scholarly journals Feasibility and Acceptability of a Text Message–Based Intervention to Reduce Overuse of Alcohol in Emergency Department Patients: Controlled Proof-of-Concept Trial

10.2196/17557 ◽  
2020 ◽  
Vol 8 (6) ◽  
pp. e17557
Author(s):  
Elizabeth Burner ◽  
Mark Zhang ◽  
Sophie Terp ◽  
Kelsey Ford Bench ◽  
Joshua Lee ◽  
...  

Background Emergency department (ED) patients have high rates of risky alcohol use, and an ED visit offers an opportunity to intervene. ED-based screening, brief intervention, and referral to treatment (SBIRT) reduces alcohol use and health care costs. Mobile health (mHealth) interventions may expand the impact of SBIRTs but are understudied in low-resource ED populations. Objective The objective of this study was to assess the feasibility of and patient satisfaction with a text-based mHealth extension of an ED screening program to reduce risky alcohol use in low-income, urban patients. Methods Research assistants screened a convenience sample of ED patients in person for risky alcohol use via the Alcohol Use Disorders Identification Test (AUDIT). Patients who reported AUDIT scores ≥8 and <20 were informed of their AUDIT score and risk. RAs invited patients with SMS text message–capable phones to receive mROAD (mobilizing to Reduce Overuse of Alcohol in the ED), an SMS text message–based extension of the ED screening program. mROAD is a 7-day program of twice-daily SMS text messages based on the National Institutes of Health’s Rethinking Drinking campaign. Participants were allocated to a control group (daily sham text messages without specific guidance on behaviors, such as “Thanks for taking part!”) or to the mROAD intervention group. Patients were interviewed at 30 days to assess acceptability, satisfaction, and changes in drinking behavior. Satisfaction was examined descriptively. Pre and post measurements of drinking behaviors and motivation were compared, as were differences in change scores between the intervention arms. Results Of 1028 patients screened, 95 (9.2%) exhibited risky alcohol use based on AUDIT, and 23/95 (24%) of those patients did not own an SMS text messaging–capable phone; this left 72/95 (76%) eligible patients. Among eligible participants, 48/72 (67%) agreed to enroll; 31/48 (65%) achieved follow-up (18/24 (75%) in the intervention group and 13/24 (55%) in the control group). Participants who completed follow-up reported high satisfaction. Changes in behavior were similar between the arms. Overall, the number of drinking days reported in the prior 30 days decreased by 5.0 (95% CI 1.7-8.3; P=.004), and the number of heavy drinking days decreased by 4.1 (95% CI 1.0 to 7.15, P=.01). Patients reported an 11-point increase (95% CI 2.6-20, P=.01, 10% overall increase) in motivation to change alcohol use via the Change Questionnaire. The were no statistical differences in drinking days, heavy drinking days, or motivation to change between the arms. Conclusions The mROAD trial was feasible. Over three-quarters of ED patients with risky alcohol use owned a text message–capable phone, and two-thirds of these patients were willing to participate; only 1 patient opted out of the intervention. Although 35% of patients were lost to follow-up at 30 days, those patients who did follow up had favorable impressions of the program; more than 90% reported that SMS text messages were a “good way to teach,” and 89% of intervention arm participants enjoyed the program and found that the messages were motivating. Both the mROAD and sham message groups showed promising changes in alcohol use and motivation to change. mROAD is a feasible intervention that may reduce rates of risky alcohol use in ED patients. Trial Registration ClinicalTrials.gov NCT02158949; https://clinicaltrials.gov/ct2/show/NCT02158949

2019 ◽  
Author(s):  
Elizabeth Burner ◽  
Mark Zhang ◽  
Sophie Terp ◽  
Kelsey Ford Bench ◽  
Joshua Lee ◽  
...  

