SMS Program Research Articles

An SMS chatbot digital educational program to increase healthy eating behaviors in adolescence: A multifactorial randomized controlled trial among 7,890 participants in the Danish National Birth Cohort.

Few cost-effective strategies to shift dietary habits of populations in a healthier direction have been identified. We examined if participating in a chatbot health education program transmitted by Short Messages Service ("SMS-program") could improve adolescent dietary behaviors and body weight trajectories. We also explored possible added effects of maternal or peer involvement. We conducted a randomized controlled trial (RCT) among adolescents from the Danish National Birth Cohort (DNBC). Eligible were adolescents who during 2015 to 2016 at age 14 years had completed a questionnaire assessing height, weight, and dietary habits. Two thirds were offered participation in an SMS-program, whereas 1/3 ("non-SMS group") received no offer. The SMS program aimed to improve 3 key dietary intake behaviors: sugar-sweetened beverages (SSBs), fruit and vegetables (FV), and fish. The offered programs had 3 factorially randomized schemes; the aims of these were to test effect of asking the mother or a friend to also participate in the health promotion program, and to test the effect of a 4-week individually tailored SMS program against the full 12-week SMS program targeting all 3 dietary factors. Height and weight and intakes of SSB, FV, and fish were assessed twice by a smartphone-based abbreviated dietary questionnaire completed at 6 months (m) and 18 m follow-up. Main outcome measures were (1) body mass index (BMI) z-score; and (2) an abbreviated Healthy Eating Index (mini-HEI, 1 m window, as mean of z-scores for SSB, FV, and fish). Among the 7,890 randomized adolescents, 5,260 were assigned to any SMS program; 63% (3,338) joined the offered program. Among the 7,890 randomized, 74% (5,853) and 68% (5,370) responded to follow-ups at 6 m and 18 m, respectively. Effects were estimated by intention-to-treat (ITT) analyses and inverse probability weighted per-protocol (IPW-PP) analyses excluding adolescents who did not join the program. Mean (standard deviation (SD)) mini-HEI at baseline, 6 m and 18 m was -0.01 (0.64), 0.01 (0.59), and -0.01 (0.59), respectively. In ITT-analyses, no effects were observed, at any time point, in those who had received any SMS program compared to the non-SMS group, on BMI z-score (6 m: -0.010 [95% confidence interval (CI) -0.035, 0.015]; p = 0.442, 18 m: 0.002 [95% CI -0.029, 0.033]; p = 0.901) or mini-HEI (6 m: 0.016 [95% CI -0.011, 0.043]; p = 0.253, 18m: -0.016 [95% CI -0.045, 0.013]; p = 0.286). In IPW-PP analyses, at 6 m, a small decrease in BMI z-score (-0.030 [95% CI -0.057, -0.003]; p = 0.032) was observed, whereas no significant effect was observed in mini-HEI (0.027 [95% CI -0.002, 0.056]; p = 0.072), among those who had received any SMS program compared to the non-SMS group. At 18 m, no associations were observed (BMI z-score: -0.006 [95% CI -0.039, 0.027]; p = 0.724, and mini-HEI: -0.005 [95% CI -0.036, 0.026]; p = 0.755). The main limitations of the study were that DNBC participants, though derived from the general population, tend to have higher socioeconomic status than average, and that outcome measures were self-reported. In this study, a chatbot health education program delivered through an SMS program had no effect on dietary habits or weight trajectories in ITT analyses. However, IPW-PP-analyses, based on those 63% who had joined the offered SMS program, suggested modest improvements in weight development at 6 m, which had faded at 18 m. Future research should focus on developing gender-specific messaging programs including "booster" messages to obtain sustained engagement. ClinicalTrials.gov Identifier: NCT02809196 https://clinicaltrials.gov/study/NCT02809196.

Real-world implementation of an EHR-integrated, SMS text remote patient monitoring platform at an academic cancer center.

