Two-way Messaging Research Articles

A behaviourally informed chatbot increases vaccination rates in Argentina more than a one-way reminder.

Maintaining COVID-19 vaccine demand was key to ending the global health emergency. To help do this, many governments used chatbots that provided personalized information guiding people on where, when and how to get vaccinated. We designed and tested a WhatsApp chatbot to understand whether two-way interactive messaging incorporating behaviourally informed functionalities could perform better than one-way message reminders. We ran a large-scale preregistered randomized controlled trial with 249,705 participants in Argentina, measuring vaccinations using Ministry of Health records. The behaviourally informed chatbot more than tripled COVID-19 vaccine uptake compared with the control group (a 1.6 percentage point increase (95% confidence interval, (1.36 pp, 1.77 pp)) and nearly doubled uptake compared with the one-way message reminder (a 1 percentage point increase (95% confidence interval, (0.83 pp, 1.17 pp)). Communications tools designed with behaviourally informed functionalities that simplify the vaccine user journey can increase vaccination more than traditional message reminders and may have applications to other health behaviours.

Behaviourally-informed two-way text messaging to improve return to HIV care in South Africa: evidence from a randomised controlled trial.

One-way text messaging to re-engage people in HIV care has shown promise, but little is known about two-way messaging where the recipient is asked to respond. We evaluated a two-way text messaging intervention, informed by behavioural science, to increase re-engagement in care following missed antiretroviral therapy (ART) visits. We conducted an individual-level randomised controlled trial between February and March 2023 in Capricorn District, South Africa. Adults aged ≥18 years who had missed an ART visit by >28 days were randomised to (1) a standard one-way text message, or (2) behaviourally informed two-way text messages. Two-way messages asked recipients to reply by selecting from a list of reasons for their missed visit. Those who responded received another text message tailored to their response and designed using behavioural economics principles (affect heuristic, availability heuristic, loss aversion, social norms, providing slack, expanding choice). The primary outcome was return to care within 45 days, analysed as 1) intention to treat, and 2) restricted to successful message delivery. 3,695 participants were randomised: 1,845 to the one-way message group and 1,850 to the two-way message group. 27.9% (515/1845) of participants sent a one-way message and 27.2% (503/1850) sent a two-way message returned for an ART visit within 45 days (proportion difference:-0.7%, p-value: 0.622). In an analysis restricted to participants whose text message was delivered, 28.3% (310/1094) in the one-way message group compared to 28.3% (304/1076) in the two-way message group returned to care (proportion difference:-0.09%, p-value: 0.966). 19.5% (210/1076) responded to the two-way message. The two most commonly reported reasons for missed appointments were being out of town (41.0%) and still having medication (31.0%.). Among those who responded, 27.1% (95%CI: 21.3-33.7) returned for an ART visit. Clients ≥50 years were less likely to respond to the two-way text message, (AOR 0.4; 95%CI: 0.2-0.9). Behaviourally informed two-way text messages did not improve return to care over one-way messages. However, they elicited reasons for disengagement, which could inform future outreach for missed visits. Additional research is needed on the mode, content and timing of two-way messages intended to increase return to care. PACTR202202748760768 & DOH-27-042022-6703.

Tactile Speech Communication: Reception of Words and Two-Way Messages through a Phoneme-Based Display

The long-term goal of this research is the development of a stand-alone tactile device for the communication of speech for persons with profound sensory deficits as well as for applications for persons with intact hearing and vision. Studies were conducted with a phoneme-based tactile display of speech consisting of a 4-by-6 array of tactors worn on the dorsal and ventral surfaces of the forearm. Unique tactile signals were assigned to the 39 English phonemes. Study I consisted of training and testing on the identification of 4-phoneme words. Performance on a trained set of 100 words averaged 87% across the three participants and generalized well to a novel set of words (77%). Study II consisted of two-way messaging between two users of TAPS (TActile Phonemic Sleeve) for 13 h over 45 days. The participants conversed with each other by inputting text that was translated into tactile phonemes sent over the device. Messages were identified with an accuracy of 73% correct in conjunction with 82% of the words. Although rates of communication were slow (roughly 1 message per minute), the results obtained with this ecologically valid procedure represent progress toward the goal of a stand-alone tactile device for speech communication.

