A Randomized Controlled Trial on Mobile Phone Text Messaging to Improve Sexo-Reproductive Health Among Adolescent Girls in Cameroon

Abstract Background: We conducted a single-centered randomized controlled single-blinded trial (i.e trained interviewers; blinded to group allocation). The target population included adolescent girls in the Kumbo West Health District (KWHD) of Cameroon. This trial tested the efficacy of weekly educational one-way text messages to improve perception of adolescent girls on sexo-reproductive health. Methods: Allocation concealment (1:1) was determined by sequentially numbered sealed opaque envelopes. A total of 398 participants either received the mobile phone sexo-reproductive health text messages (199) or not (199). A blinded program secretary send out text messages and recorded delivery. Data was collected and managed at baseline and at 6 month intervals using an interviewer-administered questionnaire before and after intervention, then analysed using the independent T-test (mean differences) and ANOVA on SPSS version 21.Results: The mean knowledge, attitude and practice scores respectively increased significantly from 6.03, 4.01 and 3.45 at baseline to 7.99, 5.83 and 4.99 at the end of the study. After performing ANOVA for the overall correct knowledge, positive attitudes and good practices respectively for between and within the intervention groups, we obtained: (F=15.12, P=0.023), (F=60.21, P=0.001) and (F=57., P=0.013) which showed statistical significance thus indicating the overall improvement in adolescents girls perception as a result of the intervention and not by chance. Majority (65.3%) of the participants were satisfied with the Short Message Service (SMS). Conclusion: This trial has contributed to the body of knowledge and evidence on the use of mobile phone technology using educative SMS to improve adolescent girl’s perception on sexo-reproductive health in Cameroon. Trial Registration: Pan African Clinical Trials Registry, PACTR201805003259293. Registered 28 March 2018, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3259

Download Full-text

A protocol for a randomized controlled trial on mobile phone text messaging to improve sexo-reproductive health in Cameroon

Journal of Public Health and Epidemiology ◽

10.5897/jphe2019.1141 ◽

2020 ◽

Vol 12 (3) ◽

pp. 179-185

Author(s):

Sevidzem Wirsiy Frankline ◽

Shey Nsagha Dickson ◽

Tchikamgoua Njajou Omer ◽

Besong Besong Joseph

Keyword(s):

Randomized Controlled Trial ◽

Reproductive Health ◽

Mobile Phone ◽

Text Messaging ◽

Controlled Trial ◽

Randomized Controlled

Download Full-text

SmokefreeTXT for Homeless Smokers: Pilot Randomized Controlled Trial

JMIR mhealth and uhealth ◽

10.2196/13162 ◽

2019 ◽

Vol 7 (6) ◽

pp. e13162 ◽

Cited By ~ 3

Author(s):

Travis P Baggett ◽

Claire McGlave ◽

Gina R Kruse ◽

Awesta Yaqubi ◽

Yuchiao Chang ◽

...

Keyword(s):

