Simple Reminder Research Articles

Fighting COVID-19 Misinformation on Social Media: Experimental Evidence for a Scalable Accuracy-Nudge Intervention

Across two studies with more than 1,700 U.S. adults recruited online, we present evidence that people share false claims about COVID-19 partly because they simply fail to think sufficiently about whether or not the content is accurate when deciding what to share. In Study 1, participants were far worse at discerning between true and false content when deciding what they would share on social media relative to when they were asked directly about accuracy. Furthermore, greater cognitive reflection and science knowledge were associated with stronger discernment. In Study 2, we found that a simple accuracy reminder at the beginning of the study (i.e., judging the accuracy of a non-COVID-19-related headline) nearly tripled the level of truth discernment in participants’ subsequent sharing intentions. Our results, which mirror those found previously for political fake news, suggest that nudging people to think about accuracy is a simple way to improve choices about what to share on social media.

Altering Intention to Mudik during COVID-19 Pandemic: A Salient Cue and Simple Reminder Treatment

Mudik is a unique exodus in Indonesia where people travel to hometown during Eid festive season. It posed a challenge for the government to cope with the COVID-19 pandemic. Several reports have identified that people still stick with their plan to mudik amidst the latest mudik ban. Thus, a scientific nudge campaign is pivotal to influence mudik behaviour—the present study designed and tested five visual campaigns to identify key elements which can reduce mudik intention. A pre-post field experiment used six between-subject groups designed on Qualtrics collected 767 responses measuring intention to mudik. We asked participants respective mudik ban institution in anticipating the latest nation-wide mudik ban. Treatments with mother visual and a reminder of the elderly's high risk to contagion are of which effective reducing mudik intention. The treatment effect holds in certain people conditions. The study yielded an initially worked nudge campaign to support government mudik ban policy.

Eye movements support behavioral pattern completion

The ability to recall a detailed event from a simple reminder is supported by pattern completion, a cognitive operation performed by the hippocampus wherein existing mnemonic representations are retrieved from incomplete input. In behavioral studies, pattern completion is often inferred through the false endorsement of lure (i.e., similar) items as old. However, evidence that such a response is due to the specific retrieval of a similar, previously encoded item is severely lacking. We used eye movement (EM) monitoring during a partial-cue recognition memory task to index reinstatement of lure images behaviorally via the recapitulation of encoding-related EMs or gaze reinstatement. Participants reinstated encoding-related EMs following degraded retrieval cues and this reinstatement was negatively correlated with accuracy for lure images, suggesting that retrieval of existing representations (i.e., pattern completion) underlies lure false alarms. Our findings provide evidence linking gaze reinstatement and pattern completion and advance a functional role for EMs in memory retrieval.

Non-attendance at diabetes outpatient appointments: a systematic review.

Non-attendance at diabetes outpatient appointments is a sizeable problem worldwide and has been associated with suboptimal health outcomes. We aimed to describe the characteristics, health outcomes and reasons given for non-attendance at doctor- or nurse-led diabetes appointments, and interventions to improve attendance. PubMed, EMBASE, CINAHL and PsychInfo were searched from database inception to February 2019. Included articles were peer-reviewed, published in English, related to adults or young people with type 1 or type 2 diabetes, and addressed one of the above aspects of non-attendance. Studies were excluded if reporting on other types of diabetes or reviewing attendance at structured education, retinal screening, paediatric, antenatal, podiatry or dietetic clinics. Thirty-four studies of varied designs were identified (15 observational, 1 randomized control trial, 9 qualitative, 5 surveys, 4 service improvements). The definition of non-attendance varied. Younger adults, smokers and those with financial pressures were less likely to attend. Non-attendance was associated with higher HbA1c ; other outcomes were varied but typically worse in non-attenders. Reasons for non-attendance in qualitative studies fell into three categories: balancing the costs and benefits of attendance, coping strategies, and the relationships between the person with diabetes and healthcare professionals. Interventions included appointment management strategies, service improvements, patient navigators and WebCam appointments. Non-attendance is only partially explained by logistical issues. Qualitative studies suggest complex psychosocial factors are involved. Interventions have progressed from simple appointment reminders in an attempt to address some of the psycho-social determinants, but more work is needed to improve attendance.