Peer Texting to Promote Quitline Use and Smoking Cessation Among Rural Participants in Vietnam: Randomized Clinical Trial.

Objectives: We tested an adapted version of an effective U.S.-based peer-texting intervention to promote Quitline use and smoking cessation among rural participants in Vietnam. Methods: We conducted a two-arm randomized trial with participants recruited at four rural community centers. The intervention included peer messages sent for six months that promoted Quitline use and smoking cessation. Additionally, biweekly two-way text messages assessed participants' interest in Quitline referral and current smoking status. Comparison participants received only the bi-weekly text message assessment of their current smoking status. At six months, we assessed Quitline use and smoking cessation. Smoking cessation was assessed using the 7-day point prevalence question and verified with a carbon monoxide breath monitor (<=6ppm). Results: Among 750 participants, the intervention had higher Quitline verified use (18%, 95% CI 0.14, 0.22) than comparison (1%, 95% CI .2, 2, p < 0.0001). Carbon-monoxide-verified smoking cessation did not differ between the two groups. However, intervention (28.3%, 95% CI) and comparison (28.1%, 95% CI) participants had substantial rates of carbon monoxide cessation at 6months (both 28%). Conclusion: Our study highlighted the promise of texting interventions to extend tobacco control efforts in Vietnam.

Abstract 13191: Effectiveness of a Telemedicine Intervention in Reducing Heart Failure Hospitalizations in Brazil: A Randomized Clinical Trial

Introduction: Telemedicine interventions (TMI) for heart failure (HF) can reduce hospitalizations and deaths. It is unknown if lower literacy and access to technology in low- and middle-income countries could hamper these positive results. We evaluated if a TMI could reduce HF-related rehospitalizations in HF patients discharged from public hospitals in Brazil compared to usual care. Methods: In a randomized clinical trial (UTN: U1111-1263-9802), patients &gt;30 years, hospitalized due to HF in 6 public hospitals (09/2021 to 06/2022) were randomized before discharge to usual care (n=57) or to a multi-component TMI (n=70). The TMI included a weekly structured telephone support from a nurse to evaluate the daily monitoring of weight, blood pressure and heart rate collected by the patient, assess decompensation signs and treatment adherence barriers, and promote self-care education - including flexible diuretics dosing. The nurse was linked to a cardiologist for teleconsultations, according to pre-defined clinical decision trees. An educational program was also available, including unidirectional messages and two-way messaging in working hours. The primary outcome was HF-related rehospitalizations after 180 days, analyzed by intention-to-treat. Results: Of 127 patients, mean age was 64±11 years, 48% were female, 71% were black/“pardo”, 33% had &lt;4 years of education, and 68% had reduced ejection fraction. At 180 days, HF-related hospitalizations occurred in 18 (26%) patients from the TMI vs. 26 (46%) from the usual care group (RR=0.56, 95%CI 0.34-0.91, p&lt;0.01). Kaplan-Meier curves for the primary outcome are shown in Figure 1 . All-cause death or rehospitalizations (secondary outcome) occurred in 30% of patients in the TMI vs 47% in the usual care group (RR=0.63, CI95% 0.40-0.99, p=0.04). Conclusions: In HF patients discharged from hospitals in Brazil, a TMI reduced HF-related rehospitalizations compared to usual care.

Text intervention to minimize time burden of cancer care (TIME).