Mobile Phone ◽

Text Messaging ◽

Nicotine Patch ◽

Controlled Trial ◽

Qualitative Interviews ◽

Text Messages ◽

Smoking Abstinence ◽

Randomized Controlled ◽

Pilot Randomized Controlled Trial ◽

Sms Text Messaging

Background Homeless smokers want to quit smoking but face numerous barriers to doing so, including pervasive smoking among peers and a lack of social support for quitting. An SMS (short message service) text messaging intervention could address these challenges by providing virtual daily support for homeless smokers who are trying to quit but coping with multiple triggers to smoke. Objective This study aimed to assess whether a free SMS text messaging program, added to evidence-based pharmacotherapy and counseling, improved smoking abstinence among homeless adult smokers. Methods From October 2015 to June 2016, we conducted an 8-week pilot randomized controlled trial (RCT) of nicotine patch therapy and weekly in-person counseling with (n=25) or without (n=25) SmokefreeTXT, a free SMS text messaging service administered by the National Cancer Institute (NCI) at Boston Health Care for the Homeless Program. All participants were provided with a mobile phone and a 2-month prepaid voice and text plan at no cost. SmokefreeTXT enrollees were sent 1 to 5 automated SMS text messages daily for up to 8 weeks and could receive on-demand tips for managing cravings, mood symptoms, and smoking lapses. The primary outcome was smoking abstinence, defined as an exhaled carbon monoxide count of <8 parts per million, assessed 14 times over 8 weeks of follow-up, and analyzed using repeated-measures logistic regression with generalized estimating equations. Other outcomes were use of SmokefreeTXT, assessed by data obtained from NCI; perceptions of SmokefreeTXT, assessed by surveys and qualitative interviews; and mobile phone retention, assessed by self-report. Results Of the SmokefreeTXT arm participants (n=25), 88% (22) enrolled in the program, but only 56% (14) had confirmed enrollment for ≥2 weeks. Among 2-week enrollees, the median response rate to interactive messages from SmokefreeTXT was 2.1% (interquartile range 0-10.5%). Across all time points, smoking abstinence did not differ significantly between SmokefreeTXT and control arm participants (odds ratio 0.92, 95% CI 0.30-2.84). Of SmokefreeTXT enrollees who completed exit surveys (n=15), two-thirds were very or extremely satisfied with the program. However, qualitative interviews (n=14) revealed that many participants preferred in-person intervention formats over phone-based, found the SMS text messages impersonal and robotic, and felt that the messages were too frequent and repetitive. Only 40% (10/25) of SmokefreeTXT arm participants retained their study-supplied mobile phone for the 8-week duration of the trial, with phone theft being common. Storing and charging phones were cited as challenges. Conclusions SmokefreeTXT, added to nicotine patch therapy and in-person counseling, did not significantly improve smoking abstinence in this 8-week pilot RCT for homeless smokers. SMS text messaging interventions for this population should be better tuned to the unique circumstances of homelessness and coupled with efforts to promote mobile phone retention over time. Trial Registration ClinicalTrials.gov NCT02565381; https://clinicaltrials.gov/ct2/show/NCT02565381 (Archived by WebCite at http://www.webcitation.org/78PLpDptZ)

Download Full-text

Mobile Phone Support for Diabetes Self-Care Among Diverse Adults: Protocol for a Three-Arm Randomized Controlled Trial (Preprint)

10.2196/preprints.9443 ◽

2017 ◽

Author(s):

Lyndsay A Nelson ◽

Kenneth A Wallston ◽

Sunil Kripalani ◽

Robert A Greevy Jr ◽

Tom A Elasy ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Mobile Phone ◽

Text Messaging ◽

Controlled Trial ◽

Self Care ◽

Exercise Adherence ◽

Text Messages ◽

Patient Specific ◽

Randomized Controlled

BACKGROUND Nonadherence to self-care is common among patients with type 2 diabetes (T2D) and often leads to severe complications. Moreover, patients with T2D who have low socioeconomic status and are racial/ethnic minorities disproportionately experience barriers to adherence and poor outcomes. Basic phone technology (text messages and phone calls) provides a practical medium for delivering content to address patients’ barriers to adherence; however, trials are needed to explore long-term and sustainable effects of mobile phone interventions among diverse patients. OBJECTIVE The aim of this study is to evaluate the effects of mobile phone–based diabetes support interventions on self-care and hemoglobin A1c (HbA1c) among adults with T2D using a 3-arm, 15-month randomized controlled trial with a Type 1 hybrid effectiveness-implementation approach. The intervention arms are (1) Rapid Encouragement/Education And Communications for Health (REACH) and (2) REACH + Family-focused Add-on for Motivating Self-care (FAMS). METHODS We recruited primary care patients with T2D (N=512) from Federally Qualified Health Centers and an academic medical center, prioritizing recruitment of publicly insured and minority patients from the latter. Eligible patients were prescribed daily diabetes medication and owned a cell phone with text messaging capability. We excluded patients whose most recent HbA1c result within 12 months was <6.8% to support detection of intervention effects on HbA1c. Participants were randomly assigned to REACH only, REACH + FAMS, or the control condition. REACH provides text messages tailored to address patient-specific barriers to medication adherence based on the Information-Motivation-Behavioral skills model, whereas FAMS provides monthly phone coaching with related text message content focused on family and friend barriers to diet and exercise adherence. We collect HbA1c and self-reported survey data at baseline and at 3, 6, and 12 months, and again at 15 months to assess sustained changes. We will use generalized estimating equation models to test the effects of REACH (either intervention arm) on HbA1c relative to the control group, the potential additive effects of FAMS, and effects of either intervention on adherence to self-care behaviors and diabetes self-efficacy. RESULTS The trial is ongoing; recruitment closed December 2017. We plan to perform analyses on 6-month outcomes for FAMS in July 2018, and project to have 15-month data for REACH analyses in April 2019. CONCLUSIONS Our study will be one of the first to evaluate a long-term, theory-based text messaging intervention to promote self-care adherence among racially/ethnically and socioeconomically diverse adults with T2D. Moreover, our study will assess the feasibility of a family-focused intervention delivered via mobile phones and compare the effects of text messaging alone versus text messaging plus phone coaching. Findings will advance our understanding of how interventions delivered by phone can benefit diverse patients with chronic conditions. CLINICALTRIAL ClinicalTrials.gov NCT02409329; https://clinicaltrials.gov/ct2/show/NCT02409329 (Archived by WebCite at http://www.webcitation.org/6yHkg9SSl); NCT02481596; https://clinicaltrials.gov/ct2/show/NCT02481596 (Archived by WebCite at http://www.webcitation.org/6yHkj9XD4)