An analytical model to evaluate reminders for medication adherence

ObjectivesSeveral interventions have been proposed to improve medication adherence including those using reminders. The performance of reminders, including effectiveness and side effects, varies widely in different settings. We must study this for improving decision making on how, when, and where to use what type of reminders. MethodsAnalytical modeling is an effective and low-cost method to derive preliminary or intermediate results and insights for further study of interventions for medication adherence. We developed an analytical model that can be used to evaluate the performance of reminders in various settings, including effectiveness, side effects, and healthcare cost savings for medication adherence. ResultsContext-aware reminders perform better than simple reminders for willing patients even when they completely rely on reminders for taking their doses. Simple reminders lead to more side effects than context-aware reminders. Further, context-aware reminders generate more healthcare savings without side effects and a comparable cost of the intervention. The results contribute to an improved understanding of reminders and are used to derive a set of guidelines for patients, healthcare professionals, decision-makers, and mobile app developers. ConclusionsThe proposed model is a low cost and effective tool to derive results and insights for the use of reminders in different settings to improve medication adherence. Therefore, the model can be utilized as a decision-making tool for deciding whether to pursue an RCT on healthcare interventions. The analytical model can be extended for complex scenarios of multiple interdependent medications, adaptation with patients’ condition and behavior, and composite interventions.

Effectiveness of smartphone-based medication reminder application on medication adherence of patients with essential hypertension: A clinical trial study

Context: Failure to adhere to drug therapy in patients with high blood pressure can endanger their lives. Aims: The aim of this study was to determine the effectiveness of smartphone-based medication reminder application on medication adherence of patients with essential hypertension.Settings and Design: This clinical trial study was conducted in Yazd Cardiac Research Center.Material and Methods: Seventy-eight patients with essential hypertension were assigned to intervention (39 patients) and control (39 patients) groups using a random sampling method. In the intervention group, the DaroYab 2.1.0 was installed on the patient's smartphone. The control group received routine care. Data were collected using demographic characteristics form and Morriskey's medication adherence scale (MMAS-8). The MMAS-8 completed prior to and 3 months after the intervention. Statistical Analysis Used: Data were analyzed using IBM SPSS, American multinational technology company, Armonk, New York and nonparametric tests including the Wilcoxon test and Mann–Whitney U-test. Results: The mean age of the 78 patients who completed the study was 46.6 ± 7.98 years. All of the participants had a history of drug forgetfulness and 92.5% of them had poor medication adherence before the intervention. Three months after the intervention, the ratio of good medication adherence and medication adherence scores was significantly improved in the DaroYab software group (P < 0.001).Conclusions: Considering the positive impact of DaroYab as a simple, practical, and inexpensive drug reminder, on medication adherence it is recommended that health-care providers introduce this application to of hypertensive patients and encourage them to use it.

Nudging businesses to pay their taxes: Does timing matter?

This paper provides empirical evidence on the implications of the timing of reminders by studying the effect of varying the timing of reminder letters to taxpayers on their payment behavior. The collection of unpaid tax debts constitutes a considerable challenge for tax authorities. We discuss potential mechanisms through which reminders may affect taxpayers’ behavior and study the payment behavior of business taxpayers in a field experiment in Australia. We find that a simple reminder letter increases the probability of payment by about 25 percentage points relative to a control group that does not receive a letter from the tax authority. However, variation over a three-week period in the timing of the reminder letter has no effect on the probability of payment within seven weeks of the due date. Our findings indicate that sending reminders early results in faster payment of debts with no effect on the ultimate probability of payment.

Medication adherence: A method for designing context-aware reminders

ObjectivesSeveral interventions have been proposed to improve medication adherence including those using reminders. Context-aware reminders can be effective because they operate when the dose is due, has not been taken, and is still safe to take. Although very promising, we find that there is no method to design context-aware reminders. To address these, we focus on proposing a method to design context-aware reminders. MethodsWe conducted a systematic review of context-aware reminders for medication adherence using PRISMA approach. The analysis of literature leads to several interesting observations including the need for a method to design context-aware reminders. In this study, we present Method to Design Context-Aware Reminders (MDCAR) that can also meet special requirements. We used domain experts reasoning to evaluate the designed Context-Aware Reminders for Medication Adherence (CARS-MA). Further, we used analytical model to evaluate reliability, side effects, and cost of intervention. ResultsThis is the first paper that addresses “how to” design context-aware reminders. The proposed design method can lead to range of context-aware reminders including CARS-MA. The verification, validation, and evaluation of CARS-MA indicate that the context-aware reminders perform better than simple reminders in improving medication adherence. ConclusionsThe proposed method for context-aware reminders will help healthcare professionals and researchers to implement and select a suitable intervention to improve medication adherence. Further, it can lead to decision support systems for patients, healthcare professionals, researchers and policy makers for medication adherence. The design method can be extended for complex scenarios of multiple medications, persistent-reminders, and composite interventions.

