Impact of Clinical Pharmacist Mediated Discharge Counseling and SMS Reminders Service on Medication Adherence in Chronic Disorders

Aims: This study aimed to assess the effect of discharge counseling with SMS reminders on medication adherence in chronic disorders. Study Design: Prospective randomized open-label trial Place and Duration of Study: The study was conducted at the dispensing department of a secondary care referral charity hospital located in a small village. The study was conducted for a period of six months from October 2018 to April 2019. Methodology: Upon consent, a total of 364 patients were enrolled in this study and randomized into two groups viz., intervention group (n=182) and control group (n=182) respectively, with and without discharge counseling and SMS reminder on medication usage by the clinical pharmacist. The level of medication adherence was measured using a pill count and visual analog scale (VAS) methods at two follow-up visits includes baseline and final follow-up visit (gap of two months). A two-sample Wilcoxon rank‑sum (Mann–Whitney) was used to compare the statistical mean difference of medication adherence levels between two groups at each follow‑up visit. Results: The mean age of intervention and control groups were 57.1±8.55 and 58.5±8.53; most of the subjects were >60 years of age and were typically suffering from hypertension (30.2%) and diabetes (34.8%). Initially, at baseline, the values of medication adherence level (pill-count method) were closer in both intervention (82.4±7.3) and control group (81.35±6.4), whereas at follow up visits, the levels of the intervention group (93.2±6.0, 95.6±2.25) were significantly increased (p<0.0001) as compared to the control group (81.2±8.5, 80.6±8.1). Conclusion: Thus, the statistical significance infers that the clinical pharmacist-mediated discharge counseling with SMS reminders would increase medication adherence levels in chronic disorders.

Can Digital Health Interventions Improve Adherence to Antiretroviral (ART) for Patients Living with HIV/AIDS in Sub-Saharan Africa? Systematic Review

BACKGROUND: Human Immunodeficiency Virus (HIV) infection is one of the most devastating human pandemics in Sub-Saharan Africa (SSA) and this is the region most hit by pandemic. Adherence to Antiretroviral Therapy (ART remains challenging and varies between 27% and 80% compared to the required level of 95%. Lack of adherence is of one the major causes of treatment failures. Given the increase in the use of mobile phones in Africa, text messaging is seen as a potential strategy to improve medication adherence although there is little evidence to support this argument. The aim of this review is to evaluate the efficacy of text messaging interventions to improve adherence to antiretroviral treatment. METHODS: The Effective Public Health Practice Project (APHPP) tool was used to ensure that included Randomized Controlled Trials (RCT) studies follow vigorous methodological standards including selection bias, study design, confounders, blinding, data collection methods, and withdrawal and dropout. Selected bibliographic databases MEDLINE, Web of Science, and CINAHL Plus were searched for relevant articles published in English and dated between 2005 and 2018. Six trials met the inclusion criteria as set out in the protocol. Due to the inconsistency and the likely observed heterogeneity, narrative synthesis of evidence was carried out. RESULTS: The results from 2/3 of included studies provided evidence that text messages reminders improve adherence to antiretroviral treatment whereas 1/3 produced contradictory results. Nevertheless, weekly Short Messaging Service (SMS) reminders were more effective than daily (SMS) in achieving 95% self-reported adherence to antiretroviral treatment and in reducing the frequency of treatment interruptions. The results indicated that patients receiving text messages had their plasma HIV viral load suppressed, median CD4+ cell counts increased and were on 100% on time picking up monthly ART refills compared to the control. CONCLUSION: Included studies in this review provided evidence that simple SMS reminders were important in improving and sustaining optimal ART adherences. Text messaging is seen as potential strategy to improve medication adherence. Therefore, it should be included in health systems strategies to help improve sustainable development goals. The results suggest that preventing treatment failure can be achieved by SMS reminders in a resource limited setting.

Interventions to improve vaccination coverage of children in hard-to-reach population: A systematic review

In the last decade, vaccination has reduced a quarter of child deaths worldwide. Vaccination coverage increased, but the coverage remains low in the hard-to-reach population. We searched articles from Pubmed MEDLINE, SCOPUS, Web of Science, and Science Direct to systematically review interventions to improve children's vaccination coverage in hard-to-reach populations. The expected outcome was vaccination coverage, which mentioned Odds Ratio, mean difference, or difference-in-difference with a 95% CI or p-value. Out of 102 articles identified, five articles from four different countries met the inclusion criteria. Four of the five studies reported a positive impact in increasing vaccination coverage. Interventions that showed good effectiveness in increasing the coverage of childhood immunizations were the application of mHealth given to vaccinators, multiple interventions involving the community, modification of immunization schedules during outreach activities, and immunization screening cards. Despite the inconsistent finding, mHealth with SMS reminders was the most effective intervention to increase vaccination coverage and relatively low-cost. More research was needed in developing a strategic intervention to increase vaccination coverage of children in hard-to-reach populations.