301 Background: Innovative strategies to mitigate the time toxicity of cancer therapy are desperately needed. We have shown that a text-based e-triage can utilize patient-reported outcomes to identify patients without immune checkpoint inhibitor (ICI) toxicity who could safely fast-track to ICI infusion without a pre-infusion office visit. We report the efficacy of e-triage versus usual care to minimize the time toxicity of cancer care. Methods: This hybrid type 1 effectiveness-implementation randomized controlled trial was conducted at Penn Medicine between December 2021 and December 2022. Eligible patients spoke English, were receiving single agent ICI for a solid tumor, and had access to a mobile device with text messaging. The e-triage arm included ICI toxicity symptom assessment via two-way text messaging 96 hours prior to scheduled ICI and routine laboratory testing. Patients on the e-triage arm with normal bloodwork and no symptoms identified by the e-triage were eligible to fast-track to ICI infusion, bypassing the pre-treatment office visit. Usual care was standard office visits. Primary endpoint was care time (total time per ambulatory encounter including commute-, wait-, infusion-, and lab-times). Secondary endpoints were patient wait time per encounter, incident emergency department (ED) or hospital visits during follow-up, health related quality of life (HRQOL) measured by The Functional Assessment of Cancer Therapy-General, and patient satisfaction measured by PSQ-18. Differences in proportions of ED or hospital visits between arms were evaluated by the Fisher’s exact test. Linear mixed-effects models with random intercepts for each individual evaluated differences in all other endpoints between arms, accounting for within-patient correlation. Implementation outcomes were adoption (# patients who participated in the trial out of # approached) and fidelity (# patients on the intervention arm who followed their triage assignment). Acceptability, feasibility, and appropriateness outcomes were reported previously. Results: Among 152 eligible patients, 51 consented onto study (adoption rate 33.6%) and 40 were randomized (n=21, usual care; n=19, e-triage). Patient characteristics will be presented. Of 52 encounters on the e-triage arm, 23 adhered to their e-triage assessment (fidelity rate 44.2%). Compared with the usual care arm, patients on the e-triage arm had an average of 70 minutes less care time per encounter (95% CI -123.7 to –8.08 minutes, p=0.03) and 30.1 minutes less wait time (95% CI -61 to 1.1 minutes, p=0.08). The incidence of ED or hospital visits did not differ by treatment arm (usual care, n=2, 12.5% vs. intervention, n=3, 20%, p=0.65). HRQOL and patient satisfaction scores were similar by treatment arm. Conclusions: Results from this pilot trial support further work to optimize the design and implementation of a mobile e-triage program to personalize cancer care delivery and minimize time toxicity. Clinical trial information: NCT05134636 .

Adapting Effective mHealth Interventions to Improve Uptake and Adherence to HIV Pre-Exposure Prophylaxis Among Thai Young Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial.

Young men who have sex with men (YMSM) are the fastest-growing HIV-positive population worldwide. Thailand has the highest adult HIV seroprevalence in Asia; over 25% of men having sex with men in Bangkok are HIV positive. Pre-exposure prophylaxis (PrEP) is an efficacious HIV prevention strategy recommended for all at-risk individuals. PrEP is highly effective when taken as prescribed, but PrEP utilization rate has been low, and adherence is often inadequate. We propose to develop and pilot a multicomponent, technology-based intervention to promote motivation to begin PrEP ("uptake") and sustained adherence to PrEP among HIV-negative Thai YMSM. We will adapt an existing 2-session technology-delivered, motivational interviewing-based intervention to focus on PrEP use in YMSM in Thailand. The resulting intervention is called the Motivational Enhancement System for PrEP Uptake and Adherence (MES-PrEP). We will also develop motivational text messaging (MTM) to send two-way motivational messages to promote PrEP use. The proposed study includes 3 phases. Phase 1 includes in-depth interviews with HIV-negative Thai YMSM and providers to explore barriers and facilitators of PrEP initiation and adherence, aiming to inform intervention content. Phase 2 consists of adapting and beta-testing MES-PrEP and MTM for functionality and feasibility using a youth advisory board of Thai YMSM. In Phase 3, we will conduct a pilot randomized controlled trial to evaluate the feasibility, acceptability, and preliminary efficacy of MES-PrEP and MTM to increase PrEP uptake and adherence among Thai YMSM. A total of 60 HIV-negative Thai YMSM who have not started PrEP and 60 YMSM who are on PrEP but not adherent to it will be randomized 2:1 to receive MES-PrEP and MTM (n=40) or standard PrEP counseling (n=20). The feasibility and acceptability of the intervention will be assessed through usage patterns and the System Usability Scale. The preliminary impact will be assessed by evaluating the proportion of PrEP initiation and level of adherence to PrEP. Participants will complete the assessments at baseline and at 1-, 3-, and 6-month postintervention. Biomarkers of adherence to PrEP and biomarkers of HIV and sexually transmitted infections will be collected. Recruitment for this study began in January 2022 for phase 1. Qualitative interviews were completed with 30 YMSM and 5 clinical providers in May 2022. Phase 3, the pilot feasibility and acceptability trial, began in July 2023. Upon project completion, we shall have developed a highly innovative mobile health intervention to support YMSM using PrEP, which will be ready for testing in a larger efficacy trial. This study addresses a critical problem (ie, high HIV incidence and low PrEP use) among Thai YMSM. We are developing 2 potentially synergistic technology-based, theory-driven interventions aimed at maximizing PrEP use. The proposed project has the potential to make significant contributions to advancing HIV prevention research and implementation science. ClinicalTrials.gov NCT05243030; https://clinicaltrials.gov/ct2/show/NCT05243030. DERR1-10.2196/46435.

