Nudge me: tailoring text messages for prescription adherence through N-of-1 interviews

2021 ◽  
Author(s):  
Joy Waughtal ◽  
Phat Luong ◽  
Lisa Sandy ◽  
Catia Chavez ◽  
P Michael Ho ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Text Messaging ◽  
Healthcare Delivery ◽  
Text Message ◽  
Text Messages ◽  
Multiple Chronic Conditions ◽  
Medication Refill ◽  
Interactive Text ◽  
Prompt Action ◽  
Negative Messages

Abstract Almost 50% of patients with cardiovascular diseases face challenges in taking medications and increased morbidity and mortality. Text messaging may impact medication refill behavior and can be delivered at scale to patients by texting mobile phones. To obtain feedback from persons with chronic conditions on the design of interactive text messages and determine language of message for making messages that can motivate patients to refill medications on time. We purposively sampled 35 English and Spanish speaking patients with at least one chronic condition from three large healthcare delivery systems to participate in N-of-1 video-based synchronous interviews. Research assistants shared ideas for theory-informed text messages with content intended to persuade patients to refill their medication. We transcribed recorded interviews and conducted a content analysis to identify strategies to employ generating a dynamic interactive text message library intended to increase medication refill. Those interviewed were of diverse age and race/ethnicity and typical of persons with multiple chronic conditions. Several participants emphasized that personally tailored and positively framed messages would be more persuasive than generic and/or negative messages. Some patients appreciated humor and messages that could evoke a sense of social support from their providers and rejected the use of emojis. Messages to remind patients to refill medications may facilitate improvements in adherence, which in turn can improve chronic care. Designing messages that are persuasive and can prompt action is feasible and should be considered given the ease with which such messages can be delivered automatically at scale.

scholarly journals Improving Refill Adherence in Medicare Patients With Tailored and Interactive Mobile Text Messaging: Pilot Study (Preprint)

2017 ◽  
Author(s):  
Rena Brar Prayaga ◽  
Erwin W Jeong ◽  
Erin Feger ◽  
Harmony K Noble ◽  
Magdalen Kmiec ◽  
...  
Keyword(s):  
Health Plan ◽  
Text Messaging ◽  
Text Message ◽  
Text Messages ◽  
Phone Calls ◽  
Medication Refill ◽  
Significant Difference ◽  
Integrated Health ◽  
Medicare Patients ◽  
Interactive Text

BACKGROUND Nonadherence is a major concern in the management of chronic conditions such as hypertension, cardiovascular disease, and diabetes where patients may discontinue or interrupt their medication for a variety of reasons. Text message reminders have been used to improve adherence. However, few programs or studies have explored the benefits of text messaging with older populations and at scale. In this paper, we present a program design using tailored and interactive text messaging to improve refill rates of partially adherent or nonadherent Medicare members of a large integrated health plan. OBJECTIVE The aim of this 3-month program was to gain an understanding of whether tailored interactive text message dialogues could be used to improve medication refills in Medicare patients with one or more chronic diseases. METHODS We used the mPulse Mobile interactive text messaging solution with partially adherent and nonadherent Medicare patients (ie, over age 65 years or younger with disabilities) of Kaiser Permanente Southern California (KP), a large integrated health plan, and compared refill rates of the text messaging group (n=12,272) to a group of partially adherent or nonadherent Medicare patients at KP who did not receive text messages (nontext messaging group, n=76,068). Both groups were exposed to other forms of refill and adherence outreach including phone calls, secure emails, and robo-calls from December 2016 to February 2017. RESULTS The text messaging group and nontext messaging group were compared using an independent samples t test to test difference in group average of refill rates. There was a significant difference in medication refill rates between the 2 groups, with a 14.07 percentage points higher refill rate in the text messaging group (P<.001). CONCLUSIONS The results showed a strong benefit of using this text messaging solution to improve medication refill rates among Medicare patients. These findings also support using interactive text messaging as a cost-effective, convenient, and user-friendly solution for patient engagement. Program outcomes and insights can be used to enhance the design of future text-based solutions to improve health outcomes and promote adherence and long-term behavior change.