BACKGROUND Emergency department (ED) patients have high rates of risky alcohol use, and an ED visit offers an opportunity to intervene. ED-based screening, brief intervention, and referral to treatment (SBIRT) reduces alcohol use and health care costs. Mobile health (mHealth) interventions may expand the impact of SBIRTs but are understudied in low-resource ED populations. OBJECTIVE The objective of this study was to assess the feasibility of and patient satisfaction with a text-based mHealth extension of an ED screening program to reduce risky alcohol use in low-income, urban patients. METHODS Research assistants screened a convenience sample of ED patients in person for risky alcohol use via the Alcohol Use Disorders Identification Test (AUDIT). Patients who reported AUDIT scores ≥8 and &lt;20 were informed of their AUDIT score and risk. RAs invited patients with SMS text message–capable phones to receive mROAD (mobilizing to Reduce Overuse of Alcohol in the ED), an SMS text message–based extension of the ED screening program. mROAD is a 7-day program of twice-daily SMS text messages based on the National Institutes of Health’s Rethinking Drinking campaign. Participants were allocated to a control group (daily sham text messages without specific guidance on behaviors, such as “Thanks for taking part!”) or to the mROAD intervention group. Patients were interviewed at 30 days to assess acceptability, satisfaction, and changes in drinking behavior. Satisfaction was examined descriptively. Pre and post measurements of drinking behaviors and motivation were compared, as were differences in change scores between the intervention arms. RESULTS Of 1028 patients screened, 95 (9.2%) exhibited risky alcohol use based on AUDIT, and 23/95 (24%) of those patients did not own an SMS text messaging–capable phone; this left 72/95 (76%) eligible patients. Among eligible participants, 48/72 (67%) agreed to enroll; 31/48 (65%) achieved follow-up (18/24 (75%) in the intervention group and 13/24 (55%) in the control group). Participants who completed follow-up reported high satisfaction. Changes in behavior were similar between the arms. Overall, the number of drinking days reported in the prior 30 days decreased by 5.0 (95% CI 1.7-8.3; <i>P</i>=.004), and the number of heavy drinking days decreased by 4.1 (95% CI 1.0 to 7.15, <i>P</i>=.01). Patients reported an 11-point increase (95% CI 2.6-20, <i>P</i>=.01, 10% overall increase) in motivation to change alcohol use via the Change Questionnaire. The were no statistical differences in drinking days, heavy drinking days, or motivation to change between the arms. CONCLUSIONS The mROAD trial was feasible. Over three-quarters of ED patients with risky alcohol use owned a text message–capable phone, and two-thirds of these patients were willing to participate; only 1 patient opted out of the intervention. Although 35% of patients were lost to follow-up at 30 days, those patients who did follow up had favorable impressions of the program; more than 90% reported that SMS text messages were a “good way to teach,” and 89% of intervention arm participants enjoyed the program and found that the messages were motivating. Both the mROAD and sham message groups showed promising changes in alcohol use and motivation to change. mROAD is a feasible intervention that may reduce rates of risky alcohol use in ED patients. CLINICALTRIAL ClinicalTrials.gov NCT02158949; https://clinicaltrials.gov/ct2/show/NCT02158949


2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Gimbo M. Hyuha ◽  
Hendry R. Sawe ◽  
Said Kilindimo ◽  
Raya Y. Mussa ◽  
Masuma A. Gulamhussein ◽  
...  

Abstract Background Due to the high prevalence of human immunodeficiency virus (HIV) in Tanzania, provider-initiated HIV testing for patients attending any health care setting is recommended. However, follow-up and linkage to care by those tested remain poor. We determined the feasibility and efficacy of text messaging to promote follow-up among otherwise healthy trauma patients who underwent provider-initiated HIV testing and counseling at an emergency department (ED) in Tanzania. Material and methods This randomized controlled trial (RCT) was conducted at Muhimbili National Hospital (MNH) ED between September 2019 and February 2020. Adult trauma patients consenting to HIV testing and follow-up text messaging were randomized to standard care (pre-test and post-test counseling) or standard care plus a series of three short message service (SMS) text message reminders for follow-up in an HIV clinic, if positive, or for retesting, if negative. Investigators blinded to the study assignment called participants 2 months after the ED visit if HIV-positive or 4 months if HIV-negative. We compared the proportion of people in the intervention and control groups completing recommended follow-up. Secondary outcomes were the proportion of patients agreeing to testing, proportion of patients agreeing to receiving text messages, and the proportion of HIV-positive and HIV-negative patients in each study arm who followed up. Results Of the 290 patients approached, 255 (87.9%) opted-in for testing and agreed to receive a text message. The median age of the study population was 29 [IQR 24–40] years. There were 127 patients randomized to the intervention group and 128 to the control group. The automated SMS system verified that 381 text messages in total were successfully sent. We traced 242 (94.9%) participants: 124 (51.2%) in the intervention group and 18 (488%) in the control group. A total of 100 (39.2%) subjects reported completing a follow-up visit, of which 77 (60.6%) were from the intervention group and 23 (17.9%) were from the control group (RR = 3.4, 95% CI 2.3–5.0). This resulted in a number needed to treat (NNT) of 2.3. Of the 246 HIV-negative participants, 37% underwent repeat screening: 59% of those in the intervention group and 16% in the control group (RR = 3.7, P = < 0.0001, NNT 2.3). Among the nine positive patients, all five in the intervention group and only three in the controls had follow-up visits. Conclusion Automated text message is a feasible and effective way to increase follow-up in HIV-tested individuals in a limited income country.


