase the expectations people have of healthcare services. This is a finding which needs to be considered and managed but should not discourage the use of automated short messaging service.