scholarly journals Text Message Medication Adherence Reminders Automated and Delivered at Scale Across Two Institutions: Testing the Nudge System: Pilot Study

2021 ◽  
Author(s):  
Phat Luong ◽  
Thomas J. Glorioso ◽  
Gary K. Grunwald ◽  
Pamela Peterson ◽  
Larry A. Allen ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Pilot Study ◽  
Phase I ◽  
Phase Ii ◽  
Text Messaging ◽  
Care Delivery ◽  
Text Message ◽  
Text Messages ◽  
Medication Refill ◽  
The Impact

Background: Medication refill behavior in patients with cardiovascular diseases is suboptimal. Brief behavioral interventions called Nudges may impact medication refill behavior and can be delivered at scale to patients using text messaging. Methods: Patients who were prescribed and filled at least one medication for hypertension, hyperlipidemia, diabetes, atrial fibrillation, and coronary artery disease were identified for the pilot study. Patients eligible for the pilot (N=400) were enrolled with an opportunity to opt out. In phase I of the pilot, we tested text message delivery to 60 patients. In phase II, we tested intervention feasibility by identifying those with refill gap of ≥7 days and randomized them to intervention or control arms. Patients were texted Nudges and assessed whether they refilled their medications. Results: Of 400 patients sent study invitations, 56 (14%) opted out. In phase I, we successfully delivered text messages to 58 of 60 patients and captured patient responses via text. In phase II, 207 of 286 (72.4%) patients had a medication gap ≥7 days for one or more cardiovascular medications and were randomized to intervention or control. Enrolled patients averaged 61.7 years old, were primarily male (69.1%) and White (72.5%) with hypertension being the most prevalent qualifying condition (78.7%). There was a trend towards intervention patients being more likely to refill at least 1 gapping medication (30.6% versus 18.0%; P =0.12) and all gapping medications (17.8% versus 10.0%; P =0.27). Conclusions: It is possible to set up automated processes within health care delivery systems to identify patients with gaps in medication adherence and send Nudges to facilitate medication refills. Text message Nudges could potentially be a feasible and effective method to facilitate medication refills. A large multi-site randomized trial to determine the impact of text-based Nudges on overall CVD morbidity and mortality is now underway to explore this further. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03973931.

Text Messaging as a Mental Health Treatment Intervention: A Corpus-Based Study

2019 ◽  
Author(s):  
Megan Partch ◽  
Cass Dykeman
Keyword(s):  
Mental Health ◽  
Mental Health Treatment ◽  
Text Messaging ◽  
Low Cost ◽  
Statistical Significance ◽  
Text Message ◽  
Treatment Session ◽  
Text Messages ◽  
Health Treatment ◽  
Emotional Tone

Mental health treatment providers seek high-impact and low-cost means of engaging clients in care. As such, text messaging is becoming more frequently utilized as a means of communication between provider and client. Research demonstrates that text message interventions increase treatment session attendance, decrease symptomology, and improve overall functioning. However, research is lacking related to the linguistic make up of provider communications. Text messages were collected from previously published articles related to the treatment of mental health disorders. A corpus of 39 mental health treatment text message interventions was composed totaling 286 words. Using Linguistic Inquiry and Word Count (LIWC) software, messages were analyzed for prevalence of terminology thought to enhance client engagement. Clout, demonstrating the writer’s confidence and expertise, and positive Emotional Tone were found to be at a high level within the corpus. Results demonstrated statistical significance for five linguistic variables. When compared with national blog norms derived from Twitter, Clout, Emotional Tone, and use of Biological terminology were found to be at higher rates than expected. Authenticity and Informal terminology were found at significantly lesser rates.

scholarly journals Addressing Implementation Challenges to Digital Care Delivery for Adults With Multiple Chronic Conditions: Stakeholder Feedback in a Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Kelly Williams ◽  
Sarah Markwardt ◽  
Shannon M Kearney ◽  
Jordan F Karp ◽  
Kevin L Kraemer ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Care Delivery ◽  
Text Message ◽  
Chronically Ill ◽  
High Tech ◽  
Multiple Chronic Conditions ◽  
Broadband Internet ◽  
Implementation Challenges ◽  
Before And After ◽  
The Impact

