scholarly journals How Acceptable Is A Wireless Pill Bottle That Monitors and Texts In Response To Missed Doses: Focus Groups With Young African American MSM Living With HIV

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S422-S422 ◽  
Author(s):  
Mark Dworkin ◽  
Palak Panchal ◽  
Antonio Jimenez ◽  
Robert Garofalo ◽  
Jessica E Haberer ◽  
...  
Keyword(s):  
African American ◽  
Focus Groups ◽  
Technology Acceptance ◽  
Text Message ◽  
Social Contact ◽  
Case Manager ◽  
Text Messages ◽  
Pill Bottle ◽  
African American Msm ◽  
Living With Hiv

Abstract Background African American MSM (AAMSM) living with HIV are less likely to have viral suppression than other racial groups. Wisepill, a wireless pill bottle, transmits a cellular signal to a server when opened and is designed to measure antiretroviral therapy (ART) adherence. The objective of this study was to explore the acceptability of a proposed intervention in these young AAMSM using the Wisepill device opening data to trigger a real-time text alert that ART may not have been taken during a planned time to either the user, a trusted social contact, or a healthcare worker, depending on the duration of consecutively missed doses (1 dose, 3 doses, 7 doses, respectively). Methods From December 2016 – May 2017, AAMSM living with HIV age 18–34 years (N = 25) participated in a study that included five focus groups (n = 23) and one on one interviews (n = 2). We performed theory-based discussion grounded in the Technology Acceptance Model. Specifically, we explored usefulness, convenience, concerns, and intention to use. Results Fifty-two percent missed at least one dose in the 4 days prior to the focus group meeting. Almost all participants (94%) favored the idea of a wireless pill bottle monitor and linked text message notification that ART may have been missed. The device was considered convenient for use at home or in a backpack, but too large for a pocket. Stigma and privacy were common concerns. For example, participants did not want to carry the device with them if the pills would “sound like a walking pharmacy” and did not want a text message that said, “You missed your HIV meds.” They preferred text message notifications that ranged from emoji icons to cryptic short texts and wanted to receive an email as a backup plan. Most believed that the device appearance would not gain unwanted attention. Thirty percent of the participants identified a partner as a social contact to whom the 3-day missed dose reminders would be sent whereas others designated their mother, aunt, brother, friend, pastor, and case-manager. Conclusion An adherence intervention using a wireless pill bottle monitoring device linked to text notifications was acceptable to most of the young AAMSM in this study. Acceptability may be enhanced by personalization of the responsive text messages and a backup email option. Disclosures J. E. Haberer, Merck: Consultant, Consulting fee; Natera: Shareholder, Stock ownership

scholarly journals Usability and Acceptability of a Text Message-Based Developmental Screening Tool for Young Children: Pilot Study (Preprint)

2018 ◽  
Author(s):  
Pamela Ryden Johnson ◽  
Jessica Bushar ◽  
Margaret Dunkle ◽  
Sharon Leyden ◽  
Elizabeth T Jordan
Keyword(s):  
Focus Groups ◽  
Low Income ◽  
Screening Tool ◽  
Text Message ◽  
Text Messages ◽  
Developmental Screening ◽  
Screening Questions ◽  
Low Income Mothers ◽  
Developmental Screening Tool

