SMS Intervention Research Articles

How Can mHealth Keep New Moms out of the Blue? Evidence of the Heterogeneous Treatment Effects on Depression from a Large-Scale Field Experiment

Background: While there is substantial evidence showing the effectiveness of mHealth in treating chronic conditions, researchers now realize that mHealth does not always benefit every patient. This heterogeneity may be due to personal factors, which moderate the effectiveness of mHealth tools. However, there is relatively little research examining these moderating factors, particularly for interventions targeting postpartum depression. Objective: This study specifically looks at factors that could moderate the effect of an mHealth intervention on postpartum depression (PPD) among women in China, where the prevalence of PPD is 10%-15%. Two moderating factors of interest are the psychological factors of perceived susceptibility and intrinsic motivation. Perceived susceptibility is the expectant mother’s perception of her and her baby’s risk of health problems. Intrinsic motivation is the natural human propensity of an expectant mother to act for her and her baby’s health. The hypotheses for this study are: 1) those with higher perceived susceptibility are more likely to benefit from the intervention, and 2) those with higher intrinsic motivation are more likely to benefit from the intervention. Methods: One of the world’s largest field experiments was conducted to explore the effectiveness of an SMS messaging application on the health of expectant mothers in China. The application delivered timely, accurate prenatal health messages, including some on postpartum depression, to pregnant women over the course of their pregnancy. The study enrolled 4,629 expectant mothers in northern China over a period of two years. Participants entered one of four groups, including three different treatment groups and a control group. Subjects were interviewed in postpartum home visits to obtain a measure of PPD. In total, PPD measures were obtained for 1,293 new mothers. Moderator variable data were reported by the expectant mothers at enrollment. In this analysis, the PPD outcome was measured between the treatment (comprising all three treatment groups) and the control group for expectant mothers with low versus high levels of susceptibility perception, and low versus high levels of intrinsic motivation. Results: Results reveal significant moderating effects of an expectant mother’s intrinsic motivation and perceived susceptibility on the effectiveness of the SMS intervention. Specifically, SMS was associated with reduced PPD score among expectant mothers with high perceived susceptibility by 31%, compared to the control group. However, expectant mothers with low perceived susceptibility do not seem to benefit from the SMS messaging. Also, contrary to previous studies, results show that expectant mothers with low intrinsic motivation enjoy the benefits of the intervention by a reduction of 20% in PPD score. Furthermore, those with high intrinsic motivation showed a 17% increase in PPD score. Conclusions: Our results suggest that if resources are limited, the most efficient way to reduce PPD in a population may be to target pregnant women with high susceptibility perception and low intrinsic motivation using SMS health messaging. Our findings also suggest that those with high intrinsic motivation may not be the optimal target population for clinical mobile messaging. Overall, the evidence generated from this large-scale field experiment contributes to our understanding of effective use of mHealth for postpartum depression.

Using participatory methods to design an mHealth intervention for a low income country, a case study in Chikwawa, Malawi

BackgroundmHealth holds the potential to educate rural communities in developing countries such as Malawi, on issues which over-burdened and under staffed health centres do not have the facilities to address. Previous research provides support that mHealth could be used as a vehicle for health education campaigns at a community level; however the limited involvement of potential service users in the research process endangers both user engagement and intervention effectiveness.MethodsThis two stage qualitative study used participatory action research to inform the design and development of an mHealth education intervention. First, secondary analysis of 108 focus groups (representing men, women, leadership, elderly and male and female youth) identified four topics where there was a perceived health education need. Second, 10 subsequent focus groups explored details of this perceived need and the acceptability and feasibility of mHealth implementation in Chikwawa, Malawi.ResultsStage 1 and Stage 2 informed the design of the intervention in terms of target population, intervention content, intervention delivery and the frequency and timing of the intervention. This has led to the design of an SMS intervention targeting adolescents with contraceptive education which they will receive three times per week at 4 pm and will be piloted in the next phase of this research.ConclusionThis study has used participatory methods to identify a need for contraception education in adolescents and inform intervention design. The focus group discussions informed practical considerations for intervention delivery, which has been significantly influenced by the high proportion of users who share mobile devices and the intervention has been designed to allow for message sharing as much as possible.

Use of Mobile Phone Technology to Improve follow-up at a Community Mental Health Clinic: A Randomized Control Trial.

