Two-way Text Research Articles

A Review of the Applications of Through-the-Earth (TTE) Communication Systems for Underground Mines

AbstractUnderground mining accidents have the potential of leaving miners trapped in unknown and life-threatening locations for an extended period of time. The lives of the trapped and unaccounted-for miners are at risk and require emergency rescue. But, the primary tracking systems are highly susceptible to damage during accidents and are most likely to be defunct and inoperable post-accident. This prompted the need for a robust and reliable post-accident communication and locator system. Subsequently, the through-the-earth (TTE) communication systems were developed and tested in underground mines. Under ideal conditions, these systems are capable of post-accident full-duplex two-way voice, text, and data communication and fingerprint detection of the geolocations of the trapped miners. This is achieved through a wireless link established by the transmission of electromagnetic and seismic waves between surface and underground, even in challenged underground environments. Unlike the primary tracking systems, the TTE communication systems do not require extensive shaft-to-workplace backbone infrastructure. This has made the TTE systems to be less susceptible to damage and therefore suitable for post-accident communication. Instead, the Earth’s crust acts as the signal transmission medium which forms an uplink and downlink communication path. This is achieved by injecting an electric current into the ground using electrodes, by transmitting magnetic fields from a radiating loop antenna, or by inducing fingerprint geolocations using seismic waves. Range and data rates are the critical requirements for the effectiveness of these systems and are dependent on factors such as the antenna design, frequency, and rock properties. This study provides a review of the applications of the different types of TTE communication systems, their evolution, factors that affect them, and techniques for improving their efficiencies and capabilities. These systems present the mining industry with an opportunity to improve safety by providing post-accident communication and locating trapped miners as quickly as possible. This will improve their survival chances and ultimately reduce fatality rates in the mining industry.

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.

Kids SIPsmartER reduces sugar-sweetened beverages among Appalachian middle-school students and their caregivers: a cluster randomized controlled trial

BackgroundHigh consumption of sugar-sweetened beverages (SSB) is a global health concern. Additionally, sugar-sweetened beverage (SSB) consumption is disproportionately high among adolescents and adults in rural Appalachia. The primary study objective is to determine the intervention effects of Kids SIPsmartER on students’ SSB consumption. Secondary objectives focus on caregivers’ SSB consumption and secondary student and caregiver outcomes [e.g, body mass index (BMI), quality of life (QOL)].MethodsThis Type 1 hybrid, cluster randomized controlled trial includes 12 Appalachian middle schools (6 randomized to Kids SIPsmartER and 6 to control). Kids SIPsmartER is a 6-month, 12 lesson, multi-level, school-based, behavior and health literacy program aimed at reducing SSB among 7th grade middle school students. The program also incorporates a two-way text message strategy for caregivers. In this primary prevention intervention, all 7th grade students and their caregivers from participating schools were eligible to participate, regardless of baseline SSB consumption. Validated instruments were used to assess SSB behaviors and QOL. Height and weight were objectively measured in students and self-reported by caregivers. Analyses included modified two-part models with time fixed effects that controlled for relevant demographics and included school cluster robust standard errors.ResultsOf the 526 students and 220 caregivers, mean (SD) ages were 12.7 (0.5) and 40.6 (6.7) years, respectively. Students were 55% female. Caregivers were mostly female (95%) and White (93%); 25% had a high school education or less and 33% had an annual household income less than $50,000. Regardless of SSB intake at baseline and relative to control participants, SSB significantly decreased among students [-7.2 ounces/day (95% CI = -10.7, -3.7); p < 0.001, effect size (ES) = 0.35] and caregivers [-6.3 ounces/day (95% CI = -11.3, -1.3); p = 0.014, ES = 0.33]. Among students (42%) and caregivers (28%) who consumed > 24 SSB ounces/day at baseline (i.e., high consumers), the ES increased to 0.45 and 0.95, respectively. There were no significant effects for student or caregiver QOL indicators or objectively measured student BMI; however, caregiver self-reported BMI significantly decreased in the intervention versus control schools (p = 0.001).ConclusionsKids SIPsmartER was effective at reducing SSB consumption among students and their caregivers in the rural, medically underserved Appalachian region. Importantly, SSB effects were even stronger among students and caregivers who were high consumers at baseline.Trial registrationClincialtrials.gov: NCT03740113. Registered 14 November 2018– Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03740113.