Turning the oil tanker: a novel approach to shifting perspectives in medical practice.

Although health care is encouraged to follow an evidence-based approach, there are perceived instances where suboptimal practice persists in the presence of better options due to an inherent resistance to change within many health care systems. To continue striving for clinical excellence, it is important to identify deficient practices and make appropriate corrections by implementing new and improved techniques and treatments. Bringing about change, however, tends to be a long, arduous process consisting of several small and successive deviations from the norm, analogous to “turning the oil tanker”. Analyzing the methods employed by successful health care innovators has allowed the development of a “three-pronged” approach to overcoming resistance to change: 1) a determined opinion leader with a network or like-minded opinion leaders; 2) the presentation of hard evidence with adequate praise for current practice and the generation of clearly worded, specific guidelines; and 3) the use of simple reminders and continuous analysis of outcomes. Employing this three-pronged approach could lead to faster and more successful implementation of change within the health care system.

SMS nudges as a tool to reduce tuberculosis treatment delay and pretreatment loss to follow-up. A randomized controlled trial

BackgroundTB persists despite being relatively easy to detect and cure because the journey from the onset of symptoms to cure involves a series of steps, with patients being lost to follow-up at each stage and delays occurring among patients not lost to follow-up. One cause of drop-off and delay occurs when patients delay or avoid returning to clinic to get their test results and start treatment.MethodsWe fielded two SMS interventions in three Cape Town clinics to see their effects on whether people returned to clinic, and how quickly. One was a simple reminder; the other aimed to overcome “optimism bias” by reminding people TB is curable and many millions die unnecessarily from it. Recruits were randomly assigned at the clinic level to a control group or one of the two SMS groups (1:2:2). In addition to estimating effects on the full sample, we also estimated effects on HIV-positive patients.ResultsSMS recipients were more likely to return to clinic in the requested two days than the control group. The effect was smaller in the intent-to-treat analysis (52/101 or 51.5% vs. 251/405 or 62.0%, p = 0.05) than in the per-protocol analysis (50/97 or 51.5% vs. 204/318 or 64.2%, p = 0.03). The effect was larger among HIV-positives (10/35 or 28.6% vs. 97/149 or 65.1%, p<0.01). The effects of SMS messages diminished as the interval increased: significant effects at the 5% level were found at five and 10 days only among HIV-positives. The second SMS message had larger effects, albeit not significantly larger, likely due in part to lack of statistical power.ConclusionsAt 2 U.S. cents per message, SMS reminders are an inexpensive option to encourage TB testers to return to clinic, especially when worded to counter optimism bias.

A Medication Adherence App for Children With Sickle Cell Disease: Qualitative Study.

BackgroundYoung people with sickle cell disease (SCD) often demonstrate low medication adherence and low motivation for effectively self-managing their condition. The growing sophistication of mobile phones and their popularity among young people render them a promising platform for increasing medication adherence. However, so far, few apps targeting SCD have been developed from research with the target population and underpinned with theory and evidence.ObjectiveThe aim of this study was to develop a theory-and-evidence-based medication adherence app to support children and adolescents with SCD.MethodsThe Behavior Change Wheel (BCW), a theoretically based intervention development framework, along with a review of the literature, 10 interviews with children and adolescents with SCD aged between 12 and 18 years, and consultation with experts informed app development. Thematic analysis of interviews provided relevant theoretical and evidence-based components to underpin the design and development of the app.ResultsFindings suggested that some patients had lapses in memory for taking their medication (capability); variation in beliefs toward the effectiveness of medication and confidence in self-managing their condition (motivation); a limited time to take medication; and barriers and enablers within the changing context of social support during the transition into adulthood (opportunity). Steps were taken to select the appropriate behavioral change components (involving behavior change techniques [BCTs] such as information on antecedents, prompts/cues; self-monitoring of the behavior; and social support) and translate them into app features designed to overcome these barriers to medication adherence.ConclusionsPatients with SCD have complex barriers to medication adherence necessitating the need for comprehensive models of behavior change to analyze the problem. Children and adolescents require an app that goes beyond simple medication reminders and takes into account the patient’s beliefs, emotions, and environmental barriers to medication adherence.