BACKGROUND Only 30% of parents of children aged 9-35 months report that their child received a developmental screening in the previous year. Screening rates are even lower in low-income households, where the rates of developmental delays are typically higher than those in high-income households. Seeking to evaluate ways to increase developmental screening, Text4baby, a national perinatal texting program, created an interactive text message-based version of a validated developmental screening tool for parents. OBJECTIVE This study aimed to assess whether a text message-based developmental screening tool is usable and acceptable by low-income mothers. METHODS Low-income mothers of infants aged 8-10 months were recruited from the Women, Infants and Children Program clinics in Prince George’s County, MD. Once enrolled, participants used text messages to receive and respond to six developmental screening questions from the Parents’ Evaluation of Developmental Status: Developmental Milestones. After confirming their responses, participants received the results and feedback. Project staff conducted a follow-up phone survey and invited a subset of survey respondents to attend focus groups. A representative of the County’s Infants and Toddlers Program met with or called participants whose results indicated that their infants “may be behind.” RESULTS Eighty-one low-income mothers enrolled in the study, 93% of whom reported that their infants received Medicaid (75/81). In addition, 49% of the mothers were Hispanic/Latina (40/81) and 42% were African American (34/81). A total of 80% participated in follow-up surveys (65/81), and 14 mothers attended focus groups. All participants initiated the screening and responded to all six screening questions. Of the total, 79% immediately confirmed their responses (64/81), and 21% made one or more changes (17/81). Based on the final responses, 63% of participants received a text that the baby was “doing well” in all six developmental domains (51/81); furthermore, 37% received texts listing domains where their baby was “doing well” and one or more domains where their baby “may be behind” (30/81). All participants received a text with resources for follow-up. In a follow-up survey reaching 65 participants, all respondents said that they would like to answer screening questions again when their baby was older. All but one participant would recommend the tool to a friend and rated the experience of answering questions and receiving feedback by text as “very good” or “good.” CONCLUSIONS A mobile text version of a validated developmental screening tool was both usable and acceptable by low-income mothers, including those whose infants “may be behind.” Our results may inform further research on the use of the tool at older ages and options for a scalable, text-based developmental screening tool such as that in Text4baby.

scholarly journals Text Message Reminders Increase Appointment Adherence in a Pediatric Clinic: A Randomized Controlled Trial

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Chia-Lei Lin ◽  
Nila Mistry ◽  
Jordana Boneh ◽  
Hong Li ◽  
Rina Lazebnik
Keyword(s):  
Randomized Controlled Trial ◽  
African American ◽  
Controlled Trial ◽  
Intervention Group ◽  
Text Message ◽  
Text Messages ◽  
Pediatric Practice ◽  
Appointment Adherence ◽  
Randomized Controlled ◽  
Text Message Reminder

Background. High no-show rates can burden clinic productivity and affect patient care. Although multiple studies have shown that text messages improve appointment adherence, very little research has focused on low-income and predominantly African American populations in resident clinic settings. Objectives. To determine whether incorporating a text message reminder reduces the no-show rate at an urban, pediatric resident clinic. Methods. A randomized controlled trial was conducted at a tertiary level ambulatory pediatric practice between August 2014 and February 2015. Following a demographic survey, 170 patients were enrolled. Patients were randomized into control or intervention groups. All patients received the standard voice message appointment reminder, but the intervention group additionally received a text message reminder. The primary outcome was no-show rate. Results. 95.3% of the participants were African American, and the overall no-show rate was 30.8%. No-show rate was significantly lower in the intervention group (23.5%) than the control group (38.1%) representing a difference of 14.6% (p=0.04). No demographic factors were found to alter the association between no-show rate and text message intervention. Conclusions. Text message reminders effectively improve show rates at a resident pediatric practice with high no-show rates, representing a promising approach to improving appointment adherence.

scholarly journals A Realistic Talking Human Embodied Agent Mobile Phone Intervention to Promote HIV Medication Adherence and Retention in Care in Young HIV-Positive African American Men Who Have Sex With Men: Qualitative Study (Preprint)

2018 ◽  
Author(s):  
Mark Dworkin ◽  
Apurba Chakraborty ◽  
Sangyoon Lee ◽  
Colleen Monahan ◽  
Lisa Hightow-Weidman ◽  
...  
Keyword(s):  
African American ◽  
Focus Groups ◽  
Mobile Phone ◽  
African American Men ◽  
Retention In Care ◽  
Hiv Positive ◽  
Behavioral Skills ◽  
African American Msm ◽  
Sex With Men ◽  
Embodied Agent