BACKGROUND Digital tools accessed via smartphones can promote chronic condition management, reduce disparities in health care and hospital readmissions, and improve quality of life. However, whether digital care strategies can be implemented successfully on a large scale with traditionally underserved populations remains uncertain. OBJECTIVE As part of a randomized trial comparing care delivery strategies for Medicaid and Medicare-Medicaid beneficiaries with multiple chronic conditions, our stakeholders identified implementation challenges, and we developed stakeholder-driven adaptions to improve a digitally delivered care management strategy (high-tech care). METHODS We used 4 mechanisms (study support log, Patient Partners Work Group log, case interview log, and implementation meeting minutes) to capture stakeholder feedback about technology-related challenges and solutions from 9 patient partners, 129 participants, and 32 care managers and used these data to develop and implement solutions. To assess the impact, we analyzed high-tech care exit surveys and intervention engagement outcomes (video visits and condition-specific text message check-ins sent at varying intervals) before and after each solution was implemented. RESULTS Challenges centered around 2 themes: difficulty using both smartphones and high-tech care components and difficulty using high-tech care components due to connectivity issues. To respond to the first theme’s challenges, we devised 3 solutions: tech visits (eg, in-person technology support visits), tech packet (eg, participant-facing technology user guide), and tailored condition-specific text message check-ins. During the first 20 months of implementation, 73 participants received at least one tech visit. We observed a 15% increase in video call completion for participants with data before and after the tech visit (n=25) and a 7% increase in check-in completion for participants with data before and after the tech visit (n=59). Of the 379 participants given a tech packet, 179 completed care during this timeframe and were eligible for an exit survey. Of the survey respondents, 76% (73/96) found the tech packet helpful and 64% (62/96) actively used it during care. To support condition-specific text message check-in completion, we allowed for adaption of day and/or time of the text message with 31 participants changing the time they received check-ins and change in standard biometric settings with 13 physicians requesting personalized settings for participants. To respond to the second theme’s challenges, tech visits or phone calls were made to demonstrate how to use a smartphone to connect or disconnect from the internet, to schedule video calls, or for condition-specific text message check-ins in a location with broadband/internet. CONCLUSIONS Having structured stakeholder feedback mechanisms is key to identify challenges and solutions to digital care engagement. Creating flexible and scalable solutions to technology-related challenges will increase equity in accessing digital care and support more effective engagement of chronically ill populations in the use of these digital care tools. CLINICALTRIAL ClinicalTrials.gov NCT03451630; https://clinicaltrials.gov/ct2/show/NCT03451630.

Recovery Following Peer and Text Messaging Support after Discharge from Acute Psychiatric Care: A Randomized Controlled Pilot Trial (Preprint)

2021 ◽  
Author(s):  
Reham Shalaby ◽  
Marianne Hrabok ◽  
Pamela Spurvey ◽  
Rabab M. Abou El-Magd ◽  
Michelle Knox ◽  
...  
Keyword(s):  
Peer Support ◽  
Text Messaging ◽  
Psychiatric Care ◽  
Text Message ◽  
Text Messages ◽  
Treatment As Usual ◽  
Usual Condition ◽  
Randomized Controlled ◽  
Acute Psychiatric Care

BACKGROUND Peer support (PS) is emotional, social, and practical help that is provided by non-professionals to assist others in sustaining health behaviours. PS is valued in recovery-oriented models of mental health and is becoming implemented increasingly at the organizational level. Text messaging is a relatively low cost, high impact, and easily scalable program that uses existing technology, is devoid of geographic barriers, and is easily accessible to end users. OBJECTIVE This study aims to evaluate the effect of an innovative peer support system plus supportive text messaging program on the recovery of discharged patients from acute psychiatric care. METHODS This is a prospective, rater-blinded, pilot randomized controlled trial, including 180 patients discharged from acute psychiatric care. Patients were randomized to one of four conditions: treatment as usual (follow-up care), daily supportive text messages, peer-support only, or peer-support plus daily supportive text messages. A standardized self-report measure of recovery (Recovery Assessment Scale; RAS) was completed at baseline, six weeks, three months, and six months. Descriptive analysis, One-Way ANOVA, and repeated measures MANCOVA were deployed to examine the changes in RAS among the study groups and over the follow-up time points. RESULTS Sixty-five patients completed assessments at each time-point. For the overall sample, higher scores were found for the peer-support plus text message condition compared to the text message only and treatment as usual condition on several scales (i.e., Willingness to ask for help and Personal Confidence and Hope) and total score on the RAS. CONCLUSIONS Peer support plus supportive text messaging results in improved recovery compared to other interventions. It is advisable to incorporate the two interventions as a part of routine practice for patients with psychiatric disorders upon their hospital discharge. CLINICALTRIAL The study received ethical approval from the Health Ethics Research Board of the University of Alberta (Ref # Pro00078427) and operational approval from the Alberta Health Services regional health authority. All patients provided written informed consent. The study was registered with clinicaltrials.gov (Trial registration number NCT03404882).