2021 ◽  
pp. 1-12
Author(s):  
Conor Farren ◽  
Aoife Farrell ◽  
Aisling Hagerty ◽  
Cliodhna McHugh

<b><i>Background and Aims:</i></b> Alcohol use disorder (AUD) is a substantial problem, causing early death and great economic burden. Research has highlighted the potential positive impact of technological interventions, such as smartphone applications (app) in treatment of AUD. The aim of this study was to explore the effectiveness of a smartphone app, incorporating computerized cognitive behavioural therapy and text messaging support, on alcohol outcomes over 6 months in a post-rehabilitation setting. <b><i>Methods:</i></b> A total of 111 participants with AUD were recruited into this randomized controlled trial, following completion of a 30-day rehabilitation programme. The intervention group (<i>n</i> = 54) used the smartphone app “UControlDrink” (UCD) over 6 months with treatment as usual (TAU), and the control group (<i>n</i> = 57) received TAU. All subjects suffered from AUD as the primary disorder, with other major psychiatric disorders excluded. All intervention subjects used the UCD smartphone app in the treatment trial, and all subjects underwent TAU consisting of outpatient weekly support groups. Drinking history in the previous 90 days was measured at baseline and at 3- and 6-month follow-ups. Additional measurements were made to assess mood, anxiety, craving, and motivation. Results were analysed using intention-to-treat analyses. <b><i>Results:</i></b> Retention in the study was 72% at 3 months and 52% at 6 months. There was a significant reduction in heavy drinking days in the intervention group relative to TAU over the 6 months, <i>p</i> &#x3c; 0.02. <b><i>Conclusions:</i></b> The UCD smartphone app demonstrates a significant benefit to reducing heavy drinking days over a 6-month post-rehabilitation period in AUD.


2019 ◽  
Author(s):  
Panpan Zhai ◽  
Khezar Hayat ◽  
Wenjing Ji ◽  
Qian Li ◽  
Li Shi ◽  
...  