Download Full-text

SmokefreeTXT for homeless smokers: A pilot randomized controlled trial (Preprint)

10.2196/preprints.13162 ◽

2018 ◽

Author(s):

Travis P Baggett ◽

Claire McGlave ◽

Gina R Kruse ◽

Awesta Yaqubi ◽

Yuchiao Chang ◽

...

Keyword(s):

Mobile Phone ◽

Text Messaging ◽

Nicotine Patch ◽

Controlled Trial ◽

Qualitative Interviews ◽

Text Messages ◽

Free Text ◽

Smoking Abstinence ◽

Randomized Controlled ◽

Pilot Randomized Controlled Trial

BACKGROUND Homeless smokers want to quit smoking but face numerous barriers to doing so, including pervasive smoking among peers and a lack of social support for quitting. A text messaging intervention could address these challenges by providing virtual daily support for homeless smokers who are trying to quit but coping with multiple triggers to smoke. OBJECTIVE We assessed whether a free text messaging program, added to evidence-based pharmacotherapy and counseling, improved smoking abstinence among homeless adult smokers. METHODS In 10/2015–06/2016, we conducted an 8-week pilot randomized controlled trial of nicotine patch therapy and weekly in-person counseling with (N=25) or without (N=25) SmokefreeTXT, a free text messaging service administered by the National Cancer Institute (NCI), at Boston Health Care for the Homeless Program. All participants were provided with a mobile phone and a 2-month prepaid voice and text plan at no cost. SmokefreeTXT enrollees were sent 1-5 automated text messages daily for up to 8 weeks and could receive on-demand tips for managing cravings, mood symptoms, and smoking lapses. The primary outcome was smoking abstinence, defined as an exhaled carbon monoxide <8 parts per million, assessed 14 times over 8 weeks of follow-up and analyzed using repeated-measures logistic regression with generalized estimating equations. Other outcomes were use of SmokefreeTXT, assessed by data obtained from NCI; perceptions of SmokefreeTXT, assessed by surveys and qualitative interviews; and mobile phone retention, assessed by self-report. RESULTS 67% of eligible individuals participated. Of SmokefreeTXT arm participants (N=25), 88% enrolled in the program but only 56% had confirmed enrollment for ≥2 weeks. Among 2-week enrollees, the median response rate to interactive messages from SmokefreeTXT was 2.1% (interquartile range 0-10.5%). Across all time points, smoking abstinence did not differ significantly between SmokefreeTXT and control arm participants (odds ratio 0.92, 95% confidence interval 0.30-2.84). Of SmokefreeTXT enrollees who completed exit surveys (N=15), two-thirds were very/extremely satisfied with the program. However, qualitative interviews (N=14) revealed that many participants preferred in-person over phone-based intervention formats, found the text messages impersonal and robotic, and felt that the messages were too frequent and repetitive. Only 40% of SmokefreeTXT arm participants retained their study-supplied mobile phone for the 8-week duration of the trial, with phone theft being most common. The logistics of storing and charging phones were cited as challenges in qualitative interviews. CONCLUSIONS SmokefreeTXT, added to nicotine patch therapy and in-person counseling, did not significantly improve smoking abstinence in this 8-week pilot RCT for homeless smokers. Text messaging interventions for this population should be better tuned to the unique circumstances of homelessness and coupled with innovative efforts to promote mobile phone retention over time. CLINICALTRIAL ClinicalTrials.gov (NCT02565381)

Download Full-text

Interactive weekly mobile phone text messaging plus motivational interviewing in promotion of breastfeeding among women living with HIV in South Africa: study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-017-2079-0 ◽

2017 ◽

Vol 18 (1) ◽

Cited By ~ 6

Author(s):

Moleen Zunza ◽

Mark F. Cotton ◽

Lawrence Mbuagbaw ◽

Richard Lester ◽

Lehana Thabane

Keyword(s):

South Africa ◽

Randomized Controlled Trial ◽

Motivational Interviewing ◽

Mobile Phone ◽

Study Protocol ◽

Text Messaging ◽

Controlled Trial ◽

Randomized Controlled ◽

Women Living With Hiv ◽

Living With Hiv

Download Full-text

The Use of Text Messaging to Improve the Hospital-to-Community Transition in Patients With Acute Coronary Syndrome (Txt2prevent): Results From a Pilot Randomized Controlled Trial (Preprint)

10.2196/preprints.24530 ◽

2020 ◽

Author(s):

Emily S Ross ◽

Brodie M Sakakibara ◽

Martha H Mackay ◽

David GT Whitehurst ◽

Joel Singer ◽

...