Background:Mobile phone technology is being used worldwide to improve follow-ups in health care.Aim:Aim of the study is to evaluate whether the use of mobile technology will improve or not the follow-up of Indian patients from a community mental health center.Materials and Methods:Patients or caregivers having mobile phones and consenting for study were enrolled, and sociodemographic and clinical details of patients were taken. Participants were randomized into two groups (short message service [SMS] vs. non-SMS group). At first intervention level, a SMS was sent to SMS group (not in non-SMS group) 1 day before their appointment. At second-level intervention (voice call level), patients from both groups who missed their first appointment were given a voice call requesting them to come for follow-up, and the reasons for first missed appointments (MA) were also elicited. The effect of these two intervention levels (first SMS for SMS group and next voice calls for both groups) on follow-up was evaluated.Results:A total of 214 patients were enrolled in the study. At first SMS intervention level of SMS group (n = 106), 62.26% of participants reached appointment-on-time (RA), while in the non-SMS/as usual group (n = 108), 45.37% of patients RA. The difference of these groups is statistically significant. At second-level intervention (voice call), 66 of 88 (another 15 were unable to contact) were came for follow-up consultation within 2 days of MA. Distance and diagnosis of alcohol dependence were significantly associated with MA. Social reasons were most common reasons for first MA.Conclusion:The use of mobile phone technology in an outpatient community psychiatric clinic improved follow-up significantly.

The effectiveness of SMS Reminders and the impact of patient characteristics on missed appointments in a public dental outpatient clinic

This paper reports on the Failure To Attend (FTA) rate of appointments as well as patients following the implementation of SMS reminders in a public dental outpatient service. Given the ineffectiveness of the intervention and a highly representative patient’s profile, this paper identifies the demographic characteristics of patients who miss all of their appointments. Data on appointment attendance, patient demographics and dental service type was collected over a time period of 46 consecutive months. Using descriptive and inferential statistics (chi-square, two sample tests and Marascuilo procedure) we found the SMS intervention was ineffective in reducing the FTA rates. Further, patients associated with high rates of non-attendance exhibited one or more of the following characteristics: male; age 26 – 44; non-concession card holders; a person of Indigenous, local, Asian or African descent, and of refugee status, persons living in low socio-economic areas; and appointments in General Care and Student Clinics. Whilst the literature overwhelmingly attributes SMS reminders to improving the attendance rate of patients in outpatient clinics, our contradictory findings suggest a more targeted approach in settings whose patients exhibit strong characteristics associated with non-attendance.

AVillage-BasedIntervention:PromotingFolicAcid UseamongRuralChineseWomen.

Background: Folic acid supplementation is effective in reducing the risk of neural tube defects (NTDs). However, the use of folic acid is low among rural women in China. Nutrition education can provide information about folic acid and encourage its use. The primary objective of this study was to test the effectiveness of a village-based nutrition intervention on folic acid use among rural women. Methods: Sixty villages were randomly selected using multiple-stage sampling and were divided into control and intervention groups. The intervention included nutritional education at village clinics, written materials, and text messages (SMS). Folic acid use knowledge and behavior was assessed at baseline and after the intervention. Results: Self-reported compliance with folic acid supplement use increased from 17.0%–29.2% at baseline to 41.7%–59.2% one year post-intervention. During the same period, the folic acid knowledge score in the intervention group increased from 3.07 to 3.65, significantly higher than the control group (3.11 to 3.35). Multivariate binary logistic regression showed that the women who received folic acid education and SMS intervention were more likely to comply with folic acid supplement recommendations. Conclusions: The results indicated that an integrated village-based folic acid education intervention may be an effective way of promoting folic acid use for the prevention of NTDs in rural women.