BACKGROUND Avatars and embodied agents are a promising innovation for human health intervention because they may serve as a relational agent that might augment user engagement in a behavioral change intervention and motivate behavioral change such as antiretroviral adherence and retention in care. OBJECTIVE This study aimed to develop a theory-driven talking avatar-like embodied agent mobile phone intervention guided by the information-motivation-behavioral skills model to promote HIV medication adherence and retention in care in young African American men who have sex with men (MSM). METHODS We performed 5 iterative focus groups in Chicago with HIV-positive African American MSM aged 18-34 years to inform the ongoing development of a mobile phone app. Participants for the focus groups were recruited from 4 University of Illinois at Chicago Community Outreach Intervention Project sites located in different high HIV incidence areas of the city and the University of Illinois at Chicago HIV clinic using fliers and word of mouth. The focus group data analysis included developing an ongoing list of priorities for app changes and discussion between two of the investigators based on the project timeline, resources, and to what extent they served the app’s objectives. RESULTS In this study, 16 men participated, including 3 who participated in two groups. The acceptability for an embodied agent app was universal in all 5 focus groups. The app included the embodied agent response to questions and antiretroviral regimen information, adherence tracking, CD4 count and viral load tracking, motivational spoken messages, and customizability. Concerns that were identified and responded to in the development process included privacy, stigma, avoiding the harsh or commanding tone of voice, avoiding negative motivational statements, and making reminder functions for a variety of health care interactions. CONCLUSIONS An avatar-like embodied agent mHealth approach was acceptable to young HIV-positive African American MSM. Its relational nature may make it an effective method of informing, motivating, and promoting health behavioral skills. Furthermore, the app’s ease of access, stigma-free environment, and audiovisual format may help overcome some adherence barriers reported in this population.

scholarly journals Development and Pilot Testing of Text Messages to Reduce Sugar-Sweetened Beverage Intake in Rural Caregivers and Adolescents: A Mixed-Methods Study (Preprint)

2019 ◽  
Author(s):  
Maryam Yuhas ◽  
Kathleen Joyce Porter ◽  
Donna-Jean Brock ◽  
Annie Loyd ◽  
Brittany Alexandra McCormick ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Groups ◽  
Pilot Trial ◽  
Text Message ◽  
Text Messages ◽  
Utilization Rate ◽  
Rural Caregivers ◽  
Message Development ◽  
Caregiver Behaviors

BACKGROUND High consumption of sugar-sweetened beverages (SSB) poses significant health concerns, particularly for rural adults and adolescents. Developing innovative strategies that target caregivers as the agents of change could be a promising way to improve both caregiver and adolescent health. Sending text messages through mobile phones has been cited as an effective way to improve behavioral outcomes, although little research has been conducted in rural areas, particularly focusing on SSB intake. OBJECTIVE Targeting rural caregivers, the objectives of this two phase study were to: 1) understand caregivers’ perceptions and language preferences for SSB-related text messages to inform and refine message development and delivery, and 2) evaluate the acceptability of text messages for SSB behavior change, and examine short-term effects on SSB behaviors. METHODS A convergent mixed-methods design was used to systematically develop and pilot test text messages with caregivers in Southwest Virginia. In phase one, five focus groups that included a card-sorting activity were conducted to explore advantages/disadvantages, language preferences (i.e., tone of voice, audience, phrase preferences), and perceived use of text messages. In phase two, caregivers participated in a 5-week text message pilot trial that included weekly educational and personalized strategy messages and SSB assessments at baseline and follow-up. Before the focus groups and after completing the pilot trial, caregivers also completed a pre-post survey that assessed SSB intake, SSB home availability, and caregiver SSB-related practices. Caregivers also completed individual follow-up telephone interviews following the pilot trial. RESULTS In phase one, caregivers (n=33) reported that text messages were convenient, accessible, and easy to read. Additionally, caregivers preferred messages with empathetic and authoritative tones of voice that provided useful strategies and stayed away from using absolute words (e.g., always, never). In the phase two pilot trial (n=30), 87% of caregivers completed baseline and 77% completed follow-up assessment suggesting a high utilization rate. Other ways caregivers reported benefiting from the text messages included sharing messages with family members, friends, and coworkers (80%), making mental notes (57%), and looking back at messages as reminders (50%). Caregivers reported significant improvements in home environment, parenting practices, and rulemaking around SSB (all P <0.05). Also, the frequency of SSB intake among caregivers and adolescents significantly decreased (P <0.01). CONCLUSIONS Spending time in the formative phases of text message development helped to understand the unique perspectives and language preferences of the target population. This study also found that delivering an intervention through text messages has the potential to improve caregiver behaviors and reduce SSB intake in rural caregivers and adolescents. Findings from this study were used to develop a larger bank of text messages, which will be used in a future study testing the effectiveness of a text message intervention targeting SSB-related caregiver behaviors.