Keyword(s):

Study Protocol ◽

Resource Use ◽

Self Efficacy ◽

Text Messaging ◽

Controlled Trial ◽

Text Messages ◽

Self Management ◽

Coronary Syndrome ◽

Randomized Controlled

BACKGROUND Acute coronary syndrome (ACS) is a leading cause of hospital admission in North America. Many patients with ACS experience challenges after discharge that impact their clinical outcomes and psychosocial well-being. Text messaging has the potential to provide support to patients during this post-discharge period. OBJECTIVE This study pilot-tested a 60-day text-messaging intervention (Txt2Prevent) for patients with ACS. The primary objective was to compare self-management domains between usual care and usual care plus Txt2Prevent. The secondary objectives were to compare medication adherence, health-related quality of life, self-efficacy, and healthcare resource use between groups. The third objective was to assess the feasibility of the study protocol and the acceptability of the intervention. METHODS This was a randomized controlled trial with blinding of outcome assessors. We recruited 76 patients with ACS from St. Paul’s Hospital in Vancouver, Canada and randomized them to one of two groups within seven days of discharge. The Txt2Prevent program included automated one-way text messages about follow-up care, self-management and healthy living. Data was collected during the index admission and at 60-days after randomization. The primary outcome was measured with the Health Education Impact Questionnaire (heiQ). Other outcomes included the EQ-5D-5L, EQ visual analogue scale, Sullivan Cardiac Self-Efficacy Scale, Morisky Medication Adherence Scale and self-reported healthcare resource use. Analyses of covariance were used to test the effect of group assignment on follow-up scores (controlling for baseline) and were considered exploratory in nature. Feasibility was assessed with descriptive characteristics of the study protocol. Acceptability was assessed with two survey questions and semi-structured interviews. RESULTS There were no statistically significant differences between the groups for the heiQ domains (adjusted mean difference: health directed activity: –0.13 [95% confidence interval (CI): –0.39-0.13]; positive and active engagement in life: 0.03 [95% CI: –0.19-0.25]; emotional distress: 0.04 [95% CI: –0.22-0.29]; self-monitoring and insight: 0.14 [95% CI: –0.33-0.05]; constructive attitudes and approaches: –0.10 [95% CI: –0.36- 0.17]; skill technique and acquisition: 0.05 [95% CI: –0.18-0.27]; social integration and support: –0.12 [95% CI: –0.34-0.19]; health services navigation: –0.05 [95% CI: –0.29-0.19]). For the secondary outcomes, there were no statistically significant differences in adjusted analyses except in one self-efficacy domain (‘Total Plus’), where the Txt2Prevent group had lower scores (mean difference: –0.36 [95% CI: –0.66 to -0.50]). The study protocol was feasible although recruitment took longer than expected. Over 90% of participants reported they were satisfied with the program. CONCLUSIONS The Txt2Prevent study was feasible to implement; however, although exploratory, there were no differences between the two groups in adjusted analyses except for one self-efficacy domain. As the intervention appeared acceptable, there is potential in using text messages in this context. The design of the intervention may need to be reconsidered to have more impact on outcome measures. CLINICALTRIAL ClinicalTrials.gov NCT02336919 INTERNATIONAL REGISTERED REPORT RR2-10.2196/resprot.6968

Download Full-text

mHealth Messaging to Motivate Quitline Use and Quitting: Protocol for a Community-Based Randomized Controlled Trial in Rural Vietnam (Preprint)

10.2196/preprints.30947 ◽

2021 ◽

Author(s):

Celine Larkin ◽

Jessica Wijesundara ◽

Hoa L Nguyen ◽

Duc Anh Ha ◽

Anh Vuong ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Smoking Cessation ◽