Comparative effectiveness of safety planning intervention with instrumental support calls (ISC) versus safety planning intervention with two-way text message caring contacts (CC) in adolescents and adults screening positive for suicide risk in emergency departments and primary care clinics: Protocol for a pragmatic randomized controlled trial

BackgroundSuicide is a leading cause of death in adolescents and adults in the US. Follow-up support delivered when patients return home after an emergency department (ED) or primary care encounter can significantly reduce suicidal ideation and attempts. Two follow-up models to augment usual care including the Safety Planning Intervention have high efficacy: Instrumental Support Calls (ISC) and Caring Contacts (CC) two-way text messages, but they have never been compared to assess which works best. This protocol for the Suicide Prevention Among Recipients of Care (SPARC) Trial aims to determine which model is most effective for adolescents and adults with suicide risk. MethodsThe SPARC Trial is a pragmatic randomized controlled trial comparing the effectiveness of ISC versus CC. The sample includes 720 adolescents (12–17 years) and 790 adults (18+ years) who screen positive for suicide risk during an ED or primary care encounter. All participants receive usual care and are randomized 1:1 to ISC or CC. The state suicide hotline delivers both follow-up interventions. The trial is single-masked, with participants unaware of the alternative treatment, and is stratified by adolescents/adults. The primary outcome is suicidal ideation and behavior, measured using the Columbia Suicide Severity Rating Scale (C-SSRS) screener at 6 months. Secondary outcomes include C-SSRS at 12 months, and loneliness, return to crisis care for suicidality, and utilization of outpatient mental health services at 6 and 12 months. DiscussionDirectly comparing ISC and CC will determine which follow-up intervention is most effective for suicide prevention in adolescents and adults.

More than just Reminders: Using text Messaging to Improve HIV care Outcomes Among Youth and Young Adults Living with HIV.

This study evaluated engagement, satisfaction, and efficacy of an automated and live two-way text messaging intervention that linked youth and young adults at high risk for poor HIV outcomes to their medical case managers, with the aims of increasing viral load suppression rates and improving medical visit attendance. Participants (N = 100) were an average age of 22-23 years old. Most were Black (93%) and men who have sex with men (82%). A total of 89,681 automated text messages were sent to participants; and 62% of participants engaged in monthly text-message exchanges with medical case managers. McNemar's test results indicated that a significantly greater proportion of intervention participants were virally suppressed at 6 and 12month follow-up than at enrollment. Adjusted odds ratio results showed a significant association between likelihood of achieving viral suppression at 6 and 12 months, and a greater number of participant responses to automated text messages. Future research should prospectively compare outcomes between usual care case management and usual care plus text-messaging to test for significant differences between groups.

A Text Messaging-Based Support Intervention to Enhance Pre-exposure Prophylaxis for HIV Prevention Adherence During Pregnancy and Breastfeeding: Protocol for a Randomized Controlled Trial.