Correlational study and randomised controlled trial for understanding and changing red meat consumption: The role of eating identities

RationaleThe present studies aimed to contribute to the literature on psychological variables involved in reducing red meat consumption (RMC). ObjectiveStudy 1 investigated whether the theory of planned behaviour (TPB), plus healthy-eating and meat-eating identities, could explain intentions to reduce RMC. Study 2 evaluated the effectiveness of an SMS text message intervention on self-monitoring to reduce RMC. MethodsIn Study 1, data were collected daily using online food diaries for one week and a TPB questionnaire. Study 2 was a randomised controlled trial assessing pre– and post–RMC and TPB constructs by online food diaries and questionnaires over a one-week period. Participants were Italian undergraduates in each study (Study 1: N = 405; Study 2: N = 244). In Study 2, participants were randomly allocated to control and message condition groups. Participants in the message condition group received a daily SMS, which reminded them to monitor RMC, while participants in the control group did not receive any message. Only students who completed all measures were considered in the analyses (Study 1: N = 342; Study 2: N = 228). ResultsStudy 1 showed that affective and instrumental attitudes, perceived behavioural control, and meat-eating identity explained intentions to reduce RMC, while subjective norm, past behaviour, and healthy-eating identity did not. Study 2 showed that an SMS intervention was effective in increasing intentions and reducing RMC. Mediation analyses indicated partial serial mediation through healthy-eating and meat-eating identities and intentions. ConclusionThe present studies provide support for the predictive validity of TPB in explaining intentions to reduce RMC and for the efficacy of an SMS intervention targeting self-monitoring in reducing RMC. Findings confirmed the important role of eating identities in explaining intentions to reduce RMC and in changing this behaviour.

Effectiveness of an SMS-based maternal mHealth intervention to improve clinical outcomes of HIV-positive pregnant women

ABSTRACTWe conducted a retrospective study to investigate the effectiveness of an mHealth messaging intervention aiming to improve maternal health and HIV outcomes. Maternal health SMSs were sent to 235 HIV-infected pregnant women twice per week in pregnancy and continued until the infant’s first birthday. The messages were timed to the stage of the pregnancy/infant age and covered maternal health and HIV-support information. Outcomes, measured as antenatal care (ANC) visits, birth outcomes and infant HIV testing, were compared to a control group of 586 HIV-infected pregnant women who received no SMS intervention. Results showed that intervention participants attended more ANC visits (5.16 vs. 3.95, p < 0.01) and were more likely to attend at least the recommended four ANC visits (relative risk (RR): 1.41, 95% confidence interval (CI): 1.15–1.72). Birth outcomes of intervention participants improved as they had an increased chance of a normal vaginal delivery (RR: 1.10, 95% CI: 1.02–1.19) and a lower risk of delivering a low-birth weight infant (<2500 g) (RR: 0.14, 95% CI: 0.02–1.07). In the intervention group, there was a trend towards higher attendance to infant polymerase chain reaction (PCR) testing within six weeks after birth (81.3% vs. 75.4%, p = 0.06) and a lower mean infant age in weeks at HIV PCR testing (9.5 weeks vs. 11.1 weeks, p = 0.14). These results add to the growing evidence that mHealth interventions can have a positive impact on health outcomes and should be scaled nationally following comprehensive evaluation.

TextWithSurgeryPatients - A Research Hypothesis in Enhancing Education and Physical Assessment for Abdominal Surgical Patients.

Medical surgical nurses may not have the time or resources to provide effective pre- and post-operative instructions for patients in today's healthcare system. And, making timely physical assessments following discharge from the hospital is not always straightforward. Therefore, the risk for readmission associated with post-surgical complications is a concern. At present, mobile healthcare technologies and patient care are precipitously evolving and may serve as a resource to enhance communication between the healthcare provider and patient. A mobile telephone text message (short message service [SMS]) intervention for abdominal surgical patients may foster effective education (communication) and timely self-reported physical assessment in the home environment hence preventing deleterious outcomes. The aim of this research proposal is to identify the feasibility of using a SMS intervention via smart phones to improve health outcomes via timely communication, reach large numbers of at-risk surgical patients and, establish and sustain uniform protocols in a cost-efficient manner.

Providing HIV results via SMS one day after testing: more popular than rapid point-of-care tests.

An inner Sydney sexual health service introduced the option to gay and bisexual men of receiving a negative HIV result by SMS to mobile phone one business day after venipuncture (rapid SMS). Men could also choose one of the other options: a point-of-care-test (POCT), by phone, or in-person (clinicians could also require in-person). We followed-up patients choosing the rapid SMS method to ascertain their satisfaction. During 12 months, 473 men had 591 HIV tests. Of these tests, 5.4% were POCTs, 9.1% were in-person, 24% were by phone, and 62% were rapid SMS. HIV POCTs declined from being 22% of result methods in the pre-study period to 5.4% during the rapid SMS intervention period (odds ratio 0.20, 95% CI 0.13-0.32, P < 0.0001). Phone/in-person results declined from 78% to 33% (odds ratio 0.14, 95% CI 0.10-0.20, P < 0.0001). SMS was sent by the next business day in 95% of cases; 96% of men were satisfied; and 95% would choose this method for their next test. Of 77 men who previously had an HIV POCT, 56 (73%) elected a rapid SMS result rather than having another POCT. The higher accuracy of conventional serology was commonly expressed as the reason for choosing rapid SMS for results.