BACKGROUND Hypertension is one of the leading risk factors for ischemic heart diseases, and high rates of hypertension prevalence have either remained the same or increased in developing countries in recent years. Unfortunately, about 20% to 50% of patients with chronic diseases have been nonadherent to their drug therapy. SMS text messaging and pharmacy student–led consultations have the potential to help patients manage their blood pressure (BP). OBJECTIVE The aim of this study was to assess the effectiveness, feasibility, and acceptability of SMS text messaging and consultation to manage the BP of Chinese patients with hypertension. METHODS We conducted a two-arm cluster randomized controlled trial among patients with hypertension in Xi’an City, Shaanxi Province, China, and recruited 384 patients from 8 community health care centers. Patients were randomized into an intervention group to receive SMS text messages and consultations or into a control group to receive usual care for 3 months. We sent SMS text messages at 3-day intervals and collected data at baseline (including demographics, clinical outcomes, medication complexity, side effects, patient behavior, knowledge about hypertension, BP, and medication adherence) and the 3-month follow-up (including BP, medication adherence, and knowledge about hypertension). RESULTS We assessed 445 patients with hypertension and excluded 61 patients who were not eligible or who had not filled out their questionnaires. The mean age of the patients was 68.5 (SD 7.9) years in the intervention group and 69.4 (SD 9.7) years in the control group, and the sample was primarily female (265/384, 69.0%). Patients in the intervention group showed significant improvements in systolic BP (SBP; mean 134.5 mm Hg, SD 15.5 mm Hg vs mean 140.7 mm Hg, SD 15.2 mm Hg; <i>P</i>=.001), medication adherence (mean 7.4, SD 1.2 vs mean 7.0, SD 1.3; <i>P</i>=.04), and knowledge about hypertension (mean 6.3, SD 0.9 vs mean 5.9, SD 1.2; <i>P</i>=.004) compared with those in the control group. In measures of diastolic BP (DBP), the two arms showed nonsignificant improvements (mean 78.2 mm Hg, SD 9.0 mm Hg vs mean 77.2 mm Hg, SD 10.3 mm Hg; <i>P</i>=.06). In total, 176 patients had controlled BP at the 3-month follow-up (98 patients in the intervention group vs 78 patients in the control group), but it was nonsignificant (<i>P</i>=.08). CONCLUSIONS The use of SMS text messaging and consultation to manage SBP and improve medication adherence is effective, feasible, and acceptable among Chinese patients with hypertension, although a significant difference was not observed with regard to DBP. It is important to maximize the potential of SMS text messaging and consultation by increasing the feasibility and acceptance of mobile interventions and conduct a cost-effectiveness analysis on this method. CLINICALTRIAL Chinese Clinical Trial Registry ChiCTR1900026862; http://www.chictr.org.cn/showproj.aspx?proj=42717.


2010 ◽  
Vol 13 (8) ◽  
pp. 1271-1278 ◽  
Author(s):  
Gail Rees ◽  
Savita Bakhshi ◽  
Alecia Surujlal-Harry ◽  
Mikis Stasinopoulos ◽  
Anna Baker

AbstractObjectiveTo evaluate the effectiveness of a computer-generated tailored intervention leaflet compared with a generic leaflet aimed at increasing brown bread, wholegrain cereal, fruit and vegetable intakes in adolescent girls.DesignClustered randomised controlled trial. Dietary intake was assessed via three 24 h dietary recalls.SettingEight secondary schools in areas of low income and/or high ethnic diversity, five in London and three in the West Midlands, UK.SubjectsGirls aged 12–16 years participated (n 823) and were randomised by school class to receive either the tailored intervention (n 406) or a generic leaflet (n 417).ResultsAt follow-up 637 (77 %) participants completed both baseline and follow-up dietary recalls. The tailored intervention leaflet had a statistically significant effect on brown bread intake (increasing from 0·39 to 0·51 servings/d) with a smaller but significant increase in the control group also (increasing from 0·28 to 0·35 servings/d). The intervention group achieved 0·05 more servings of brown bread daily than the control group (P < 0·05), which is equivalent to 0·35 servings/week. For the other foods there were no significant effects of the tailored intervention.ConclusionsThe intervention group consumed approximately 0·35 more servings of brown bread weekly than the control group from baseline. Although this change between groups was statistically significant the magnitude was small. Evaluation of the intervention was disappointing but the tailored leaflet was received more positively in some respects than the control leaflet. More needs to be done to increase motivation to change dietary intake in adolescent girls.


Life ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 253
Author(s):  
Jenny Vilchis-Gil ◽  
Miguel Klünder-Klünder ◽  
Ximena Duque ◽  
Gloria Martínez-Andrade ◽  
Andrea Martínez-Almaráz ◽  
...  

Foods and beverages that schoolchildren carry in their lunchboxes have high energy values but lack plain water, fresh fruits and vegetables. A nutrition-related community intervention on the quantity and quality of school almuerzo was performed, in which four primary schools participated, as part of two groups: 225 children in the intervention group (IG) and 177 children in the control group (CG). The parents from the IG had access to a website where they could consult information on eating habits and physical activity or school almuerzo menus. They were sent weekly text messages on their mobile phones and attended in-person sessions. Anthropometric measurements and surveys were performed in both groups at the start of the study, as well as after 6 and 12 months. The school almuerzo was assessed by recording foods that the children brought in their lunchboxes. At baseline, 88% of children brought a school almuerzo, 37% fruit, 17% vegetables, 40% plain water and 50% sweet drinks. In both groups, 50% of children brought a school almuerzo with an energy value above the recommended value (>340 kcal) during follow-up; however, the percentage of children who brought sweet drinks decreased (p < 0.05), with sweet drinks contributing between 26% and 33% of the calories in the school almuerzo. In the IG, the quantity in milliliters of plain water increased at the end of the follow-up period (p = 0.044). From the point of view of food-and-beverage quantity and quality, school almuerzo were unhealthy for both groups. The intervention failed to increase the frequency with which parents provided children with school almuerzo or enhance the quality of the latter.