Cisgender women in Kenya are at elevated risk of HIV acquisition during pregnancy and post partum. Acute HIV infection during pregnancy and breastfeeding accounts for approximately one-third of all vertical HIV transmissions. The World Health Organization recommends offering oral tenofovir-based pre-exposure prophylaxis (PrEP) to pregnant and postpartum women who are HIV negative but at substantial and ongoing risk for HIV acquisition. PrEP delivery for pregnant and postpartum women is expanding within routine maternal child health clinics in Kenya. However, approximately half of pregnant women discontinue PrEP within 30 days of initiation. Therefore, it is crucial to develop PrEP adherence strategies that enhance support for adherence when peripartum events and health issues pose challenges to sustaining PrEP adherence. We are conducting a randomized controlled trial to determine the effect of a bidirectional communication platform named Mobile Solutions for Women's and Children's Health (mWACh), which utilizes two-way SMS text messaging between patients and remote nurses to support PrEP adherence and address maternal health concerns in real time during the peripartum period. The mWACh-PrEP study is a randomized trial designed to support PrEP adherence during the peripartum period by comparing mWACh-PrEP to the standard of care (ie, in-clinic adherence counseling) among women who are HIV negative and initiating PrEP. Purposive sampling was used to select 5 facilities offering PrEP in antenatal clinics in Kisumu and Siaya Counties, and block randomization will be used to divide participants into groups. Participants in the intervention arm will receive a customized messaging curriculum via SMS text messages targeted toward their particular perinatal stage. The primary outcome, PrEP adherence at 6 months post partum, will be evaluated using a log-binomial regression model, adjusting for imbalanced baseline characteristics. Based on a previous study of directly observed dosing conditions, we will use a hair tenofovir concentration cutoff of 0.038 ng/mg (corresponding to 7 doses/week) as the primary adherence outcome measured at 6 months post partum (binary outcome). Qualitative interviews and cost-effective analyses will be conducted to understand the feasibility, acceptability, and economic impact of the intervention. Enrollment began in March 2022 and is projected to continue until July 2023, with follow-up through March 2024. The study results are expected to be reported in 2025. This trial will provide insights into using mobile health to enhance PrEP adherence among pregnant and postpartum mothers. Additionally, the findings will have implications for the use of mobile health technology to improve adherence to other daily medications during the peripartum period. ClinicalTrials.gov NCT04472884; https://clinicaltrials.gov/ct2/show/NCT04472884. DERR1-10.2196/41170.

Exploration of a community pharmacy delivered mobile health intervention to support medication taking for patients with multiple long-term conditions

Abstract Introduction Up to half of people with long-term conditions (LTCs) do not take their medicines as prescribed. Mobile health interventions, such as text messaging, have been shown to have positive impact on medication adherence.1 However, interventions for patients with multiple LTCs are lacking, and there are limited examples of their delivery from community pharmacy settings. We have developed a new intervention which combines a pharmacist consultation and automated two-way text messaging to support medicines taking. This has been developed using peer-reviewed literature and focus groups with patients and healthcare professionals (GPs, pharmacists, nurses). The intervention is tailored to the individual using a questionnaire and delivers content for up to eight LTCs. Aim To explore the acceptability of our new intervention with patients. Methods The new intervention was delivered to patients in a simulated environment, including a consultation with a pharmacist and two weeks of text messaging. Diary-interviews were used to gather feedback from eight patients, recruited through a public, patient and carer involvement group based at a university. Patients kept a diary during the period of text messaging and follow-up semi-structured interviews were conducted. Interviews were audio recorded and transcribed verbatim for analysis. Transcripts were coded for aspects of the intervention that the patients liked and ideas on how the intervention could be changed, including the impact of delivering the intervention from community pharmacies. Ethical approval for this study was granted by the University of Sunderland Research Ethics Committee. Results The intervention had good acceptability with patients. Patients were happy to interact with the text messaging content, including providing information about symptoms of their long-term condition and result of home monitoring. Patients liked that the intervention was linked to a pharmacist consultation, where there were opportunities to identify medication issues which text messaging could not solve. Delivering the intervention from a community pharmacy setting was felt to promote stronger engagement with the text messaging component, including the opportunity to build rapport with the pharmacist who would be overseeing the intervention. The mechanism to monitor medication adherence using two-way text messaging was suggested to be made more streamlined, and patients also wanted more examples of text message responses included in the patient information leaflet for the intervention. Discussion/Conclusion We found that our intervention to support medication taking from community pharmacies has initial acceptability with patients. Whilst others have trialled similar technologies from community pharmacies2 our intervention focussed solely on medication taking, and this seemed to result in positive attitudes towards its delivery from community pharmacies. The consultation was found to be an important component alongside the text messaging, how combining digital and non-digital components work together to support medication adherence was a gap highlighted in our previous review of similar interventions.3 Our intervention now requires changes based on the feedback gathered in this study and further testing in a larger and more diverse group.