e13669 Background: Remote monitoring studies in oncology have shown improved quality of life, decreased healthcare utilization, and even improved overall survival in an oncologic population, however applications in a real-world setting have been limited. Barriers to successful deployment include low patient engagement rates with smartphone apps, lack of integration with the EHR and burdensome clinical workflows for staff. Methods: We sought to assess the feasibility of an EHR-integrated, SMS text conversational AI agent to automate the collection of ePRO data as well as the assessment and triage of common patient symptoms for patients with GI and GU tumors receiving anti-cancer therapy. This program was developed collaboratively by a health system digital health team, nursing informatics, IT support resources, oncology nurses, medical oncologists, and representatives from Memora Health. Core components included 1) weekly ePRO collection based on the NIH’s CTCAE, 2) NLP activated symptom triage for 16 common symptoms and toxicities 3) weekly symptom check-in 4) weekly medication adherence assessment for patients on oral therapy. Patients received all messages through SMS on their phones, and all data collected were routed into the EHR. In-EHR visualizations allowed nurse coordinators to track ePRO symptoms over time and symptoms that met pre-specified criteria triggered EHR-based alerts. Results: Of 99 patients ordered into this SMS program, 83 enrolled (84% enrollment rate), with 55 Uro Onc patients; 44 GI Onc patients. A total of 2,583 surveys were sent to patients. 98% of patients completed at least 1 survey. Overall patient survey completion rate was 62%. Medication adherence surveys had the highest completion rate at 81%. ePRO completion rates were higher for GU (65%) vs GI (39%) patients (p<0.01). 71% of ePRO surveys generated a symptom alert to the nursing staff. Patient satisfaction was high with 93% rating this SMS program as “excellent” or “good” (n=78). Care team surveys found that 3 of the 6 Oncologists believe ePRO collection is valuable and 3 of 6 used ePRO data to adjust a care plan. Nurse coordinators had a mixed view of the program with a majority reporting that there were too many symptom alerts. Conclusions: We successfully deployed an EHR-integrated SMS program to collect ePRO data, track patient symptoms, and monitor adherence to oral therapy. We believe having a physician champion influenced patient engagement in the GU patient population. Patients had a favorable impression of this program and survey completion rates demonstrated ease of use for patients. Clinical staff, particularly nurses, felt that there were too many alerts. Additional workflow changes may reduce alert burden and better incorporate ePRO learnings into clinical practice.

Local wisdom-based flood early warning system: a case study on Glintung Water Street (GWS) Malang City

A flood early warning system as part of flood risk management must be applied in a flood-prone area. This study aims to develop and examine a flood early warning system using an information and communication technology (ICT) appropriate to the local wisdom values of the Glintung Water Street (GWS) community, Malang City. This study used a descriptive qualitative research method. Data collection techniques include interviews, observation, and documentation/literature studies. The flood early warning system was developed using the SMS system. The warning information sent by the system consists of alert-1 for a water level of 0 cm - 20 cm, alert-2 for a water level of 20 cm - 30 cm, and alert-3 for a water level of 30 cm - 50 cm and probe sensors for electronic devices that play an important role in this system consisting of probe sensors as water level detectors, the GSM/GPRS SIM900 module, as the sending medium to the cellphone and Arduino which functions as the control system. Based on the research results, the design of a flood early warning system using the Probe Sensor combined with Arduino and the SMS Program is appropriate for the study area concerning the local wisdom values already embedded in the community.

Small Steps over time: A longitudinal usability test of an automated interactive text messaging intervention to support self-management of depression and anxiety symptoms

BackgroundDigital mental health interventions (DMHIs) offer potential solutions for addressing mental health care gaps, but often suffer from low engagement. Text messaging is one promising medium for increasing access and sustaining user engagement with DMHIs. This paper examines the Small Steps SMS program, an 8-week, automated, adaptive text message-based intervention for depression and anxiety. MethodsWe conducted an 8-week longitudinal usability test of the Small Steps SMS program, recruiting 20 participants who met criteria for major depressive disorder and/or generalized anxiety disorder. Participants used the automated intervention for 8 weeks and completed symptom severity and usability self-report surveys after 4 and 8 weeks of intervention use. Participants also completed individual interviews to provide feedback on the intervention. ResultsParticipants responded to automated messages on 70 % of study days and with 85 % of participants sending responses to messages in the 8th week of use. Usability surpassed established cutoffs for software that is considered acceptable. Depression symptom severity decreased significantly over the usability test, but reductions in anxiety symptoms were not significant. Participants noted key areas for improvement including addressing message volume, aligning message scheduling to individuals' availability, and increasing the customizability of content. LimitationsThis study does not contain a control group. ConclusionsAn 8-week automated interactive text messaging intervention, Small Steps SMS, demonstrates promise with regard to being a feasible, usable, and engaging method to deliver daily mental health support to individuals with symptoms of anxiety and depression.

Testing the acceptability of stillbirth awareness messages in an SMS program for fathers.