Children's Text Messaging and Traditional Literacy

2009 ◽  
pp. 492-504 ◽  
Author(s):  
Beverly Plester ◽  
Clare Wood ◽  
Samantha Bowyer
Keyword(s):  
Mobile Phone ◽  
Text Messaging ◽  
Reading Ability ◽  
School Achievement ◽  
Text Message ◽  
Text Messages ◽  
Standard English ◽  
Verbal Reasoning ◽  
Mobile Phone Use ◽  
Lack Of Knowledge

The authors present three investigations into pre-teen children’s text message language and measures of their standard literacy abilities. The children translated sentences, from standard English into text, and from text into standard English , and wrote text messages appropriate to a set of scenarios. They categorised text abbreviations used and calculated the proportion of abbreviations to total words. The children completed a questionnaire about their mobile phone use. Text messaging facility was positively associated with verbal reasoning, vocabulary, school achievement in English, and reading ability across the three studies. Texting provides opportunity for children to communicate in writing without the constraints of standard English, and we propose that the playful variants on words that they use in texting, and their ability to encode spoken slang graphically, show not a lack of knowledge of English, but a light hearted use of phonological and alphabetic decoding principles that also underpin standard English.

scholarly journals Implementation of a Text Message to Improve Adherence to Clinic and Social Service Appointments

2019 ◽  
Vol 18 ◽  
pp. 232595821987016
Author(s):  
Nishal Anthony ◽  
Jennifer Molokwu ◽  
Ogechika Alozie ◽  
Diego Magallanes
Keyword(s):  
Low Income ◽  
Text Messaging ◽  
Text Message ◽  
Text Messages ◽  
P Value ◽  
Convenience Sample ◽  
Reminder System ◽  
Essential Components ◽  
Treatment Plans ◽  
Hiv Aids

Introduction: Attendance to clinic appointments and compliance with treatment plans are essential components of HIV/AIDS care. Compliance is especially important in young and minority individuals living with HIV/AIDS. We assessed the effectiveness of a text-based reminder system compared with usual care in improving the attendance to clinic and social work appointments at a Ryan White-funded clinic based in an academic institution. Methods: Convenience sample looking at 2 periods, 6 months before initiation of text messages and 6 months after initiation of text messages. Results: Following a 6-month postintervention period, we found a statistically significant reduction in our no-show rates (individuals failing to keep scheduled appointments) of 24.8% versus 17.7%, P value .05. Conclusion: Using an inexpensive online text messaging system, we were able to significantly decrease no-show rates in a primarily younger, low-income, and uninsured population.

scholarly journals Text message content as a window into college student drinking: Development and initial validation of a dictionary of “alcohol-talk”

2019 ◽  
Vol 45 (1) ◽  
pp. 3-10 ◽  
Author(s):  
Michaeline Jensen ◽  
Andrea M. Hussong
Keyword(s):  
College Students ◽  
Text Messaging ◽  
Text Message ◽  
Text Messages ◽  
Message Content ◽  
Digital Platforms ◽  
Student Drinking ◽  
Related Risk ◽  
Prevention Studies ◽  
High Risk Drinking