Text Messaging ◽

Health Workers ◽

Controlled Trial ◽

Text Messages ◽

Community Based ◽

Middle Income ◽

Middle Income Countries ◽

Randomized Controlled

BACKGROUND Tobacco kills more than 8 million people each year, mostly in low- and middle-income countries. In Vietnam, 1 in every 2 male adults smokes tobacco. Vietnam has set up telephone Quitline counseling that is available to all smokers, but it is underused. We previously developed an automated and effective motivational text messaging system to support smoking cessation among US smokers. OBJECTIVE The aim of this study is to adapt the aforementioned system for rural Vietnamese smokers to promote cessation of tobacco use, both directly and by increasing the use of telephone Quitline counseling services and nicotine replacement therapy. Moreover, we seek to enhance research and health service capacity in Vietnam. METHODS We are testing the effectiveness of our culturally adapted motivational text messaging system by using a community-based randomized controlled trial design (N=600). Participants were randomly allocated to the intervention (regular motivational and assessment text messages) or control condition (assessment text messages only) for a period of 6 months. Trial recruitment took place in four communes in the Hung Yen province in the Red River Delta region of Vietnam. Recruitment events were advertised to the local community, facilitated by community health workers, and occurred in the commune health center. We are assessing the impact of the texting system on 6-month self-reported and biochemically verified smoking cessation, as well as smoking self-efficacy, uptake of the Quitline, and use of nicotine replacement therapy. In addition to conducting the trial, the research team also provided ongoing training and consultation with the Quitline during the study period. RESULTS Site preparation, staff training, intervention adaptation, participant recruitment, and baseline data collection were completed. The study was funded in August 2017; it was reviewed and approved by the University of Massachusetts Medical School Institutional Review Board in 2017. Recruitment began in November 2018. A total of 750 participants were recruited from four communes, and 700 (93.3%) participants completed follow-up by March 2021. An analysis of the trial results is in progress; results are expected to be published in late 2022. CONCLUSIONS This study examines the effectiveness of mobile health interventions for smoking in rural areas in low- and middle-income countries, which can be implemented nationwide if proven effective. In addition, it also facilitates significant collaboration and capacity building among a variety of international partners, including researchers, policy makers, Quitline counselors, and community health workers. CLINICALTRIAL ClinicalTrials.gov NCT03567993; https://clinicaltrials.gov/ct2/show/NCT03567993. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/30947

Download Full-text

One-Way and Two-Way Mobile Phone Text Messages for Treatment Adherence Among Patients With HIV: Protocol for a Randomized Controlled Trial (Preprint)

10.2196/preprints.16127 ◽

2019 ◽

Author(s):

Dickson Shey Nsagha ◽

Vincent Verla Siysi ◽

Same Ekobo ◽

Thomas Obinchemti Egbe ◽

Odette Dzemo Kibu

Keyword(s):

Quality Of Life ◽

Data Collection ◽

Text Messaging ◽

Controlled Trial ◽

Text Message ◽

Text Messages ◽

Randomized Controlled ◽

The Impact ◽

Sms Text Messaging

BACKGROUND Incomplete adherence to antiretroviral therapy (ART) is one of the factors that contribute to HIV drug resistance, and it is a major problem for the public health system in controlling the HIV pandemic. There is emerging evidence that SMS can play an important role in health care delivery among patients with HIV on ART, especially in resource-limited settings. OBJECTIVE This paper aims to assess the impact of two-way and one-way SMS text messaging on adherence to HIV treatment. We hypothesized that sending weekly text messages through the one-way and two-way SMS text messaging approach will improve adherence to ART among patients with HIV and improve associated clinical outcomes (quality of life). METHODS A randomized controlled trial is being carried out among participants with HIV who have been on ART for at least one month from an accredited treatment center, namely the Buea Regional Hospital and Kumba District Hospital of South West Region, Cameroon. Participants with HIV, both male and female, aged 21 years and older make up a sample size of 207. The interventions involved the use of mobile phone text messages. Before commencing the intervention, a focus group discussion was carried out among the participants to understand their perception about the use of SMS-based interventions to improve adherence. A total of 246 participants were randomized to receive either a one-way text message (SMS sent to a recipient without recipient sending a reply) or two-way text message (SMS sent to a recipient and recipient sends a reply) or the control (no SMS, only standard care). Data on adherence and quality of life were collected at baseline and after 6 months and will be analyzed using SPSS version 21, while qualitative data will be analyzed using Atlas.ti 7.5. RESULTS Data collection began in September 2019 with focus group discussions and baseline data collection. After 1 month of baseline data collection, the intervention began in October 2019, and postintervention data were collected after 6 months (March 2020). At the end of the study, we will be able to understand the perception of patients toward SMS text messaging–based interventions and also assess the impact of one-way and two-way SMS text messages on treatment adherence among patients with HIV and on associated clinical outcomes (quality of life). CONCLUSIONS The impact of SMS text messaging varies across different settings. The results from this study will determine the perception of patients toward an SMS text messaging–based intervention and its impact on adherence to ART. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/16127

Download Full-text