Lessons learned from a mobile technology-based intervention informed by behavioral economics to improve ART adherence among youth in Uganda

ABSTRACTEvidence suggests that simple text messaging interventions may not suffice to improve ART adherence among youth in low-resource settings. To address this shortcoming, we developed an intervention that shared weekly real-time adherence feedback to youth in Uganda using short message services (SMS), based on information tracked by an electronic device (Wisepill). We present results from 7 formative and 6 exit focus groups (FGs) in Mulago and Entebbe, Uganda with youth ages 15–24, providers, and Community Advisory Board members. Participants consistently conveyed positive impressions of Wisepill, noting that it helped store their medications, facilitated travel, served as a reminder, and motivated adherence. Participants raised phone-related issues before the study; most were addressed but some remained (e.g., limited network access, electricity for powering phones). Further, they highlighted the importance of carefully crafting text messages (e.g., use slang rather than potentially stigmatizing words) and viewed personalizing messages favorably but were divided on the desirability of including their name in study-related texts. Exit FGs confirmed that sharing group adherence levels with participants tapped into the competitive spirit common among youth. Our results suggest future mobile technology-based interventions can be improved by providing messages that go beyond simple reminders to provide individual and group-level adherence feedback.

How Knowledge Management Can Capture Untapped Alpha: A Case Study of Informed Rebalancing at the San Bernardino County Employees’ Retirement Association

Asset owners have to deal with the challenge of a potentially low-yielding investment environment for the foreseeable future and the likelihood of a market correction in the nearer term, with Q4 2018 providing a simple reminder of the downside risk of asset allocation. The traditional approach for many asset owners has been to use external managers to achieve their goals and hope that diversification will allow them to navigate difficult markets. A complementary strategy is to use knowledge management to improve returns and governance and capture a typically untapped alpha source in portfolios. Knowledge management in institutional asset management is defined as the explicit and systematic management of knowledge – and its associated processes of creation, organization, diffusion, use and exploitation – in pursuit of improving portfolio performance and managing risks. This paper highlights how the San Bernardino County Employees’ Retirement Association (SBCERA) used Knowledge Management and InvestTech to develop its own internal investment model to dynamically manage asset allocations and has added over $1billion (over 12 years) through its Informed Rebalancing program. In doing so, the portfolio and risks are better managed by the investment team and the program has survived many staff departures demonstrating that knowledge has been institutionalized. This approach is easily replicable by other asset owners, and each fund can develop its own bespoke approach based on their objectives and abilities.

Identification of the determinants of incomplete vaccination in Australian children

Background and aimsWe aimed to understand the risk factors associated with incomplete vaccination, which may help to identify and prioritise opportunities to intervene. MethodsConsenting parents of children <6 years old attending an outpatient clinic completed a questionnaire, which captured demographic information and their level of agreement with belief statements about vaccination using a 7-point Likert scale. Vaccination status was determined from the Australian Childhood Immunisation Register and deemed either “complete” (no doses overdue) or “incomplete” (1 or more doses overdue) at the time of questionnaire completion. ResultsOf 589 children of respondents, 116 (20%) had an incomplete vaccination status. Of these, nearly two-thirds (63%) of parents believed that their child was, in fact, fully-vaccinated. Compared to those with a complete vaccine status, children with an incomplete vaccine status were more likely to be born overseas (p < 0.001), have a larger family size (p = 0.02) and to have parents with lower educational attainment (p = 0.001). Parents of children with an incomplete status reported more doubt about the importance of vaccination and greater concern about vaccine safety, compared to parents of children with a complete status. ConclusionMost parents are supportive of vaccination. Sociodemographic factors may contribute more to the risk of incomplete vaccination than attitudes or beliefs. Some parents are unaware of their child’s vaccination status, suggesting that simple and modern reminders may assist parents to keep up to date.