The Effect of Human Immunodeficiency Virus Prevention and Reproductive Health Text Messages on Human Immunodeficiency Virus Testing Among Young Women in Rural Kenya: A Pilot Study.

More than half of human immunodeficiency virus (HIV)-infected individuals in Kenya are unaware of their status, and young women carry a disproportionate burden of incident HIV infections. We sought to determine the effect of an SMS intervention on uptake of HIV testing among female Kenyan college students. We conducted a quasi-experimental study to increase HIV testing among women 18 to 24 years old. Four midlevel training colleges in Central Kenya were allocated to have their study participants receive either weekly SMS on HIV and reproductive health topics or no SMS. Monthly 9-question SMS surveys were sent to all participants for 6 months to collect data on HIV testing, sexual behavior, and HIV risk perception. We used multivariate Cox proportional hazards regression to detect differences in the time to the first HIV test reported by women during the study period. We enrolled 600 women between September 2013 and March 2014 of whom 300 received weekly SMS and monthly surveys and 300 received only monthly surveys. On average, women were 21 years of age (interquartile range, 20-22), 71.50% had ever had sex and 72.62% had never tested for HIV. A total of 356 women reported testing for HIV within the 6 months of follow-up: 67% from the intervention arm and 51% from the control arm (hazard ratio, 1.57; 95% confidence interval, 1.28-1.92). Use of weekly text messages about HIV prevention and reproductive health significantly increased rates of HIV testing among young Kenyan women and would be feasible to implement widely among school populations.

Developing an SMS Intervention for the Prevention of Underage Drinking: Results From Focus Groups

ABSTRACTBackground: There is growing evidence that text messaging—”short message service” (SMS)—is useful for health promotion and behavior change. SMS has become a preferred channel of communication among adolescents. Despite burgeoning interest, there remains a critical need for formative research regarding developmentally and culturally appropriate SMS-based health promotion with teenagers. Objectives. The primary objective was to develop SMS message protocols and procedures effective for reducing underage drinking among Hispanic teens. Using focus groups, we sought our target population's perspectives on SMS parameters including scheduling, frequency, content, themes, and confirmation-of-receipt. Method: We conducted, recorded, and transcribed six mixed-gender focus groups (20 adolescents, 4–5 per group) recruited from the Division of Adolescent Medicine at Miami Children's Hospital. Alcohol-related and “attention control” text messages were assembled from two sources (http://www.mobilehealth4youth.org and the existing literature); these SMSs, along with SMS procedures, were the focus of discussion. The recordings and transcription were reviewed by two researchers who employed a qualitative iterative process analytical approach. Results: Findings revealed distinct preferences among teenagers about the scheduling, frequency, content, themes, and confirmation-of-receipt of SMSs. Moreover, teens were most enthusiastic about SMSs that addressed alcohol-related knowledge, self-efficacy, social support, or future orientation. Conclusion/Importance: Seeking our target population's perspectives on SMS parameters was essential for developing SMS message protocols and procedures with potential effectiveness for reducing underage drinking among Hispanic teens. It is strongly recommended that researchers or clinicians considering SMS-based interventions conduct a similar formative process prior to implementation.

Mobile phone based interventions for promoting adherence to tuberculosis treatment: a systematic review and meta-analysis