To raise expectant fathers' awareness of risk factors for stillbirth. A set of brief text messages was developed addressing recognised risk factors for stillbirth: avoidance of maternal cigarette smoking, maternal going to sleep on side messaging, awareness of the importance of noticing and reporting changes in foetal movement and fathers' involvement in shared decision making for timing of birth. Eight messages were inserted into the SMS4dads pilot program being conducted by NSW Health. Feedback on the messages was requested. Participants rated the quality of the messages on a three-point Likert scale and provided comments. Overall, 2528 messages were sent to 626 fathers' mobile phones, 45% of fathers replied with 666 ratings and 115 comments evaluating the texts. The quantitative ratings indicated substantial overall approval of the messages. Within the coding category "Evaluation of Message Content," three themes described fathers' reactions and feelings about the smoking, movement, side sleeping and birth timing messages: "important-good information," "not appropriate/anxiety provoking" and "not relevant-obvious." Three themes reflecting the attributes of the messages within the "Service Quality" category were "need more information," "complements public health" and "child voice fit." Results indicate that the messages are an acceptable way to provide information and suggested actions addressing stillbirth risk factors to fathers-to-be. SO WHAT?: Fathers' awareness of the risk factors for stillbirth can assist mothers to take appropriate actions for a healthy birth. Information on risk factors can be provided to fathers via a father-focused text messaging service.

Patient engagement in a mobile health intervention to improve preparedness for prostate biopsy.

We designed and implemented a peri-procedural text message (SMS) program for patients undergoing transrectal prostate biopsy and aimed to evaluate predictors of patient enrollment and engagement with the SMS program. We designed an SMS-based program with 8 messages containing web-based modules with educational content and reminders confirming MRI for fusion biopsy, antibiotic adherence, enema use, and anticoagulation cessation. Data on patient demographics, enrollment, and engagement with modules were collected from June 1, 2018 to February 28, 2021. Engagement was defined as a patient clicking a link delivered via SMS to access modules. We made multivariable models to identify predictors of patient enrollment and engagement. Of the 1,760 prostate biopsies between June 2018 and March 2021, 1,383 (78.6%) were enrolled in SMS, 182 (10.3%) in email, 106 (6.0%) in both, and 240 (13.6%) were not enrolled. Of 1418 patients enrolled, 1,270 (89.6%) engaged with at least one module. African American patients had 50% lower odds of being enrolled (OR = 0.50, 95% CI 0.28-0.96; P = 0.03), but once enrolled there were no differences in engagement. Patients for whom English was not listed as their primary language had 60% lower odds of engagement (OR = 0.40, 95% CI 0.17-1.00, P = .04) and patients who were single or divorced had a 40% lower odds of engagement (OR = 0.60, 95% CI 0.41-0.91, P = 0.01). A cohort of older men undergoing prostate biopsy were able to engage with a text message-based education and reminder program. Future efforts must address barriers to enrollment for Black or African American men and improve accessibility to non-English speaking patients.

Adaptation and Assessment of a Text Messaging Smoking Cessation Intervention in Vietnam: Pilot Randomized Controlled Trial.

BackgroundText message (ie, short message service, SMS) smoking cessation interventions have demonstrated efficacy in high-income countries but are less well studied in low- and middle-income countries, including Vietnam.ObjectiveThe goal of the research is to assess the feasibility, acceptability, and preliminary efficacy of a fully automated bidirectional SMS cessation intervention adapted for Vietnamese smokers.MethodsThe study was conducted in 3 phases. In phase 1, we adapted the SMS library from US-based SMS cessation programs (ie, SmokefreeTXT and Text2Quit). The adaptation process consisted of 7 focus groups with 58 smokers to provide data on culturally relevant patterns of tobacco use and assess message preferences. In phase 2, we conducted a single-arm pilot test of the SMS intervention with 40 smokers followed by in-depth interviews with 10 participants to inform additional changes to the SMS library. In phase 3, we conducted a 2-arm pilot randomized controlled trial (RCT) with 100 smokers. Participants received either the SMS program (intervention; n=50) or weekly text assessment on smoking status (control; n=50). The 6-week SMS program consisted of a 2-week prequit period and a 4-week postquit period. Participants received 2 to 4 automated messages per day. The main outcomes were engagement and acceptability which were assessed at 6 weeks (end of intervention). We assessed biochemically confirmed smoking abstinence at 6 weeks and 12 weeks. Postintervention in-depth interviews explored user experiences among a random sample of 16 participants in the intervention arm.ResultsParticipants in both arms reported high levels of engagement and acceptability. Participants reported using the program for an average of 36.4 (SD 3.4) days for the intervention arm and 36.0 (SD 3.9) days for the control arm. Four of the 50 participants in the intervention arm (8%) reset the quit date and 19 (38%) texted the keyword TIPS. The majority of participants in both arms reported that they always or usually read the text messages. Compared to the control arm, a higher proportion of participants in the intervention arm reported being satisfied with the program (98% [49/50] vs 82% [41/50]). Biochemically verified abstinence was higher in the intervention arm at 6 weeks (20% [10/50] vs 2% [1/50]; P=.01), but the effect was not significant at 12 weeks (12% [6/50] vs 6% [3/50]; P=.49). In-depth interviews conducted after the RCT suggested additional modifications to enhance the program including tailoring the timing of messages, adding more opportunities to interact with the program, and placing a greater emphasis on messages that described the harms of smoking.ConclusionsThe study supported the feasibility and acceptability of an SMS program adapted for Vietnamese smokers. Future studies need to assess whether, with additional modifications, the program is associated with prolonged abstinence.Trial RegistrationClinicalTrials.gov NCT03219541; https://clinicaltrials.gov/ct2/show/NCT03219541