scholarly journals Development and Pilot Testing of Text Messages to Help Reduce Sugar-Sweetened Beverage Intake Among Rural Caregivers and Adolescents: Mixed Methods Study

10.2196/14785 ◽  
2019 ◽  
Vol 7 (7) ◽  
pp. e14785
Author(s):  
Maryam Yuhas ◽  
Kathleen J Porter ◽  
Donna-Jean P Brock ◽  
Annie Loyd ◽  
Brittany A McCormick ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Groups ◽  
Phase 1 ◽  
Pilot Trial ◽  
Text Message ◽  
Text Messages ◽  
Phase 2 ◽  
Rural Caregivers ◽  
Caregiver Behaviors

Background A high consumption of sugar-sweetened beverages (SSBs) poses significant health concerns, particularly for rural adults and adolescents. A manner in which the health of both caregivers and adolescents can be improved is by developing innovative strategies that target caregivers as the agents of change. Sending text messages through mobile phones has been cited as an effective way to improve behavioral outcomes, although little research has been conducted in rural areas, particularly focusing on SSB intake. Objective By targeting rural caregivers, this 2-phase study aimed to (1) understand caregivers’ perceptions and language preferences for SSB-related text messages to inform and refine message development and delivery and (2) evaluate the acceptability of text messages for SSB intake behavior change and examine short-term effects on SSB intake behavior. Methods A convergent mixed methods design was used to systematically develop and pilot-test text messages with caregivers in Southwest Virginia. In phase 1, 5 focus groups that included a card-sorting activity were conducted to explore advantages/disadvantages, language preferences (ie, tone of voice, audience, and phrase preferences), and perceived use of text messages. In phase 2, caregivers participated in a 5-week text message pilot trial that included weekly educational and personalized strategy messages and SSB intake assessments at baseline and follow-up. Before the focus groups and after completing the pilot trial, caregivers also completed a pre-post survey that assessed SSB intake, SSB home availability, and caregivers’ SSB-related practices. Caregivers also completed individual follow-up telephone interviews following the pilot trial. Results In phase 1, caregivers (N=33) reported that text messages were convenient, accessible, and easy to read. In addition, they preferred messages with empathetic and authoritative tones that provided useful strategies and stayed away from using absolute words (eg, always and never). In the phase 2 pilot trial (N=30), 87% of caregivers completed baseline and 77% completed follow-up assessment, suggesting a high utilization rate. Other ways in which caregivers reported benefiting from the text messages included sharing messages with family members and friends (80%), making mental notes (57%), and looking back at messages as reminders (50%). Caregivers reported significant improvements in home environment, parenting practices, and rulemaking around SSB (P=.003, P=.02, and P=.04, respectively). In addition, the frequency of SSB intake among caregivers and adolescents significantly decreased (P=.003 and P=.005, respectively). Conclusions Spending time in the formative phases of text message development helped understand the unique perspectives and language preferences of the target population. Furthermore, delivering an intervention through text messages has the potential to improve caregiver behaviors and reduce SSB intake among rural caregivers and adolescents. Findings from this study were used to develop a larger bank of text messages, which would be used in a future study, testing the effectiveness of a text message intervention targeting SSB intake–related caregiver behaviors.