BackgroundPoor adherence to tuberculosis treatment remains a global health challenge, and mobile phone based interventions have the potential to address this problem. This study aimed to systematically review and synthesise existing evidence on the acceptability and efficacy of mobile phone based interventions in improving patients’ adherence to tuberculosis treatment. MethodsWe searched Embase, PubMed, WHOLIS, WHOIRIS, Cochrane Library, and Web of Science for studies published in English from Jan 1, 1992, to May 25, 2015, using the search terms “TB”, “tuberculosis”, “mobile”, and “messag*”. We also did manual, snowball searches. We included descriptive and qualitative studies of the acceptability of mobile phone based interventions, and randomised controlled trials (RCTs) of efficacy. For descriptive and qualitative studies, a framework analysis was used. For RCTs, we pooled data with a random-effects meta-analysis. Findings70 articles were identified from 6601 initial searches. 14 studies were included (five qualitative studies [270 participants]—two USA, one Peru, one India, one Argentina; six descriptive survey studies [2259]—one South Africa, one India, one Philippines, one China, one Kenya, one USA; three RCTs [566]—one Kenya, one Argentina, one Thailand). 56–82% of patients were willing to accept mobile phone based communication. Developed countries seemed to have lower acceptability than developing ones, but reasonable usage of the mobile phone (for example, frequency of sending SMS) increased the acceptability. Older age and literacy were not crucial limiting factors to participating. The mobile phone based interventions helped overcome barriers such as stigma, loss of privacy, transportation limitations, and burdens associated with traditional interventions, and made participants feel “cared for” and that they were “responsible for their treatment”. Compared with participants without mobile phone based interventions, SMS intervention significantly improved adherence to tuberculosis treatment (pooled relative risk 1·155, 95% CI 1·047–1·274), with no evidence of publication bias (Begg test z=0·939, p=0·348) or heterogeneity among trials (χ2=1·039, df=2, p=0·595, I2=0%). InterpretationThese findings support the important role of mobile phone based interventions for promoting adherence to treatment by patients with tuberculosis, which will help policy makers. FundingFunding was received from the Natural Science Foundation of China (no 71203068) and from the China National Health and Family Planning Commission and the Gates Foundation TB Project (no 51914). The funders had no role in the study.

Can mobile phone messages to drug sellers improve treatment of childhood diarrhoea?--A randomized controlled trial in Ghana.

Oral rehydration solution (ORS) and zinc are the recommended treatment in developing countries for the management of uncomplicated diarrhoea in children under five (World Health Organization and UNICEF 2004). However, drug sellers often recommend costly and unnecessary treatments instead. This article reports findings from an experiment to encourage licensed chemical sellers (LCS) in Ghana to recommend ORS and zinc for the management of childhood diarrhoea. The intervention consisted of mobile phone text messages (Short Message Service or SMS) sent to a randomly assigned group of LCS who had been trained on the diarrhoea management protocols recommended by the World Health Organization (WHO). The SMS campaign comprised informational messages and interactive quizzes sent over an 8-week period. The study measured the impact of the SMS messages on both reported and actual practices. Analysis of data from both face-to-face interviews and mystery client visits shows that the SMS intervention improved providers' self-reported practices but not their actual practices. The study also finds that actual practices deviate substantially from reported practices.

An augmented SMS intervention to improve access to antenatal CD4 testing and ART initiation in HIV-infected pregnant women: a cluster randomized trial.

BackgroundLess than one-third of HIV-infected pregnant women eligible for combination antiretroviral therapy (ART) globally initiate treatment prior to delivery, with lack of access to timely CD4 results being a principal barrier. We evaluated the effectiveness of an SMS-based intervention to improve access to timely antenatal ART.MethodsWe conducted a stepped-wedge cluster randomized trial of a low-cost programmatic intervention in 20 antenatal clinics in Gaborone, Botswana. From July 2011-April 2012, 2 clinics were randomly selected every 4 weeks to receive an ongoing clinic-based educational intervention to improve CD4 collection and to receive CD4 results via an automated SMS platform with active patient tracing. CD4 testing before 26 weeks gestation and ART initiation before 30 weeks gestation were assessed.ResultsThree-hundred-sixty-six ART-naïve women were included, 189 registering for antenatal care under Intervention and 177 under Usual Care periods. Of CD4-eligible women, 100 (59.2%) women under Intervention and 79 (50.6%) women under Usual Care completed CD4 phlebotomy before 26 weeks gestation, adjusted odds ratio (aOR, adjusted for time that a clinic initiated Intervention) 0.87 (95% confidence interval [CI]0.47–1.63, P = 0.67). The SMS-based platform reduced time to clinic receipt of CD4 test result from median of 16 to 6 days (P<0.001), was appreciated by clinic staff, and was associated with reduced operational cost. However, rates of ART initiation remained low, with 56 (36.4%) women registering under Intervention versus 37 (24.2%) women under Usual Care initiating ART prior to 30 weeks gestation, aOR 1.06 (95%CI 0.53–2.13, P = 0.87).ConclusionsThe augmented SMS-based intervention delivered CD4 results more rapidly and efficiently, and this type of SMS-based results delivery platform may be useful for a variety of tests and settings. However, the intervention did not appear to improve access to timely antenatal CD4 testing or ART initiation, as obstacles other than CD4 impeded ART initiation during pregnancy.