Finally they are convinced and will release the cheque this upcoming sunday and verbally told to collect it.

Background and objectives: Science congresses have begun to be recognized as a tourism model that named as congress tourism. The hotels where the National Emergency Medicine Congresses are hosted, which are held once a year, contribute to congress tourism.The aim of this study is to find out views of attendees of emergency medicine congresses about the congress and presentations.
 Methods: A survey form consisting of 16 questions (without demographic question) was shared with participants attending the 14th National Emergency Medicine Congress of the Association of Emergency Medicine Specialists (EPAT) by SMS, e-mail, and social media messenger programs (WhatsApp, etc.).
 Results: A total of 238 participants took part in the study of whcih73.9% (n = 176) were male. The age of the majority (68, 28.6%) participants was between 35 to 39 years. Maximum participants (n = 95, 39.9%) were specialist titleholders and the majority's (n = 81, 34.0%) length of service was 6-10 years. Of the total particinats, 73.1% and 65% expressed that curiosity about the scientific content and refreshing the knowledge respectively were the reasons for attending the conferences.
 Conclusion: Even if congresses are held in holiday hotels, participants are more interested in scientific content. Paramedical activities and visuals used in presentations are viewed positively. Although there are very intense programs in the congress, the majority of the participants stated that they would listen to eight presentations most efficiently.
 Ibrahim Med. Coll. J. 2021; 15(2): 38-43

Abstract 17: Adaptation and Assessment of a Text Message Cessation Intervention for Tobacco Users in Viet Nam

Abstract Purpose: Text message (i.e., short message service, SMS) smoking cessation interventions have demonstrated efficacy, but most evaluations were conducted in high-income countries. We assessed the feasibility, acceptability and preliminary efficacy of a smoking cessation SMS intervention adapted to the sociocultural context, language and communication styles of Vietnamese smokers. Methods: Participants were current adult cigarette-only or dual cigarette and waterpipe users. We adapted a message library from two SMS smoking cessation programs with proven efficacy in increasing quit rates in the US. The iterative adaptation process included focus groups with 58 smokers to provide data on culturally relevant patterns of tobacco use and to assess message preferences. We then pilot tested (n=40) a 6-week SMS intervention using brief text surveys to obtain real time feedback on messages and conducted post-test interviews (n=10) to inform further adaptation. Finally, we randomized 100 smokers to the SMS intervention (including bidirectional messages and key words to generate additional support) vs. weekly text assessments of tobacco use. Surveys assessed engagement and acceptability at 6 weeks, cessation at 6 and 12 weeks. Results: Significant modifications were made in terms of content (e.g. preference for negative framing of health risks, and focus on enhancing refusal skills) and tone (e.g., preferences for action-oriented advice for craving management). We found high rates of engagement (e.g. 82% usually or always read messages) and satisfaction with the SMS program (e.g. 70% satisfied, 24% very satisfied). Conclusion: Intervention participants suggested enhancing the program with additional telephone support, extending the length of the program, and adding images and more interactive content. This pilot study provided support for the feasibility and acceptability of culturally-adapted SMS smoking cessation treatment among smokers in Viet Nam. It also showed promising early efficacy in promoting abstinence. Future studies are needed to assess whether, with additional modifications, the program is associated with long-term abstinence. Citation Format: Donna Shelley, Nan Jiang, Charles Cleland, Trang Nguyen, Lorien Abroms, Nam Nguyen. Adaptation and Assessment of a Text Message Cessation Intervention for Tobacco Users in Viet Nam [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 17.