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.

Understanding Heterogeneous Patterns of Family Engagement With Educational Technology to Inform School-Family Communication in Linguistically Diverse Communities

We leverage log data from an educational app and two-way text message records from over 3,500 students during the summers of 2019 and 2020 and in-depth interviews in Spanish and English to identify patterns of family engagement with educational technology. Based on the type and timing of technology use, we identify several distinct profiles of engagement, which we group into two categories: independent users who engage with technology-based educational software independently and interaction-supported users who use two-way communications to support their engagement. We also find that as the demands of families from schools increased during the COVID-19 pandemic, Spanish-speaking families were significantly more likely than English-speaking families to engage with educational technology across all categories of families, particularly as interaction-supported users.

Centering healthcare workers in digital health design: Usability and acceptability of two-way texting to improve retention in antiretroviral therapy in a public HIV clinic in Lilongwe, Malawi.

New initiates on antiretroviral therapy (ART) are at high risk of treatment discontinuation, putting their health at risk. In low- and middle-income countries, like Malawi, appropriate digital health applications (apps) must fit into local clinic, connectivity and resource constraints. We describe the human centered design (HCD) and development process of an open-source, hybrid, two-way texting (2wT) system to improve ART retention. We detail the critical role of diverse healthcare workers (HCWs) in the HCD process to inform app usability, create buy-in, and ensure appropriate optimization for the local context. We optimized 2wT usability and acceptability over three HCD phases: 1) informal feedback sessions with diverse 2wT stakeholders, 2) a small pilot, and 3) key informant interviews. Phase one included four sessions with diverse HCWs, including "expert ART clients", clinical, technical, supervisory, and evaluation teams to inform 2wT design. In phase 2, a small pilot with 50 participating ART clients aimed to inform implementation improvement. Phase three included interviews with ten HCWs to deepen understanding of 2wT acceptability and usability, documenting strengths and weaknesses to inform optimization. Multi-phase feedback sessions with HCWs helped refine 2wT language and message timing for both weekly and tailored client-specific visit reminders. The pilot led to improvements in educational materials to guide client responses and ease interaction with HCWs. In interviews, the HCWs appreciated the HCD co-creation process, suggested ways to increase access for low-literacy clients or those without consistent phone access, and felt integrating 2wT with other eHealth platforms would improve scalability. Inclusion of HCWs across phases of HCD design, adaption, and optimization increased 2wT usability and acceptability among HCWs in this setting. Engaging HCWs into 2wT co-ownership from inception appears successful in co-creation of an app that will meet HCW needs, and therefore, enhance support for 2wT clients to attend visits and remain in care.

Supplementing a Paper Questionnaire with Web and Two-way Short Message Service (SMS) Surveys

Abstract When deciding which modes to offer, researchers consider cost, known respondent contact information, and potential mode effects. For a short survey on employment, we evaluate the effect of adding one of two new electronic data collection modes to a mailed questionnaire. We sent a survey to principals who previously responded to the National Center for Education Statistics’ (NCES) National Teacher and Principal Survey (NTPS) asking about their current job status. This questionnaire, known as the Principal Follow-up Survey (PFS), has typically been administered as a short paper form that is mailed to NTPS respondents. In 2022, the PFS introduced two new modes of completion, and principals were randomly assigned to receive: (i) a paper form only; (ii) a paper form, as well as emails with a direct link to complete a web survey; or (iii) a paper form, as well as invitations by text message to complete an automated two-way short message service text survey by responding to texted “yes/no” questions. This article compares overall response rates and time-to-response by mode to determine respondent preferences for completing short surveys. Adding either electronic mode significantly increased response rates and decreased the number of days in which completed surveys were received, compared to offering only a paper questionnaire. Although email and text messages are both forms of electronic communication that may be accessible on a smartphone, the added text message survey resulted in higher response rates than the added web survey. This suggests that respondents interact differently with emails and text messages they receive and that offering an option to complete a survey by text message can increase the speed and efficiency of data collection for short surveys.