2019 ◽  
Author(s):  
Ditte S Linde ◽  
Marianne S Andersen ◽  
Julius Mwaiselage ◽  
Rachel Manongi ◽  
Susanne K Kjaer ◽  
...  

BACKGROUND Rapid human papillomavirus (HPV) DNA testing is an emerging cervical cancer screening strategy in resource-limited countries, yet it requires follow-up of women who test HPV positive. OBJECTIVE This study aimed to determine if one-way text messages improved attendance to a 14-month follow-up cervical cancer screening among HPV-positive women. METHODS This multicenter, parallel-group randomized controlled trial was conducted at 3 hospitals in Tanzania. Eligible participants were aged between 25 and 60 years, had tested positive to a rapid HPV test during a patient-initiated screening, had been informed of their HPV result, and had a private mobile phone with a valid number. Participants were randomly assigned in a 1:1 ratio to the intervention or control group through an incorporated algorithm in the text message system. The intervention group received one-way text messages, and the control group received no text messages. The primary outcome was attendance at a 14-month health provider-initiated follow-up screening. Participants were not blinded, but outcome assessors were. The analysis was based on intention to treat. RESULTS Between August 2015 and July 2017, 4080 women were screened for cervical cancer, of which 705 were included in this trial—358 women were allocated to the intervention group, and 347 women were allocated to the control group. Moreover, 16 women were excluded before the analysis because they developed cervical cancer or died (8 from each group). In the intervention group, 24.0% (84/350) women attended their follow-up screening, and in the control group, 23.8% (80/335) women attended their follow-up screening (risk ratio 1.02, 95% CI 0.79-1.33). CONCLUSIONS Attendance to a health provider-initiated follow-up cervical cancer screening among HPV-positive women was strikingly low, and one-way text messages did not improve the attendance rate. Implementation of rapid HPV testing as a primary screening method at the clinic level entails the challenge of ensuring a proper follow-up of women. CLINICALTRIAL ClinicalTrials.gov NCT02509702; https://clinicaltrials.gov/ct2/show/NCT02509702. INTERNATIONAL REGISTERED REPORT RR2-10.2196/10.2196/15863


2019 ◽  
Author(s):  
Stephanie Ruth Partridge ◽  
Rebecca Raeside ◽  
Anna Singleton ◽  
Karice Hyun ◽  
Julie Redfern

BACKGROUND The incidence of obesity among adolescents is increasing. Text messages are a primary communication form for adolescents and potentially a scalable strategy for delivering population health interventions. OBJECTIVE This study aimed to determine the effectiveness of text message interventions in reducing BMI in adolescents and describe characteristics that are common to effective interventions. METHODS This systematic review included randomized controlled trials of text message lifestyle interventions involving adolescents aged 10 to 19 years with outcomes focused on obesity prevention or management. Primary outcome was objective or self-report change in BMI. RESULTS In total, 4362 records were identified, and 215 full-text articles were assessed for eligibility. A total of 8 unique studies were identified, including 767 participants, mean age 14.3 (SD 0.9) years, BMI 29.7 (SD 1.6) kg/m2 and 53.1% (407/767) female (31/101, 30.7%-172/172, 100.0%). All interventions were multicomponent. The median active intervention period was 4.5 months. During the active and extended intervention phases, text messages accounted for &gt;50% (8 studies) and &gt;85% (3 studies) of contact points, respectively. Text messages were heterogeneous, with a median of 1.5 text messages sent per week (range: 1-21). A total of 4 studies utilized two-way text message communication with health professionals Of the 8 studies, 7 demonstrated reductions in BMI or BMI z-score in the intervention group compared with the control at the end of the final follow-up. The effect was only statistically significant in 1 study at 6 months. Over 6 months, reductions in BMI (kg/m2) ranged from 1.3% to 4.5% and BMI z-score ranged from 4.2% to 28.1%. Overall quality of the studies was low. CONCLUSIONS Further research is required to elucidate the effectiveness and potential impact of text message interventions on weight and weight-related behaviors in adolescents.