Text-Based Intervention Increases Mammography Uptake at an Urban Safety-Net Hospital.

BackgroundThe low mammography rates at the authors’ safety-net hospital (SNH) are associated with higher rates of late-stage disease. Previously, they showed that a phone call-based intervention with reminder and scheduling components significantly increased mammography uptake by 12% in their population, but implementation was resource-heavy. This study analyzed whether a text-based intervention with reminder and scheduling components could increase mammography uptake at 3 months compared with usual care.MethodsThis randomized controlled study analyzed 1277 women ages 50 to 65 years who were overdue for a mammogram but had established care at a primary-care clinic within an urban SNH. The patients received intervention 1 (a text reminder with specific scheduling options), intervention 2 (a text reminder with open-ended scheduling options), or usual care (control). Differences in the percentage of mammography uptake at 3 months were compared between the intervention and control groups using a two-tailed chi-square test.ResultsThe patients receiving a text-based reminder and scheduling opportunity were significantly more likely to receive mammograms within 3 months than those in the usual-care control group (10.2% vs 6.2%; χ2 = 5.6279; p = 0.03). In the intervention group, 10.3% of the participants scheduled an appointment for a mammogram via text, and 63% of these participants received a mammogram. Finally, mammography compliance did not differ by the type of scheduling offered (specific vs general) or by primary care clinic.ConclusionsLeveraging technology for reminders and scheduling via two-way text messaging is effective in increasing mammography uptake in an urban safety-net setting and may be used as part of a multi-tiered intervention to increase breast cancer screening in a safety-net setting.

РЕАЛИЗАЦИЯ MQTT КЛИЕНТА НА БАЗЕ ОДНОКРИСТАЛЬНОГО МИКРОКОНТРОЛЛЕРА ДЛЯ ЗАДАЧ УДАЛЕННОГО УПРАВЛЕНИЯ ОБОРУДОВАНИЕМ

The article describes a device that transmits data and processes commands over the MQTTprotocol on the Internet. A small batch was made to assess the performance in real practice. Thesoftware for the microcontroller is written in C using a real-time operating system (RTOS), whichallows you to streamline software development through pseudo-parallel code execution, task synchronizationmechanisms (semaphores, mutexes), and a queue mechanism. The paper presents anexample of an algorithm for the interaction of FreeRTOS tasks: the tasks of waiting for a commandfrom the server, the tasks of measuring temperature, the main thread that sends a messageto the server in response to the appearance of a line in the message queue. The core of the MQTTclient being developed is the STM32 microcontroller and the GSM/GPRS SIM800 module. A largenumber of interfaces are displayed on the device, which allows you to connect a wide variety ofperipherals (temperature, humidity, pressure sensors, servos, etc.). The device is able to independentlyrestore the connection to the network in case of its interruption. The proprietary implementationof the MQTT protocol version 3.1 QoS 0 is used in the software of the control microcontroller.MQTT messages are transmitted as part of a TCP connection established by means of a GSM module. The control microcontroller communicates with the GSM module via AT commands.The possibility of two-way real-time messaging is implemented, which allows using the developedmicroprocessor system both in the mode of an autonomous control device and in the interactivemode of executing commands received wirelessly and sending the execution statuses of thesecommands. The main feature of the MQTT client is the ability to remotely update the microcontrollersoftware (OTA), implemented using an auxiliary microcontroller and a flash memory chip.The developed MQTT client is intended to be used as the basis of microprocessor systems - clientsof the Internet of Things.