The effect of proactive, interactive, two-way texting on 12-month retention in antiretroviral therapy: Findings from a quasi-experimental study in Lilongwe, Malawi.

Retaining clients on antiretroviral therapy (ART) is challenging, especially during the first year on ART. Mobile health (mHealth) interventions show promise to close retention gaps. We aimed to assess reach (who received the intervention?) and effectiveness (did it work?) of a hybrid two-way texting (2wT) intervention to improve ART retention at a large public clinic in Lilongwe, Malawi. Between August 2021-June 2023, in a quasi-experimental study, outcomes were compared between two cohorts of new ART clients: 1) those opting into 2wT who received automated, weekly motivation short messaging service (SMS) messages and response-requested appointment reminders; and 2) a matched historical cohort receiving standard of care (SoC). Reach was defined as "the proportion clients ≤6 months of ART initiation eligible for 2wT". 2wT effectiveness was assessed in time-to-event analysis. Retention was presented in a Kaplan-Meier plot and compared between 2wT and SoC using a log-rank test. The effect of 2wT on ART dropout (lost to follow-up or stopped ART) was estimated using Fine-Gray competing risk regression models, adjusting for sex, age and WHO HIV stage at ART initiation. Of 1,146 clients screened, 501 were eligible for 2wT, a reach of 44%. Lack of phone (393/645; 61%) and illiteracy (149/645; 23%) were the most common ineligibility reasons. Among 468 participants exposed to 2wT, 12-month probability of ART retention was 91% (95% CI: 88% - 94%) compared to 76% (95% CI: 72% - 80%) among 468 SoC participants (p<0.001). Compared to SoC, 2wT participants had a 65% lower hazard of ART dropout at any timepoint (sub-distribution hazard ratio 0.35, 95% CI: 0.24-0.51; p<0.001). 2wT did not reach all clients. For those who opted-in, 2wT significantly increased 12-month ART retention. Expansion of 2wT as a complement to other retention interventions should be considered in other low-resource, routine ART settings.

Successful Implementation Strategies in iCARE Nigeria-A Pilot Intervention with Text Message Reminders and Peer Navigation for Youth Living with HIV.

To address poor outcomes among adolescents and young adults living with HIV (AYA-HIV), iCARE Nigeria successfully piloted two-way text message antiretroviral therapy (ART) reminders together with peer navigation. Study participants had significant improvement in ART adherence and viral suppression at 48 weeks. Understanding facto of this intervention. We used explanatory, mixed methods to assess implementation outcomes (feasibility, acceptability, and adoption) and identify implementation strategies used or adapted to promote intervention success. Quantitative data included participant surveys, program records, and back-end mHealth data, and were summarized using descriptive statistics. Qualitative data were collected from key informants and focus group discussions with program staff and summarized using directed content analysis. iCARE Nigeria was feasible as evidenced by ease of recruitment, high retention of patients and peer navigators (PN), and successful deployment of initial text message reminders (99.9%). Most participants (95%) and PN (90%) found text message reminders were not bothersome or intrusive. Implementation strategies employed to facilitate intervention success included: (1) selecting, training, supervising, and matching of PN to patients; (2) tailoring frequency (daily to weekly) and mode of communication between PN and patients according to patient need; (3) routine screening for adherence challenges; (4) changing phone airtime stipends from monthly to weekly in response to rapid depletion; and (5) conducting telecommunication needs assessments, to identify and troubleshoot implementation barriers (issues with mobile devices, power availability). iCARE Nigeria was feasible and acceptable with high adoption by stakeholders. The implementation strategies identified here can be tailored for intervention scale-up in similar environments to promote ART adherence for AYA-HIV.