SMS reminders to improve the tuberculosis cure rate in developing countries (TB-SMS Cameroon): a protocol of a randomised control study

BackgroundTuberculosis is a public health problem in Cameroon, just like in many other countries in the world. The National Tuberculosis Control Programme (PNLT) put in place by the state, aims to fight tuberculosis through the implementation of international directives (Directly Observed Treatment Short, DOTS). Despite the deployment of this strategy across the world, its implementation is difficult in the context of low-resource countries. Some expected results are not achieved. In Cameroon, the cure rate for patients with sputum positive pulmonary tuberculosis (TPM+) after 6 months is only about 65%, 20% below the target. This is mainly due to poor patient adherence to treatment. By relying on the potential of mobile Health, the objective of this study is to evaluate the effect of SMS reminders on the cure rate of TPM + patients, measured using 6-month bacilloscopy.Methods/designThis is a blinded, randomised controlled multicentre study carried out in Cameroon. The research hypothesis is that sending daily SMS messages to remind patients to take their prescribed tuberculosis medication, together with the standard DOTS strategy, will increase the cure rate from 65% (control group: DOTS, no SMS intervention) to 85% (intervention group: DOTS, with SMS intervention) in a group of new TPM + patients. In accordance with each treatment centre, the participants will be randomly allocated into the two groups using a computer program: the intervention group and the control group. A member of the research team will send daily SMS messages. Study data will be collected by health professionals involved in the care of patients. Data analysis will be done by the intention-to-treat method.DiscussionThe achieving of expected outcomes by the PNLT through implementation of DOTS requires several challenges. Although it has been demonstrated that the DOTS strategy is effective in the fight against tuberculosis, its application remains difficult in developing countries. This study explores the potential of mHealth to support DOTS strategy. It will gather new evidence on the effectiveness of mHealth-based interventions and SMS reminders in the improvement of treatment adherence and the cure rate of tuberculosis patients, especially in a low-resource country such as Cameroon.Trial registrationThe trial is registered on the Pan-African Clinical Trials Registry (http://www.pactr.org) under unique identification number: PACTR201307000583416.

Mobile phone text messaging for promoting adherence to anti-tuberculosis treatment: a systematic review.

BackgroundMobile phone text messaging (SMS) has the potential to promote adherence to tuberculosis treatment. This systematic review aims to synthesize current evidence on the effectiveness of SMS interventions in improving patients’ adherence to tuberculosis treatment.MethodsWe searched electronic databases (PubMed, EMBASE, Science Citation Index), reference lists of relevant articles, conference proceedings, and selected websites for eligible studies available by 15 February 2013; regardless of language or publication status. Two authors independently screened selected eligible studies, and assessed risk of bias in included studies; resolving discrepancies by discussion and consensus.ResultsWe identified four studies that compared the outcomes of the SMS intervention group with controls. Only one of the four studies was a randomized controlled trial. This was conducted in Argentina and the SMS intervention did not significantly improve adherence to tuberculosis treatment compared to self-administration of tuberculosis treatment (risk ratio [RR] 1.49, 95% confidence intervals [CI] 0.90 to 2.42). One of the non-randomized studies, conducted in South Africa, which compared SMS reminders to directly observed therapy short course (DOTS) reported similar rates of tuberculosis cure (62.35% vs. 66.4%) and treatment success (72.94% vs. 69.4%). A second study from South Africa, utilized SMS reminders when patients delayed in opening their pill bottles and reported increased tuberculosis cure (RR 2.32, 95% CI 1.60 to 3.36) and smear conversion (RR 1.62, 95% CI 1.09 to 2.42) rates compared to DOTS. In the third non-randomized study, conducted in Kenya, use of SMS reminders increased rates of clinic attendance on scheduled days compared to standard care (RR 1.56, 95% CI 1.06 to 2.29). Using the GRADE approach, we rate the quality of the evidence as low, mainly because of the high risk of bias and heterogeneity of effects across studies.ConclusionsThis systematic review indicates that there is a paucity of high-quality data on the effectiveness of SMS interventions for improving patients’ adherence to tuberculosis treatment. The low quality of the current evidence implies that further studies (in particular randomized trials) on the subject are needed. In the interim, if the intervention is implemented outside research settings an impact evaluation is warranted.