Evaluation of a novel virtual care platform for remote monitoring of LVAD patients.

The aim of this study was to evaluate a novel virtual care platform created for use in Left Ventricular Assist Device (LVAD) patients. The platform included a daily log of LVAD parameters and medication adherence, two-way messaging with providers, and educational resources. To test the feasibility of this application, we recruited 25 patients between 2017 and 2019 and followed them for 6 months post discharge. Feedback concerning the platform was very positive with an average score of 4.5 ± 0.6 (out of 5) on usability and/or satisfaction and 8.1 ± 1.8 (out of 10) on likelihood to recommend the platform. In addition, our platform was well utilized with median (IQR) engagement rates of 87 (53,100)% at 30 days and 73 (49,95)% overall. We found that patients using the platform attended significantly less outpatient visits at the 6 month mark, however there was no difference in 30-day readmission rates compared to the overall LVAD cohort.

Two-way text message interventions and healthcare outcomes in Africa: Systematic review of randomized trials with meta-analyses on appointment attendance and medicine adherence.

The growing access to mobile phones in Africa has led to an increase in mobile health interventions, including an increasing number of two-way text message interventions. However, their effect on healthcare outcomes in an African context is uncertain. This systematic review aims to landscape randomized trials involving two-way text message interventions and estimate their effect on healthcare outcomes. We searched Medline, Embase, Cochrane Central Register of Controlled Trials, The Global Health Library (up to 12 August 2021) and trial registries (up to 24 April 2020). Published and unpublished trials conducted in Africa comparing two-way text message interventions with standard care and/or one-way text message interventions were included. Trials that reported dichotomous effect estimates on healthcare appointment attendance and/or medicine adherence were assessed for risk of bias and included in meta-analyses. Results of other outcomes were reported descriptively. We included 31 trials (28,563 participants) all set in Sub-Saharan Africa with a wide range of clinical conditions. Overall, ten different trials were included in the primary meta-analyses, and two of these had data on both medicine adherence and appointment attendance. An additional two trials were included in sensitivity analyses. Of the 12 included trials, three were judged as overall low risk of bias and nine as overall high risk of bias trials. Two-way text messages did not improve appointment attendance, RR: 1.03; 95% CI: 0.95-1.12, I2 = 53% (5 trials, 4374 participants) but improved medicine adherence compared to standard care, RR: 1.14, 95% CI: 1.07-1.21, I2 = 8% (6 trials, 2783 participants). Two-way text messages seemingly improve medicine adherence but has an uncertain effect on appointment attendance compared to standard care. PROSPERO CRD42020175810.

Perceptions on mobile health use for health education in an Indigenous population.

IntroductionIndigenous peoples in Canada face numerous health needs and challenges and often have poor health status due to inequitable access to care. Providing culturally appropriate support for health conditions, particularly chronic conditions that require self-management, can assist in averting complications and morbidity. Mobile health is a useful medium for delivering health education across different populations. However, meaningful user involvement is necessary because mobile health interventions suitable for one population may not be appropriate for another. Indigenous people’s views will inform the use of mobile health interventions in Indigenous communities.ObjectiveThe study explored the perception of Indigenous women on using mobile health as a tool for receiving health information.MethodsThis was a qualitative study, and participants comprised of 22 Indigenous women (First Nations and Métis) with or at risk of diabetes, aged 18–69 years in Saskatoon, Canada. After 12 weeks of disseminating diabetic eye care information via text messaging, data were collected via sharing circle discussions and analyzed using thematic analysis.ResultsParticipants indicated that the nature of messages such as the use of Indigenous languages, the message content, frequency of messages, group activities, and delivery formats such as voice messages, mobile applications, Internet, two-way messaging, and text messages were essential considerations in using mobile health as a tool for receiving health information.ConclusionDifferent factors need to be considered in using mobile health as a tool for health education among Indigenous peoples. These factors could be applicable in implementing mobile health solutions in other populations for the management of health conditions.