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 .

"It reminds me and motivates me": Human-centered design and implementation of an interactive, SMS-based digital intervention to improve early retention on antiretroviral therapy: Usability and acceptability among new initiates in a high-volume, public clinic in Malawi.

Early retention of people living with HIV (PLHIV) in antiretroviral therapy (ART) programs is critical to improve individual clinical outcomes and viral load suppression. Although many mobile health (mHealth) interventions aim to improve retention in care, there is still lack of evidence on mHealth success or failure, including from patient's perspectives. We describe the human-centered design (HCD) process and assess patient usability and acceptability of a two-way texting (2wT) intervention to improve early retention among new ART initiates at Lighthouse Trust clinic in Lilongwe, Malawi. An iterative HCD approach focused on patient and provider users' needs, incorporating feedback from multidisciplinary teams to adapt 2wT for the local, public clinic context. We present mixed-methods usability and acceptability results from 100 participants, 50 at 3-months and 50 at 6-months, post 2wT enrollment, and observations of these same patients completing core tasks of the 2wT system. Among the 100 usability respondents, 95% were satisfied with visit reminders, and 88% would recommend reminders and motivational messages to friends; however, 17% were worried about confidentiality. In observation of participant task completion, 94% were able to successfully confirm visit attendance and 73% could request appointment date change. More participants in 4-6 months group completed tasks correctly compared to 1-3 months group, although not significantly different (78% vs. 66%, p = 0.181). Qualitative results were overwhelmingly positive, but patients did note confusion with transfer reporting and concern that 2wT would not reach patients without mobile phones or with lower literacy. The 2wT app for early ART retention appears highly usable and acceptable, hopefully creating a solid foundation for lifelong engagement in care. The HCD approach put the local team central in this process, ensuring that both patients' and Lighthouse's priorities, policies, and practices were forefront in 2wT optimization, raising the likelihood of 2wT success in other routine program contexts.

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.

Centering Frontline Health Care Workers in Digital Innovation Design to Inform the Optimization of an App for Improved Male Circumcision Follow-up in South Africa: Qualitative Usability Study.

Voluntary medical male circumcision (VMMC) is a safe and effective HIV prevention strategy. However, adherence to recommended in-person, postoperative follow-up is inefficient for procedures with few adverse events. Two-way texting (2wT)-based follow-up appears to be a safe and an efficient alternative to scheduled clinic visits for low-risk patients who underwent VMMC. To ensure that 2wT responds to the needs of health care workers (HCWs) and patients, HCWs were closely involved in app design using a human-centered design (HCD) approach. Embedded within an ongoing randomized controlled trial of 2wT in South Africa and complementary HCD processes of 2wT app optimization, this qualitative study aimed to use key informant interviews (KIIs) to explore the thoughts, suggestions, and opinions on and perceptions of 2wT's usability and acceptability among HCWs involved in 2wT implementation in both urban and rural South Africa. A total of 7 HCWs using 2wT in Gauteng and the North West province participated in KIIs regarding the usability and acceptability of 2wT. HCWs were asked for their opinions on 2wT as a viable, useful, appropriate, and accessible method of postoperative VMMC care. They were also asked about 2wT-related working, exploring areas where 2wT could add to or reduce their daily tasks. The KII data were explored, coded, and analyzed by 3 qualitative researchers using thematic content analysis and the ATLAS.ti (ATLAS.ti Scientific Software Development GmbH) software. Most HCWs felt confident, comfortable, satisfied, and well supported using a 2wT-based follow-up as an alternative to in-person clinical reviews. They felt that 2wT was easy to use and required little technical support after initial mentoring on how to use the 2wT system. Few noted safety concerns, as men can receive clinical guidance, reassurance, and referral via 2wT. Although fewer in-person visits reduced the in-person review workload and eased clinical flow, HCWs noted the added burden of having to interact with clients via SMS text messages on evenings or weekends. HCWs reinforced the need for enhanced postoperative counseling to ensure that 2wT patients could recognize and understood how to respond to early signs of complications. HCWs suggested a rotation to spread the evening and weekend workload and ensure swift patient responses. In this formative qualitative study focused on HCWs, 2wT was a highly usable alternative to in-person postoperative reviews for patients who underwent VMMC in South Africa. The HCD processes likely improved the usability and acceptability of 2wT for HCWs. HCWs supported the scale-up of 2wT given the distance from the clinic to the men's homes and the potential for reducing workload. To ensure success, providers urged sensitizing patients to the fact that 2wT augments, but does not replace, the existing after-hours and emergency care services.