Efficacy of a text messaging (SMS) based smoking cessation intervention for adolescents and young adults: Study protocol of a cluster randomised controlled trial

BackgroundParticularly in groups of adolescents with lower educational level the smoking prevalence is still high and constitutes a serious public health problem. There is limited evidence of effective smoking cessation interventions in this group. Individualised text messaging (SMS) based interventions are promising to support smoking cessation and could be provided to adolescents irrespective of their motivation to quit. The aim of the current paper is to outline the study protocol of a trial testing the efficacy of an SMS based intervention for smoking cessation in apprentices.Methods/DesignA two-arm cluster-randomised controlled trial will be conducted to test the efficacy of an SMS intervention for smoking cessation in adolescents and young adults compared to an assessment only control group. A total of 910 daily or occasional (≥ 4 cigarettes in the preceding month and ≥ 1 cigarette in the preceding week) smoking apprentices will be proactively recruited in vocational school classes and, using school class as a randomisation unit, randomly assigned to an intervention group (n = 455) receiving the SMS based intervention or an assessment only control group (n = 455). Individualised text messages taking into account demographic data and the individuals' smoking behaviours will be sent to the participants of the intervention group over a period of 3 months. Participants will receive two text messages promoting smoking cessation per week. Program participants who intend to quit smoking have the opportunity to use a more intensive SMS program to prepare for their quit day and to prevent a subsequent relapse. The primary outcome measure will be the proportion of participants with 7-day point prevalence smoking abstinence assessed at 6-months follow-up. The research assistants conducting the baseline and the follow-up assessments will be blinded regarding group assignment.DiscussionIt is expected that the program offers an effective and inexpensive way to promote smoking cessation among adolescents and young adults including those with lower educational level and independent of their motivation to quit.Trial registration numberISRCTN: ISRCTN19739792

RML: market intelligence in India with mobile SMS intervention

Subject area Agriculture knowledge, market intelligence, emerging business model. Study level/applicability It is best suited to teach undergraduates and graduates in the areas of rural marketing, agri-business management, service management and information and communication technology for development. Case overview India is changing with great pace by inclusive growth on espousal of technology into the mainstream. Indian farmers are wholly depending even now on traditional methods for decision making on entire agriculture supply chain. The constant decision making provides middle men with a chance to exploit and empower themselves on the returns produced by farmers. Technology is creating waves providing an opportunity for farmers to benefit by adopting information and technology to solve their basic livelihood problems. The Thomson Reuter group launched a SMS-based mobile information service to support India's 250-million-strong agricultural community. The service, named Reuters Market Light (RML), is trying to provide a missing link by providing required information in the quickest possible time to farmers; user need-based services are critical to this. How far RML services are delivering in this context is quizzed by some analysts. Thomson Reuter's service started with the global climb down in commodity prices, coupled with increased risk of natural disasters as per experts. The competitors providing similar services at price which differ with RML wondered about the success, scalability and sustainability of its venture. Expected learning outcomes This is a practical view of how these interventions can be better looked at and can get into policy for a framework for rural areas' socio-economic development. Supplementary materials Teaching notes.

Use of text messaging in the aftercare of patients with bulimia nervosa

AbstractThe development of a text messaging (SMS) based intervention for the aftercare treatment of bulimia nervosa is reported. The programme is offered to bulimic patients for 6 months following discharge from inpatient psychotherapy in a German hospital for psychosomatic medicine. The intervention consists of weekly messages from the patients on their bulimic symptomatology and a corresponding weekly feedback that is a mixture of pre‐programmed parts and individually tailored information. An ongoing pilot study is described, designed to investigate the acceptance, the practicability, and the effectiveness of the intervention. Preliminary results indicate that the programme is well‐accepted and gives support to bulimic patients after finishing inpatient treatment. Advantages and limitations of the use of the SMS intervention programme in the treatment of bulimia nervosa are discussed. Copyright © 2003 John Wiley &amp; Sons, Ltd and Eating Disorders Association.