Simple and rationale-providing SMS reminders to promote accelerometer use: a within-trial randomised trial comparing persuasive messages

BackgroundLiterature on persuasion suggests compliance increases when requests are accompanied with a reason (i.e. the “because-heuristic”). The reliability of outcomes in physical activity research is dependent on sufficient accelerometer wear-time. This study tested whether SMS reminders—especially those that provided a rationale—are associated with increased accelerometer wear-time.MethodsWe conducted a within-trial partially randomised controlled trial during baseline data collection in a school-based physical activity intervention trial. Of 375 participants (mean age = 18.1), 280 (75%) opted to receive daily SMS reminders to wear their accelerometers. These 280 participants were then randomised to receive either succinct reminders or reminders including a rationale. Data was analyzed across groups using both frequentist and Bayesian methods.ResultsNo differences in total accelerometer wear minutes were detected between the succinct reminder group (Mdn = 4909, IQR = 3429–5857) and the rationale group (Mdn = 4808, IQR = 3571–5743); W = 8860, p = 0.65, CI95 = − 280.90–447.20. Similarly, we found no differences in wear time between participants receiving SMS reminders (Mdn = 4859, IQR = 3527–5808) and those not receiving them (Mdn = 5067, IQR = 3201–5885); W = 10,642.5, p = 0.77, CI95 = − 424.20–305.30. Bayesian ANOVA favored a model of equal weartime means, over one of unequal means, by a Bayes Factor of 12.05. Accumulated days of valid accelerometer wear data did not differ either. Equivalence testing indicated rejection of effects more extreme than a Cohen’s d (standardised mean difference) of ±~0.3.ConclusionsThis study casts doubt on the effectiveness of using the because-heuristic via SMS messaging, to promote accelerometer wear time among youth. The because-heuristic might be limited to face-to-face communication and situations where no intention for or commitment to the behavior has yet been made. Other explanations for null effects include non-reading of messages, and reminder messages undermining the self-reminding strategies which would occur naturally in the absence of reminders.Trial registrationDRKS DRKS00007721. Registered 14.04.2015. Retrospectively registered.

Mitigating the Potentially Demotivating Effects of Early and Frequent Feedback About Goal Progress

Advances in information technology have enabled organizations to provide highly frequent feedback on goal progress. Although frequent feedback can provide timely information to individuals to improve task strategies, prior research has also shown that individuals are more likely to fixate on recent results (Lurie and Swaminathan 2009). If early feedback about performance relative to a goal is unfavorable and provided frequently, individuals may incorrectly infer a low probability of goal attainment. Thus, absent an intervention, we predict that early and frequent unfavorable feedback will reduce effort duration and, in turn, performance. However, we also predict that increasing the salience of goal attainability vis-a-vis a simple reminder about the likelihood of goal attainment will weaken the negative effects of early and frequent unfavorable feedback on effort duration and performance. Results from an experiment using undergraduate students support both predictions. We find that early, frequent, unfavorable feedback results in reduced effort duration and performance, and that our intervention completely mitigates these effects. Implications for practice and theory are discussed.

Interventions to increase influenza vaccination rates of those 60 years and older in the community.