The ubiquity of digital communication within the high-risk drinking environment of college students raises exciting new directions for prevention research. However, we are lacking relevant constructs and tools to analyze digital platforms that serve to facilitate, discuss, and rehash alcohol use. In the current study, we introduce the construct of alcohol-talk (or the extent to which college students use alcohol-related words in text messaging exchanges) as well as introduce and validate a novel tool for measuring this construct. We describe a closed-vocabulary, dictionary-based method for assessing alcohol-talk. Analyses of 569,172 text messages from 267 college students indicate that this method produces a reliable and valid measure that correlates as expected with self-reported alcohol and related risk constructs. We discuss the potential utility of this method for prevention studies.

scholarly journals Identifying and addressing gaps in the implementation of a community care team for care of Patients with multiple chronic conditions

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kasey R. Boehmer ◽  
Diane E. Holland ◽  
Catherine E. Vanderboom
Keyword(s):  
Primary Care ◽  
Chronic Conditions ◽  
Community Care ◽  
Healthcare Delivery ◽  
Research Process ◽  
Multiple Chronic Conditions ◽  
Community Programs ◽  
Community Healthcare ◽  
Science Framework ◽  
Implementation Gaps

Abstract Background Patients with multiple chronic conditions represent a growing segment for healthcare. The Chronic Care Model (CCM) supports leveraging community programs to support patients and their caregivers overwhelmed by their treatment plans, but this component has lagged behind the adoption of other model elements. Community Care Teams (CCTs) leverage partnerships between healthcare delivery systems and existing community programs to address this deficiency. There remains a gap in moving CCTs from pilot phase to sustainable full-scale programs. Therefore, the purpose of this study was to identify the cognitive and structural needs of clinicians, social workers, and nurse care coordinators to effectively refer appropriate patients to the CCT and the value these stakeholders derived from referring to and receiving feedback from the CCT. We then sought to translate this knowledge into an implementation toolkit to bridge implementation gaps. Methods Our research process was guided by the Assess, Innovate, Develop, Engage, and Devolve (AIDED) implementation science framework. During the Assess process we conducted chart reviews, interviews, and observations and in Innovate and Develop phases, we worked with stakeholders to develop an implementation toolkit. The Engage and Devolve phases disseminate the toolkit through social networks of clinical champions and are ongoing. Results We completed 14 chart reviews, 11 interviews, and 2 observations. From these, facilitators and barriers to CCT referrals and patient re-integration into primary care were identified. These insights informed the development of a toolkit with seven components to address implementation gaps identified by the researchers and stakeholders. Conclusion We identified implementation gaps to sustaining the CCT program, a community-healthcare partnership, and used this information to build an implementation toolkit. We established liaisons with clinical champions to diffuse this information. The AIDED Model, not previously used in high-income countries’ primary care settings, proved adaptable and useful.

scholarly journals The Effectiveness Of Using Text Messages Reminder On Adherence With Tuberculosis Patients: A Systematic Review

2020 ◽  
Vol 9 (2) ◽  
pp. 751-760
Author(s):  
Ardila Lailatul Barik ◽  
Retno Indarwati ◽  
Sulistiawati Sulistiawati
Keyword(s):  
Systematic Review ◽  
Digital Technology ◽  
Text Messaging ◽  
Text Message ◽  
Text Messages ◽  
Randomized Control Trials ◽  
Inclusion Criteria ◽  
Tuberculosis Patients ◽  
Randomized Control ◽  
Text Message Reminder

Non-adherence is a factor that inhibits the completion of TB cases globally. Some studies suggest that the use of digital technology in the form of text message reminders can reduce the risk of non-adherence. The purpose of writing this article is to analyze the effectiveness of text message reminders on adherence to tuberculosis (TB) patients. The method in preparing this Systematic review is based on literature studies from various electronic databases, including Scopus, ScienceDirect, ProQuest, and Sage by conducting a comprehensive review using the PRISMA guidelines. The keywords used are "Text Messaging" AND "medication adherence" AND "tuberculosis". There are 11 original articles with 9 articles using the Randomized Control Trials (RCTs) research method and 2 articles using the Quasy-experimental method that fits the inclusion criteria. The use of text message reminder interventions is effective and can be used as an optional method of increasing adherence to TB patients. 

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