Effect of Multi-Component Program on Promoting Safety of Hospitalized Children

Background: The role of family caregivers in the promotion of safety for hospitalized children is an important issue in the area of safety improvement. However, there are limited studies related to innovative programs.Aim: This study aimed to investigate the effects of a multi-component program on family caregiver’s knowledge and engagement in promoting safety.Method: A quasi-experimental study was performed on 160 female family caregivers in two pediatric wards of two public hospitals in Thailand, in 2019. Participants were assigned into two groups of intervention (n=80) and control (n=80) through consecutive sampling. The program was developed based on the standardized guidelines of child patient safety. Participants were educated and trained. The participants’ knowledge and engagement were measured using validated questionnaires. An analysis of covariance (ANCOVA), controlling for some possible confounders, was performed to examine the effect of intervention.Results: Family caregivers gained more knowledge after the implementation of the Multi-Component Program. They noticed if something was wrong and checked the administration of medication by nurses after the intervention. Engagement in promoting safety was enhanced in each domain. Mean±SD scores of three dimensions of Multi-Component Program including advocate to ask, report and response, and dimension monitoring were obtained at 4.61±0.26, 4.48±0.19, and 4.76±0.25, respectively. Moreover, the groups’ post-test scores of knowledge and engagement were significantly different (P<0.001) after adjusting the length of stay.Implications for Practice: The Leaflet, Poster, Talking, Video, and SMS program can enhance a family caregiver’s ability to take responsibility for children. The findings indicated the possible range of safety behaviors that family caregivers can perform during the childcare process. Healthcare providers should adopt this program as a part of child safety promotion in hospital settings.

Exploring Attitudes and Experiences of People With Knee Osteoarthritis Toward a Self-Directed eHealth Intervention to Support Exercise: Qualitative Study.

BackgroundKnee osteoarthritis (OA) is a highly prevalent and debilitating condition. Exercise is a recommended treatment because of its effectiveness at improving pain and function. However, exercise is underutilized in OA management. Difficulty accessing health care has been identified as a key barrier to exercise uptake. Innovative and scalable methods of delivering exercise treatments to people with knee OA are needed. We developed a self-directed eHealth intervention to enable and encourage exercise participation. The effectiveness of this intervention on pain and function in people with knee OA is being evaluated in a randomized clinical trial.ObjectiveThis study aimed to explore the attitudes and experiences of people with knee OA who accessed the self-directed eHealth intervention and the features perceived as useful to facilitate self-directed exercise.MethodsThis was a qualitative study embedded within a randomized controlled trial. Individual, semistructured phone interviews were conducted with 16 people with knee OA who had accessed a 24-week eHealth intervention (website and behavior change SMS program) designed to support exercise participation. Interviews were audiorecorded, transcribed verbatim, and thematically analyzed using an inductive approach.ResultsFive themes arose: (1) technology easy to use and follow (website ease of use, SMS ease of use), (2) facilitators to exercise participation (credible OA and exercise information, website features, prescribed exercises simple to do unsupervised, freedom to adapt the exercise to suit needs, influence of other health care experiences), (3) sense of support and accountability (SMS good reminder and prompt, accountable, SMS tone and automation could trigger negative emotions [eg, guilt or shame], inability to contact someone when needed), (4) positive outcomes (knee symptom improvements, confidence to self-manage, encouraged active living), (5) suggestions for real-world application (provided by a health professional preferred, should be provided at subsidized or low out-of-pocket cost).ConclusionsPeople with knee OA had mostly positive experiences with and attitudes towards the use of an eHealth intervention that supported exercise participation independent of a health professional. A human connection associated with the eHealth intervention appeared important.

From Presence to Participation: Engagement with an SMS Program for Fathers of Children on the Autism Spectrum

Fathers of children on the autism spectrum are often in need of support due to high levels of parenting stress and the complexity associated with raising these children. While the importance of the fathering role as both parent and partner is well recognized, the recruitment of fathers into support programs is often resource intensive and generally fails to achieve desired levels of enrollment and retention. Text2dads explored paternal engagement with a program providing text-based information and support to smartphones of Australian fathers (N = 184) raising children on the autism spectrum. The evaluation is scaffolded by Piotrowska et al.’s CAPE model of engagement—Connection, Attendance, Participation and Enactment. Analysis demonstrated high rates of connection and participation when compared to other father-focused interventions. Evidence from response rates, comments and surveys demonstrate that fathers actively participated in the project while also reporting that they applied information gained from Text2dads in their parenting behavior. Advances in mobile communication have created opportunities to engage with fathers using alternative modes of intervention. The present study demonstrates support for the acceptability of this cost effective and highly scalable program.