10.2196/15849 ◽  
2020 ◽  
Vol 8 (5) ◽  
pp. e15849 ◽  
Author(s):  
Stephanie Ruth Partridge ◽  
Rebecca Raeside ◽  
Anna Singleton ◽  
Karice Hyun ◽  
Julie Redfern

Background The incidence of obesity among adolescents is increasing. Text messages are a primary communication form for adolescents and potentially a scalable strategy for delivering population health interventions. Objective This study aimed to determine the effectiveness of text message interventions in reducing BMI in adolescents and describe characteristics that are common to effective interventions. Methods This systematic review included randomized controlled trials of text message lifestyle interventions involving adolescents aged 10 to 19 years with outcomes focused on obesity prevention or management. Primary outcome was objective or self-report change in BMI. Results In total, 4362 records were identified, and 215 full-text articles were assessed for eligibility. A total of 8 unique studies were identified, including 767 participants, mean age 14.3 (SD 0.9) years, BMI 29.7 (SD 1.6) kg/m2 and 53.1% (407/767) female (31/101, 30.7%-172/172, 100.0%). All interventions were multicomponent. The median active intervention period was 4.5 months. During the active and extended intervention phases, text messages accounted for >50% (8 studies) and >85% (3 studies) of contact points, respectively. Text messages were heterogeneous, with a median of 1.5 text messages sent per week (range: 1-21). A total of 4 studies utilized two-way text message communication with health professionals Of the 8 studies, 7 demonstrated reductions in BMI or BMI z-score in the intervention group compared with the control at the end of the final follow-up. The effect was only statistically significant in 1 study at 6 months. Over 6 months, reductions in BMI (kg/m2) ranged from 1.3% to 4.5% and BMI z-score ranged from 4.2% to 28.1%. Overall quality of the studies was low. Conclusions Further research is required to elucidate the effectiveness and potential impact of text message interventions on weight and weight-related behaviors in adolescents.


2021 ◽  
Vol 10 (1) ◽  
pp. 76
Author(s):  
Hassan Vakili Arki ◽  
Ehsan Nabovati ◽  
Mohammad Reza Saberi ◽  
Pourya Eslami ◽  
Zhila Taherzadeh ◽  
...  

Introduction: Irrational prescription of antibiotics has become a major global concern, and not only does it have health-related consequences, but it also affects countries’ overall economy. Based on reports and studies, antibiotics are prescribed in approximately 50% of prescriptions in Iran which can demand by patients as a major cause. It is anticipated that increasing the awareness and understanding of both physicians and patients, regarding the antibiotic use and resistance, could play an important role in the rational prescription of antibiotic medications. In this study, we will examine the effect of informing patients via text message right before their appointment on the proportion of prescribed antibiotic medications.Material and Methods: In this study, a randomized control trial (RCT) will be conducted. The setting in which the study will be carry out, consists of 64 physicians (29 general physician and 35 specialist). Unit of randomization will be physicians based on the proportion of their prescriptions that include antibiotic medications (PIA). The first arm of the study is the intervention group, which consists of the patients receiving three text messages in the clinic’s waiting rooms. The second arm is the control group, and consists of the patients who won’t be receiving any text messages. The content of the text messages focuses on the consequences of self-medication with antibiotics, the fact that the use of antibiotics is not an option for curing viral diseases including cold, and it also asks the patients not to demand antibiotics by trusting their physicians.Results: The main variable that will be measured is the proportion of prescriptions that include antibiotic medications.Conclusion: This trial will be the first one to evaluate the patients’ role in the proportion of prescriptions that include antibiotic medications. It is hypothesized that patients’ demand for antibiotic medication is one of the main causes of irrational antibiotic prescription by physicians.


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