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.

'I understood the texting process well'. Participant perspectives on usability and acceptability of SMS-based telehealth follow-up after voluntary medical male circumcision in South Africa.

Voluntary medical male circumcision (MC) is a biomedical HIV prevention method that requires post-operative follow-up for healing confirmation. Recent research found that a two-way texting (2wT) app providing SMS-based telehealth for MC patients was safe and reduced provider workload. We evaluated 2wT usability among MC clients in South Africa assigned the 2wT intervention within a larger randomized controlled trial (RCT) of 2wT safety and workload. This quantitative usability study is within an RCT where 547 men used 2wT to interact with an MC provider via SMS. The sub-study involved the first 100 men assigned to 2wT who completed a usability survey 14 days after surgery. Acceptability was assessed through 2wT response rates of the 547 men. Regression models analyzed associations between age, wage, location, potential adverse events (AEs), and 2wT responses. Men assigned to 2wT found it safe, comfortable, and convenient, reporting time and cost savings. High response rates (88%) to daily messages indicated acceptability. Age, wage, and location didn't affect text responses or potential AEs. 2wT for post-MC follow-up was highly usable and acceptable, suggesting its viability as an alternative to in-person visits. It enhanced confidence in wound self-management. This SMS-based telehealth can enhance MC care quality and be adapted to similar contexts for independent healing support, particularly for men.

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.

Effect of Unlimited Two-Way Texting on Maternal Self-Efficacy Toward Successful Adherence to the 2020-2025 Dietary Guidelines’ Infant Feeding Recommendations

Describe the effect of a two-way texting and video blog program with Registered Dietitian/Lactation Consultant on self-efficacy towards timely and best early feeding practices among new mothers during COVID.

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.

Blending cybersecurity education with IoT devices: A u-Learning scenario for introducing the man-in-the-middle attack

ABSTRACT Nowadays, due to the increasing number of cyberattacks, cybersecurity education, training, and awareness are considered crucial for preparing current and future IT professionals. Thus, it is essential for educational institutions to foster well-designed learning strategies in the field of cybersecurity that will not only focus on theory-based learning interventions but also on encapsulating authentic learning practices. In this context, the paper at hand presents a ubiquitous scenario-based learning (SBL) intervention, blended with IoT devices for introducing the topic of the man-in-the-middle attack to 1st-grade students in vocational education. The learning scenario enables two-way plain text communication through a LoRa network. For securing the transmission and assure confidentiality, basic encryption techniques are enabled for the transmitted messages. Meanwhile, an eavesdropper, acting as the man-in-the-middle attacker, tries to intercept the communication, by applying different decryption techniques. For this purpose, a u-Learning app was developed. The app was evaluated by ninety 1st-grade students of an educational institute of vocational training, in terms of effectiveness, efficiency, knowledge acquisition, and learners’ satisfaction. Among others, the results show that the effectiveness and the efficiency of the proposed learning process were 92.03%, and 89.63%, respectively. Finally, learners’ satisfaction was high, and their knowledge acquisition was improved.