The effectiveness of interventions to increase influenza vaccination uptake in people aged 60 years and older varies by country and participant characteristics. This review updates versions published in 2010 and 2014. To assess access, provider, system, and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and older in the community. We searched CENTRAL, which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE, Embase, CINAHL, and ERIC for this update, as well as WHO ICTRP and ClinicalTrials.gov for ongoing studies to 7 December 2017. We also searched the reference lists of included studies. Randomised controlled trials (RCTs) and cluster-randomised trials of interventions to increase influenza vaccination in people aged 60 years or older in the community. We used standard methodological procedures as specified by Cochrane. We included three new RCTs for this update (total 61 RCTs; 1,055,337 participants). Trials involved people aged 60 years and older living in the community in high-income countries. Heterogeneity limited some meta-analyses. We assessed studies as at low risk of bias for randomisation (38%), allocation concealment (11%), blinding (44%), and selective reporting (100%). Half (51%) had missing data. We assessed the evidence as low-quality. We identified three levels of intervention intensity: low (e.g. postcards), medium (e.g. personalised phone calls), and high (e.g. home visits, facilitators).Increasing community demand (12 strategies, 41 trials, 53 study arms, 767,460 participants)One successful intervention that could be meta-analysed was client reminders or recalls by letter plus leaflet or postcard compared to reminder (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.07 to 1.15; 3 studies; 64,200 participants). Successful interventions tested by single studies were patient outreach by retired teachers (OR 3.33, 95% CI 1.79 to 6.22); invitations by clinic receptionists (OR 2.72, 95% CI 1.55 to 4.76); nurses or pharmacists educating and nurses vaccinating patients (OR 152.95, 95% CI 9.39 to 2490.67); medical students counselling patients (OR 1.62, 95% CI 1.11 to 2.35); and multiple recall questionnaires (OR 1.13, 95% CI 1.03 to 1.24).Some interventions could not be meta-analysed due to significant heterogeneity: 17 studies tested simple reminders (11 with 95% CI entirely above unity); 16 tested personalised reminders (12 with 95% CI entirely above unity); two investigated customised compared to form letters (both 95% CI above unity); and four studies examined the impact of health risk appraisals (all had 95% CI above unity). One study of a lottery for free groceries was not effective.Enhancing vaccination access (6 strategies, 8 trials, 10 arms, 9353 participants)We meta-analysed results from two studies of home visits (OR 1.30, 95% CI 1.05 to 1.61) and two studies that tested free vaccine compared to patient payment for vaccine (OR 2.36, 95% CI 1.98 to 2.82). We were unable to conduct meta-analyses of two studies of home visits by nurses plus a physician care plan (both with 95% CI above unity) and two studies of free vaccine compared to no intervention (both with 95% CI above unity). One study of group visits (OR 27.2, 95% CI 1.60 to 463.3) was effective, and one study of home visits compared to safety interventions was not.Provider- or system-based interventions (11 strategies, 15 trials, 17 arms, 278,524 participants)One successful intervention that could be meta-analysed focused on payments to physicians (OR 2.22, 95% CI 1.77 to 2.77). Successful interventions tested by individual studies were: reminding physicians to vaccinate all patients (OR 2.47, 95% CI 1.53 to 3.99); posters in clinics presenting vaccination rates and encouraging competition between doctors (OR 2.03, 95% CI 1.86 to 2.22); and chart reviews and benchmarking to the rates achieved by the top 10% of physicians (OR 3.43, 95% CI 2.37 to 4.97).We were unable to meta-analyse four studies that looked at physician reminders (three studies with 95% CI above unity) and three studies of facilitator encouragement of vaccination (two studies with 95% CI above unity). Interventions that were not effective were: comparing letters on discharge from hospital to letters to general practitioners; posters plus postcards versus posters alone; educational reminders, academic detailing, and peer comparisons compared to mailed educational materials; educational outreach plus feedback to teams versus written feedback; and an intervention to increase staff vaccination rates.Interventions at the societal levelNo studies reported on societal-level interventions.Study funding sourcesStudies were funded by government health organisations (n = 33), foundations (n = 9), organisations that provided healthcare services in the studies (n = 3), and a pharmaceutical company offering free vaccines (n = 1). Fifteen studies did not report study funding sources. We identified interventions that demonstrated significant positive effects of low (postcards), medium (personalised phone calls), and high (home visits, facilitators) intensity that increase community demand for vaccination, enhance access, and improve provider/system response. The overall GRADE assessment of the evidence was moderate quality. Conclusions are unchanged from the 2014 review.

Perspectives of Chinese American smoker and nonsmoker household pairs about the creating smokefree living together program.

Chinese men smoke at high rates, and this puts household members at risk for tobacco-related diseases. Culturally responsive interventions that provide education and support are needed to promote smokefree living and reduce smoke exposure, particularly for US immigrants who experience changes in smokefree social norms. This qualitative study examines perspectives of Chinese American smoker and nonsmoker household pairs in the Creating Smokefree Living Together program. Four focus groups were conducted with 30 Chinese American participants (15 smokers and 15 nonsmokers) who, in household pairs, completed smokefree education interventions of either brief or moderate intensity. Nearly three-quarters of the smokers continued to smoke after the intervention at the time of focus group participation. All smokers were male, and most household nonsmokers were female spouses. All participants had limited English proficiency. Focus group meetings were recorded, and the recordings were translated and transcribed. Transcripts and field notes were thematically analyzed. The following themes, shared by smokers and nonsmokers across interventions, were identified: 1) there was a preference for dyadic and group interventions because of the support offered, 2) increased knowledge of the health harms of smoke exposure within a pair improved the nonsmoker's support for smokefree living, 3) learning communication strategies improved household relationships and assertiveness for smokefree environments, 4) biochemical feedback was useful but had short-term effects, and 5) project magnets provided cues to action. Involving household partners is critical to smokefree interventions. Simple reminders at home appear to be more powerful than personal biochemical feedback of smoke exposure for sustaining motivation and engagement in ongoing behavioral changes within the household. Cancer 2018;124:1599-606. © 2018 American Cancer Society.