scholarly journals Assessing the Cross-Cultural Adaptation and Translation of a Text-Based Mobile Smoking Cessation Program in Samoa (TXTTaofiTapaa): Pilot Study (Preprint)

2017 ◽  
Author(s):  
Judith McCool ◽  
Helen Tanielu ◽  
Elaine Umali ◽  
Robyn Whittaker
Keyword(s):  
Smoking Cessation ◽  
Focus Groups ◽  
Tobacco Use ◽  
Mobile Phones ◽  
Cultural Adaptation ◽  
Cultural Context ◽  
Mode Of Delivery ◽  
Text Message ◽  
Text Messages ◽  
Smoking Cessation Program

BACKGROUND Samoa faces a persistently high prevalence of adult tobacco use and few existing cessation support services. Mobile phones are ubiquitous and generally affordable. OBJECTIVE This study aimed to adopt a text message (short message service, SMS) smoking cessation program designed in New Zealand (stop smoking with mobile phones, STOMP) for use in Samoa to assist national objectives in reducing the tobacco use. METHODS Using focus groups with smokers and ex-smokers, we explored the context for tobacco use and preferences for SMS text messages. Postintervention focus groups were held after participants received SMS text messages for 1 week. Frequent face-to-face meetings with the primary partner (Ministry of Health Samoa) and key stakeholders contributed to the adaptation process. Participatory feedback and collaboration from stakeholders became an integral part of the cultural adaptation and translation of the program. Furthermore, detailed document analyses were included as part of the formal evaluation of the initiative to explore the core determinants of success in adapting the program to the Samoan cultural context. RESULTS The SMS text messages evolved remarkably following an iterative process of consultation, in situ testing, revision, and retesting to arrive at an acceptable country-specific version of the mobile smoking cessation program. The SMS text messages retained in the final set were consistent with the theory of behavioral change but reflected both linguistic and cultural nuances appropriate for Samoa. Adapting messages required simultaneous multilevel processes, including complex high-level engagement, between the team and the stakeholders, along with crafting the precise content for (character limited) messages. CONCLUSIONS Receiving cessation support messages through a mobile phone is promising and appears to be an acceptable and accessible mode of delivery for tobacco cessation, particularly in the absence of alternative support. Adapting a text-based program in Samoa requires fastidious attention to the nuances of culture, language, and sociopolitical structures in the country.

Peer Group and Text Message–Based Weight-Loss and Management Intervention for African American Women

2017 ◽  
Vol 40 (8) ◽  
pp. 1203-1219 ◽  
Author(s):  
Sohye Lee ◽  
Erica Schorr ◽  
Chih-Lin Chi ◽  
Diane Treat-Jacobson ◽  
Michelle A. Mathiason ◽  
...  
Keyword(s):  
Weight Loss ◽  
African American ◽  
African American Women ◽  
Feasibility Study ◽  
Stages Of Change ◽  
Peer Group ◽  
Weight Maintenance ◽  
Text Message ◽  
Text Messages ◽  
Intervention Protocol

About 80% of African American (AA) women are overweight or obese. Accessible and effective weight management programs targeting weight loss, weight maintenance and the prevention of weight regain are needed to improve health of AA women. A feasibility study was conducted to examine the feasibility, acceptability, and potential efficacy of a 16-week intervention protocol for weight loss and management that combined daily text messages and biweekly peer group sessions. Modest but statistically significant reductions were detected in weight and body mass index from baseline to 16 weeks. At baseline, 36% of participants were in action and maintenance stages in measures of the stages of change for weight loss and management; this percent increased to 82% at 16 weeks. Findings of this feasibility study provide preliminary evidence of an educational intervention that could motivate women and lead to successful behavior change, and successful weight loss and management for AA women.

scholarly journals 2514. Real-time Antiretroviral Electronic Adherence Monitoring In Young African American Men Who Have Sex With Men