Behavior Change Text Messages for Home Exercise Adherence in Knee Osteoarthritis: Randomized Trial.

BackgroundExercise is a core recommended treatment for knee osteoarthritis (OA), yet adherence declines, particularly following cessation of clinician supervision.ObjectiveThis study aims to evaluate whether a 24-week SMS intervention improves adherence to unsupervised home exercise in people with knee OA and obesity compared with no SMS.MethodsA two-group superiority randomized controlled trial was performed in a community setting. Participants were people aged 50 years with knee OA and BMI ≥30 kg/m2 who had undertaken a 12-week physiotherapist-supervised exercise program as part of a preceding clinical trial. Both groups were asked to continue their home exercise program unsupervised three times per week for 24 weeks and were randomly allocated to a behavior change theory–informed, automated, semi-interactive SMS intervention addressing exercise barriers and facilitators or to control (no SMS). Primary outcomes were self-reported home exercise adherence at 24 weeks measured by the Exercise Adherence Rating Scale (EARS) Section B (0-24, higher number indicating greater adherence) and the number of days exercised in the past week (0-3). Secondary outcomes included self-rated adherence (numeric rating scale), knee pain, physical function, quality of life, global change, physical activity, self-efficacy, pain catastrophizing, and kinesiophobia.ResultsA total of 110 participants (56 SMS group and 54 no SMS) were enrolled and 99 (90.0%) completed both primary outcomes (48/56, 86% SMS group and 51/54, 94% no SMS). At 24 weeks, the SMS group reported higher EARS scores (mean 16.5, SD 6.5 vs mean 13.3, SD 7.0; mean difference 3.1, 95% CI 0.8-5.5; P=.01) and more days exercised in the past week (mean 1.8, SD 1.2 vs mean 1.3, SD 1.2; mean difference 0.6, 95% CI 0.2-1.0; P=.01) than the control group. There was no evidence of between-group differences in secondary outcomes.ConclusionsAn SMS program increased self-reported adherence to unsupervised home exercise in people with knee OA and obesity, although this did not translate into improved clinical outcomes.Trial RegistrationAustralian New Zealand Clinical Trials Registry 12617001243303; https://tinyurl.com/y2ud7on5International Registered Report Identifier (IRRID)RR2-10.1186/s12891-019-2801-z

The Evidence-Based Sexual Abuse Prevention Program: Strong With Sam.

The present study was initiated to design and evaluate a sexual abuse prevention program for deaf and hard of hearing (DHH) children. This evidence-based prevention program is the first of its kind for DHH children. A total of 92 DHH children aged 8-12years participated in the program "STARK mit SAM" (Strong with Sam, SmS), a program conducted in primary schools for DHH children in Germany. The program evaluation consisted of a pretest-posttest design. As per class, the subjects were assigned to either the experimental or the wait list control group. Participants from both groups were pretested for their knowledge about content related to the prevention of sexual abuse. The experimental group received the prevention program and both groups were posttested to examine the effects of the program. Additionally, the experimental group was tested again 6 months after the program. DHH children who participated in the SmS program showed a significant knowledge gain and a nonsignificant change in their anxiety. No significant factor affecting the children's significant knowledge gain was found. SmS is an effective sexual abuse prevention program for DHH children, which can be offered without incurring anxiety in the children.

The evaluation of efficiency of the program "The automated working place of the senior medical nurse"

The qualitative functioning of any medical institution depends on both professional competence of its staff and document management. The contemporary society is moving towards e-document management. The topicality of investigation stems from necessity to give scientific rationale and put into practice modern information systems and electronic technologies in the activities of head nurses. The article considers realization issues of the Decree of the President of the Russian Federation of May 7, 2018 No. 204 "On national goals and strategic objectives of the development of the Russian Federation for the period until 2024". Among other "national development goals of the Russian Federation for the period until 2024, the Decree sets the goal to ensure the accelerated digital enabling in the economy and social sphere". Therefore, it is no coincidence that the Federal project "Creating a single digital circuit in health care based on unified state health information system" takes central position in the National Health Care Project. The study used content analysis, expert judgment, sociological and statistical methods. The introduction of the AWP SMS program into professional activities of senior medical nurses allows optimizing documents processing. Its effectiveness was evaluated using mathematical modeling methodology.