Effect of Mobile Phone Text Message Reminders on Routine Immunization Uptake in Pakistan: Randomized Controlled Trial.

BackgroundImproved routine immunization (RI) coverage is recommended as the priority public health strategy to decrease vaccine-preventable diseases and eradicate polio in Pakistan and worldwide.ObjectiveThe objective of this study was to ascertain whether customized, automated, one-way text messaging (short message service, SMS) reminders delivered to caregivers via mobile phones when a child is due for an RI visit can improve vaccination uptake and timelines in Pakistan.MethodsThis was a randomized controlled trial, conducted in an urban squatter settlement area of Karachi, Pakistan. Infants less than 2 weeks of age with at least one family member who had a valid mobile phone connection and was comfortable receiving and reading SMS text messages were included. Participants were randomized to the intervention (standard care + one-way SMS reminder) or control (standard care) groups. The primary outcome was to compare the proportion of children immunized up to date at 18 weeks of age. Vaccine given at 6, 10, and 14 weeks schedule includes DPT-Hep-B-Hib vaccine (ie, diphtheria, pertussis, and tetanus; hepatitis B; and Haemophilus influenza type b) and oral poliovirus vaccine (OPV). Data were analyzed using chi-square tests of independence and tested for both per protocol (PP) and intention-to-treat (ITT) analyses.ResultsOut of those approached, 84.3% (300/356) of the participants were eligible for enrollment and 94.1% (318/338) of the participants had a working mobile phone. Only children in the PP analyses, who received an SMS reminder for vaccine uptake at 6 weeks visit, showed a statistically significant difference (96.0%, 86/90 vs 86.4%, 102/118; P=.03).The immunization coverage was consistently higher in the intervention group according to ITT analyses at the 6 weeks scheduled visit (76.0% vs 71.3%, P=.36). The 10 weeks scheduled visit (58.7% vs 52.7%, P=.30) and the 14 weeks scheduled visit (31.3% vs 26.0%, P=.31), however, were not statistically significant.ConclusionsAutomated simple one-way SMS reminders in local languages might be feasible for improving routine vaccination coverage. Whether one-way SMS reminders alone can have a strong impact on parental attitudes and behavior for improvement of RI coverage and timeliness needs to be further evaluated by better-powered studies and by comparing different types and content of text messages in low-and middle-income countries (LMICs).Trial RegistrationClinicalTrials.gov NCT01859546; https://clinicaltrials.gov/ct2/show/NCT01859546 (Archived by WebCite at http://www.webcitation.org/6xFr57AOc)

Simple and Elaborated Clinician Reminder Prompts for Human Papillomavirus Vaccination: A Randomized Clinical Trial

ObjectiveTo evaluate the effects of simple and elaborated health care provider (HCP) reminder prompts on human papillomavirus (HPV) vaccine initiation rates. MethodsTwenty-nine pediatric HCPs serving 5 pediatric clinics were randomized to 1 of 3 arms: 1) usual practice control, 2) simple reminder prompt, and 3) elaborated reminder prompt, which included suggested language for recommending the early adolescent platform vaccines. Prompts were delivered via a computer-based clinical decision support system deployed in the 5 clinics. Eligible patients were ages 11 to 13 years, had not received HPV vaccine, and were due for meningococcal ACWY (MenACWY) vaccine and/or the tetanus, diphtheria, and pertussis booster (Tdap). Receipt of HPV vaccine was determined via automated queries sent to the Indiana immunization registry. Data were analyzed via logistic regression models, with generalized estimating equations used to account for the clustering of patients within HCPs. ResultsTen HCPs in the control group saw 301 patients, 8 HCPs in the simple prompt group saw 124, and 11 HCPs in the elaborated prompt group saw 223. The elaborated prompt arm had a higher rate of HPV vaccination (62%) than the control arm (45%): adjusted odds ratio, 2.76; 95% confidence interval, 1.07 to 7.14. The simple prompt arm did not differ significantly from the control arm with respect to HPV vaccine initiation, which might have been because of the small sample size for this arm. MenACWY and Tdap rates did not vary across the 3 arms. ConclusionsResults suggest that an elaborated HCP-targeted reminder prompt, with suggested recommendation language, might improve rates of HPV vaccine initiation.