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S873-S873
Author(s):  
Mark S Dworkin ◽  
Palak Panchal ◽  
Antonio Jimenez ◽  
Robert Garofalo ◽  
Jessica Haberer ◽  
...  
Keyword(s):  
African American ◽  
Real Time ◽  
Electronic Monitoring ◽  
African American Men ◽  
Observation Time ◽  
Text Messages ◽  
Sex With Men ◽  
Adherence Monitoring ◽  
Living With Hiv

Abstract Background Antiretroviral therapy adherence remains a challenge, particularly for young African American men who have sex with men (YAAMSM). We enrolled 40 YAAMSM for 3 months of electronic adherence monitoring (EAM). These data may be useful in developing an antiretroviral EAM intervention that responds to missed doses with real-time text messages. Methods YAAMSM (age 18–34 years) living with HIV and taking ART participated in a quantitative and qualitative study that included ART adherence monitoring with a Wisepill electronic monitoring device for up to 3 months. Interviews were performed during April 2017–April 2019 at baseline and follow-up. Monitoring data were reviewed to determine timing and patterns of missing their first true adjudicated miss for durations of 1 dose, 3 consecutive days, and 7 consecutive days. Follow-up qualitative interviews included exploring acceptability of monitoring. Results The median age was 28 years and median participant observation time was 90 days (interquartile range 88–90 days) (n = 40 participants). Among those with at least 2 weeks follow-up and adjudication (n = 32), 100% missed at least 1 day. Most (82%) of these participants were <80% adherent in at least one of their monitored months. One dose and 3-day misses did not cluster (e.g., no disproportion on weekends). Most (88%) first missed doses occurred during the first 9 days monitored and most (69%) of the 13 who missed 3 consecutive days missed within the first monitored month. Four participants missed 7 consecutive days. Among 31 with a follow-up interview, 28 (90%) felt receiving a text because of device monitoring would affect their medication taking in the future. Illustrative quotes included, “It made me more responsible” and “…it makes you want to do it right.” Conclusion Most YAAMSM living with HIV in this study had adherence below the target threshold of >80%. These data support development of a text message responsive real-time electronic adherence monitoring intervention approach. Disclosures All authors: No reported disclosures.

scholarly journals E-VOLUTION: A Text Messaging–Powered Intervention—Connection, Support, and HIV Eradication

2020 ◽  
Vol 21 (5) ◽  
pp. 716-726
Author(s):  
Donald R. Gerke ◽  
Jeff Glotfelty ◽  
Julia Schlueter ◽  
Maria Freshman ◽  
Katie Plax
Keyword(s):  
Text Messaging ◽  
Case Manager ◽  
Case Managers ◽  
Text Messages ◽  
Future Research ◽  
Viral Load Suppression ◽  
Medical Case ◽  
Medical Visits ◽  
Sex With Men ◽  
Living With Hiv

This longitudinal, nonexperimental, quantitative study examined the acceptability, feasibility, and efficacy of a texting intervention that was added to medical case management for youth and young adults at high risk for poor HIV outcomes. The intervention, E-VOLUTION, sent automated text messages to youth participants living with HIV that reminded them to take prescribed medication and attend medical visits. Automated texts also asked clients about mood, housing, and ability to pay bills. Client responses to automated texts that indicated challenges triggered alerts for their medical case manager, who then followed up to address the issue. Participants (N = 100) were an average age between 22 and 23 years and most were Black (95%) and men who have sex with men (82%). Over a period of 26 months 89,681 automated texts were sent, resulting in 450 alerts. Additionally, clients and medical case managers exchanged more than 17,000 texts. Results of Spearman correlations indicated significant associations between greater frequency of alerts triggered and greater likelihood of kept medical appointments (p < .05). Findings also showed significant associations between greater frequency of texting with a medical case manager and greater likelihood of viral load suppression and kept medical visits at 12-month follow-up (p < .01). More frequent substance use was associated with more alerts triggered (p < .01). Use of text messaging was acceptable to the participants and is a culturally responsive way to engage youth participants living with HIV in care. Future research may examine the use of structured behavioral health assessments in the automated texting framework, as well as compare outcomes between automated and two-way texting groups.

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