A novel digital health intervention to improve patient engagement to stimulants in adult ADHD in the primary care setting: Preliminary findings from an open label study

AimsWe piloted the effectiveness and acceptability of a novel text messaging-based (SMS) digital health intervention aimed at addressing the previously documented poor rate of patient engagement in stimulant treatment in the primary care setting. Methods117 adults ages 18–55 from primary care and psychiatric practices who were prescribed a stimulant medication for ADHD treatment received the SMS intervention. Comparators were age-, race-, and sex-matched patients from the same health care organization's electronic medical record who had been prescribed stimulant medications over a similar time period. Using documented prescription records, we determined whether patients had timely prescription refills. ResultsNinety-six percent (N = 112) of participants completed our a priori metric of patient engagement consisting of 37 days of the SMS program. Eighty-one percent of participants refilled their index prescriptions in a timely manner compared to only 36% of patients receiving treatment as usual (OR=7.54, 95% CI: 4.46, 12.77; p<0.001). We found no significant interaction between prescribing source (non-psychiatry vs. psychiatry) and intervention group (SMS vs. treatment as usual). ConclusionsThese data suggest that an ADHD-centric, digital health intervention using text messaging significantly improves patient engagement in stimulant treatment in adults with ADHD.

A Mobile Phone-Based Sexual and Reproductive Health Intervention for Female Sex Workers in Kenya: Development and Qualitative Study.

BackgroundFemale sex workers (FSWs) have high rates of both unintended pregnancy and HIV, but few health promotion interventions address their contraceptive needs or other sexual and reproductive health and rights (SRHR) concerns. A broader approach integrates contraceptive promotion with HIV and sexually transmitted infection (STI) prevention and management, alcohol awareness, gender-based violence and rights, and health care utilization. The Women’s Health Intervention using SMS for Preventing Pregnancy (WHISPER) mobile phone intervention uses a participatory development approach and behavior change theory to address these high-priority concerns of FSWs in Mombasa, Kenya.ObjectiveThis paper aimed to (1) describe the process of development of the WHISPER intervention, its theoretical framework, key content domains and strategies and (2) explore workshop participants’ responses to the proposed intervention, particularly with regard to message content, behavior change constructs, and feasibility and acceptability.MethodsThe research team worked closely with FSWs in two phases of intervention development. First, we drafted content for three different types of messages based on a review of the literature and behavior change theories. Second, we piloted the intervention by conducting six workshops with 42 FSWs to test and refine message content and 12 interviews to assess the technical performance of the intervention. Workshop data were thematically analyzed using a mixed deductive and inductive approach.ResultsThe intervention framework specified six SRHR domains that were viewed as highly relevant by FSWs. Reactions to intervention content revealed that social cognitive strategies to improve knowledge, outcome expectations, skills, and self-efficacy resonated well with workshop participants. Participants found the content empowering, and most said they would share the messages with others. The refined intervention was a 12-month SMS program consisting of informational and motivational messages, role model stories portraying behavior change among FSWs, and on-demand contraceptive information.ConclusionsOur results highlight the need for health promotion interventions that incorporate broader components of SRHR, not only HIV prevention. Using a theory-based, participatory approach, we developed a digital health intervention that reflects the complex reality of FSWs’ lives and provides a feasible, acceptable approach for addressing SRHR concerns and needs. FSWs may benefit from health promotion interventions that provide relevant, actionable, and engaging content to support behavior change.

A preliminary study on the acceptability of a brief SMS program for perinatal women.

This study examined the acceptability of the BabyText program, a Spanish and English textmessaging program adapted from a prevention of postpartum depression group intervention. Ten ethnically and racially diverse pregnant and postpartum women (mean age = 31.3, standard deviation = 5.25) recruited from a metropolitan, urban area of the United States received the BabyText program over a 69-day period (between October 2015 and April 2016). Each tip was assessed for the helpfulness of the content, and all women were invited to provide qualitative feedback about the program. Eighteen of the tips received a positive endorsement of helpfulness from 75 to 100 percent of the women, 12 tips received a positive endorsement of helpfulness from 50 percent of the women, and one tip was rated negatively by those who responded. Qualitative feedback described the need to personalize the tips to reflect the characteristics of women such as planned/unplanned pregnancy status, available economic resources, and current psychological distress. Women in this study favored tips that described stress management skills and emphasized caring for the self (vs only the baby). Data from this study are preliminary but add to the growing sentiment that digital tools should continue to be developed and tested, and personalization of intervention content is important to users.