"I Want a Program That Looks at My Whole Life." A Focus Group Study on the Ideal Components for an mHealth Weight Management Program for African American Women.

The high rate of obesity, ownership of smartphones, and online search for nutrition and dieting information among African American women (AAW) provide a unique opportunity to develop cost-effective, accessible, and acceptable mHealth weight management programs for them. Furthermore, they should participate in the development and evaluation of these programs. To explore ideal components of a culturally relevant mHealth weight management program for AAW and to examine how these components may vary by age group. Twelve focus group triads were conducted with AAW in north central Florida. The framework method was used to manage, organize, synthesize, and analyze data themes by age groups: 18 to 29 (young), 30 to 50 (middle age), and 51+ (older). Thirty-six smartphone owners who expressed a desire to lose weight were recruited through several community partnerships. Based on body mass index (BMI), young women were classified as overweight (BMI 26.23 ± 6.7), middle-aged women as obese (BMI30.72 ± 8.31), and older women as obese (BMI 31.03 ± 5.67). Most searched online for dieting information within the past 12 months. Five overarching themes for designing mHealth weight management programs were identified: (1) holistic program that goes beyond dieting; (2) social media integration for support and sense of community; (3) self-monitoring app; (4) two-way text messaging; and (5) programs of varying lengths and meaningful incentives. AAW were receptive to mHealth weight management programs, which may be appealing during and after the COVID-19 pandemic. Holistic programs of 4 to 6 weeks that addressed stress eating, had a social media component, and included a few educational texts per week may be appealing to AAW.

Registrar Information System through SMS

The Registrar Information System through SMS is design and develop a computer-based system that is able to provide a real-time information through SMS to students regarding of their academic records. It has a two-way interactive text messaging functionality in a Registrar’s office of Northern Iloilo Polytechnic State College Main Campus, Estancia, Iloilo. The architectural design used in this system is two-tier architecture. The developed system employed a descriptive and developmental research design. Respondents of the study were the 354 students enrolled officially in School Year 2016-2017 using a standard questionnaire International Standard Organization / International Electrotechnical Commission 25010. The Rapid Application Development Model was used in the Software Development Life Cycle. MySQL for the database, vb.net language and Windows operating system development environment. The usability of the feature of the developed system is Very Good in terms of delivering important academic information to every student. The performance of the developed system is fully functional when it comes to all the processes such as enrolling, encoding the grades, reliable and efficient to the students in sending/ receiving academic information provided to clienteles.

Evaluation of a two-way SMS messaging strategy to reduce neonatal mortality: rationale, design and methods of the Mobile WACh NEO randomised controlled trial in Kenya

IntroductionGlobally, approximately half of the estimated 6.3 million under-5 deaths occur in the neonatal period (within the first 28 days of life). Kenya ranks among countries with the highest number...

Factors influencing participants' engagement with an interactive text-message intervention to improve sun protection behaviors: "SunText" randomized controlled trial.

There is growing evidence suggesting that text-message-based interventions are effective to promote sun protection behaviors. However, it is still unclear how engagement and adherence with the intervention messages can be optimized through intervention design. This study evaluated the effect of different combinations of personalized and two-way interactive messages on participant engagement with a theory-based skin cancer prevention intervention. In the SunText study conducted in February-July 2019 in Queensland, Australia participants 18-40 years were randomized to four different text message schedules using a Latin square design. This study analyzed if the order and intensity in which the schedules were received were associated with participants' level of engagement, and if this differed by demographic factors. Out of the 389 participants enrolled in the study, 375 completed the intervention period and remained for analysis. The overall intervention engagement rate was 71% and decreased from the beginning to the end of the study (82.2%-61.4%). The group starting with personalized, but not interactive messaging showed the lowest engagement rate. The intervention involving interactive messages three times a week for 4 weeks achieved the highest engagement rate. The intervention with increasing frequency (personalized and interactive three times a week for 2 weeks; then daily for 2 weeks) had lower engagement than intervention with constant or decreasing frequency. Engagement with two-way interactive messages was high across all intervention groups. Results suggest enhanced engagement with constant or decreasing message frequency compared to increasing frequency.