Implementations of a text-message intervention to increase linkage from the emergency department to outpatient treatment for substance use disorders

AimTo determine acceptability and explore potential usefulness of a text messaging (SMS) program aimed at increasing attendance at outpatient treatment for substance use disorders (SUD) after emergency department (ED) referral. MethodA retrospective analysis of 377 adult patients from 2 urban EDs seeking treatment for SUD (opioids (n = 168), alcohol (n = 188), benzodiazepines (n = 21)) referred to outpatient treatment and offered an SMS program which included daily (1) motivational messages focused on positive thinking, (2) ecological momentary assessments (EMA) related to craving with tailored behavioral strategy messages, (3) EMA of drug use with tailored feedback to reduce abstinence violation effects, and (4) reminders about treatment location and phone number. We assessed acceptability by examining opt-in rates, EMA completion rates over the first week and end-of-program qualitative feedback. We assessed how individuals who opt in differ in outcomes from those who opt out by examining rates of outpatient SUD treatment attendance recorded from the medical record. Results167 patients (44%) opted in to the SMS program. Over 7 days, around 33% of EMA were completed. Median helpfulness score was 8 (IQR 6 to 10) out of 10 and 84% would recommend the SMS program to someone else. Individuals who opted in to the SMS program had higher rates of SUD treatment initiation than individuals who did not opt-in (70.7% vs. 40.9%). ConclusionsWe found evidence supporting acceptability and potential usefulness of an automated text message program to assist treatment attendance for some individuals with SUDs discharged from the ED. A controlled trial is needed to examine whether SMS program exposure is associated with improved treatment attendance compared to standard care.

To return or not to return for STI-HIV tests results: A study among 214 patients screened positive in a free center in Paris offering SMS reminders to reduce failure to return

Sexually transmitted infections (STI) are a major challenge in public health as nearly one million people become infected every day in the world with chlamydia, gonorrhoea, syphilis or trichomoniasis. Moreover, 2 millions of people become infected every year with HIV in the world. Despite progress in treatment and screening, incidence of STI continues to increase. To decrease the spread of STI, it is needed not only to focus on screening access but also to reduce the high proportion, 15–20%, of patients screened positive for at least one STI and who do not come back for their results generating delay in their medical care and risks of STI transmitting to their partners. In our free testing center for STI in Paris (France), in order to reduce failure to return, patients are offered the possibility of being notified by SMS after testing. If at least one of the STI results is positive, the SMS invites the patient to come back to the center to obtain his/her results. However, even when informed by up to three SMS, a part of patients still fails to return. To target improvement actions, it is needed to define their profile. This study aimed to explore factors associated with failure to return within 30 days after testing (FTR30) among patient screened positive for STI. Between October 2016 and May 2017, all patients with at least one positive result for STI testing (HIV, HBV, HVC, syphilis, gonorrhea and chlamydia) and who accepted to participate in the study were included (n = 214). Data were collected from the consultation database and a self-administered questionnaire. The FTR30 was measured based on information in the consultation database. This database also includes data on STI tested and results of the screenings performed. The self-questionnaire included socio-demographic factors, sexual behavior and factors related to the center visit. Factors associated with FTR30 were assessed using logistic regression models. The choice of the final multivariate model was based on the result of a backward stepwise selection with a 0.2 significance level for removal from the model. More than two-thirds of patients were men (72%), and the median age of patients was 27 years. Most patients were born in metropolitan France (56%) or in sub-Saharan Africa (25%). Men having sex with men represented 30% of the study population. The FTR30 rate was 14% (95% CI [10% > 19%]). Even if non-significant, FTR30 tend to be lower among the 72% of patients who accepted to be notified by SMS than among patients who did not (12% vs. 20%, P 0.10). In multivariate analysis, patients aged 25 or under were more likely to not return than patients older than 25 (aOR: 2.84; 95% CI: 1.09–7.41). A lower self-perceived risk of HIV infection was significantly associated with FTR30 (aOR: 3.05; 95% CI: 1.17–7.94), as well as not being tested for chlamydia and gonorrhea using self-swabbing (aOR: 5.98; 95% CI: 2.03–17.6). Probability of FTR30 was higher for patients coming with someone (aOR: 3.73; 95% CI: 1.41–9.88) compared to patients coming alone. The SMS program was well accepted but had a limited impact on FTR30 in our study population. To reduce the risk of failure in delivering STI screening results, systematic phone call after testing might also be proposed to patients. Moreover, no self-swabbing for chlamydia and gonorrhea testing and a lower self-perceived risk of HIV infection were associated with a higher probability of FTR30. Thus, improving STI/HIV knowledge and level of health literacy to empower patients would be an efficient way to decrease failure to return for results.