Designing an SMS reminder intervention to improve vaccination uptake in Northern Nigeria: a qualitative study

Background Penta3 coverage in Nigeria was low at 33 % in 2017. The most reported reason for non-vaccination was lack of knowledge about the immunization place, time, and need. To address knowledge gaps and improve vaccination uptake, we designed an Immunization Reminder and Information SMS System (IRISS) to educate and remind parents/caregivers about immunization using SMS. A formative study was conducted to understand the contextual and behavioural factors that would inform the IRISS intervention design and implementation. Methods We conducted the study in four Local Government Areas (LGAs) of Kebbi State Nigeria in October 2018, amongst a diverse selection of participants. Data on social norms about vaccinations, barriers to immunization uptake, mobile phone use, SMS message testing, and willingness to accept SMS reminders were collected from focus group discussions (N = 11), in-depth interviews (N = 12), and key informant interviews (N = 13). In addition, we assessed 33 messages covering schedule reminders, normative, motivational, educational, and informative contents for clarity, comprehensibility, relevance, cultural appropriateness, and ability to motivate action among community members from Argungu and Fakai LGAs. All interviews were analyzed using a thematic analysis approach. Results We interviewed 135 people, and 90 % were community members. While we found positive perceptions about immunizations among those interviewed, pockets of misconceptions existed among community members. Lack of awareness on the importance of vaccination was a consistent reason for under-vaccination across the LGAs. In addition, most community members do not own phones, could not read SMS messages, and were unaware of how to check/open text messages received. Despite concerns about low literacy levels and phone ownership, community members still saw a role in SMS reminders when phone owners receive messages. For instance, community leaders can disseminate said messages to community members through existing channels such as town announcers and religious gatherings. Therefore, the SMS becomes a source of information, with phone owners acting as a conduit to community dissemination mechanisms. We generally found the tested messages to be relevant, motivating, and culturally acceptable. Conclusions SMS reminders have the potential to bridge the information gap in community awareness for vaccination, which can translate to improved immunization uptake. In rural communities with low literacy levels and phone ownership, immunization information can be disseminated when existing community leadership structures are engaged.

Effects of call reminders, short message services (SMS) reminders, and SMS immunization facts on childhood routine vaccination timing and completion in Ilorin, Nigeria

Background: Reminders via mobile devices deployed as short message services (SMS) or calls have been identified to be a useful strategy in improving routine immunization uptake in several countries. Objective: To identify the timeliness of appointments with reminders (calls or SMS), SMS health education and the routine care, and the vaccination completion rates in Ilorin, Nigeria. Method: Mother-infant pairs presenting for the first vaccination appointment were randomized into four (three inter- ventions, one control) groups, each consisting of 140 participants. Intervention groups were reminders via calls (A), SMS reminders (B), immunization fact SMS messages (C) and controls on usual care (D). Reminders were made a day before the appointment while SMS immunization facts were sent at five weeks, nine weeks and eight months. Appropriate timing was defined as the scheduled visit ±3 days. Results: The immunization completion rates after the nine months’ visit were 99.2%, 99.3%, 97% and 90.4% for Groups A, B, C and D respectively. Compared with controls, Group A had the highest odds [AOR 8.78 (6.10, 12.63)] of presenting at an appropriate time, followed by Group B [AOR 2.56 (1.96, 3.35)], then Group C [AOR 2.44 (1.87, 3.18)]. Conclusion: Reminders/SMS immunization facts improve vaccination completion rates. Keywords: Call reminders; short message services (SMS) reminders; SMS immunization; vaccination timing; Nigeria.

Research Insights: How Digital Tools Increase Access to Government Services and Social Programs through On-time Renewals of IDs

Sending SMS reminders increased the probability of on-time renewals of IDs by 12 percentage points, while also allowing citizens to renew their IDs online only increased renewals by 8 percentage points. Providing an online option (instead of in-person renewals) was less effective due to a poor user experience with the online procedure. The poorest individuals who received reminders were also more likely to receive transfers from an emergency in-kind transfer delivered through digital vouchers.

Short message service (SMS) reminders for childhood immunisation in low-income and middle-income countries: a systematic review and meta-analysis

IntroductionChildhood vaccine delivery services in the low- and middle-income countries (LMIC) are struggling to reach every child with lifesaving vaccines. Short message service (SMS) reminders have demonstrated positive impact on a number of attrition-prone healthcare delivery services. We aimed to evaluate the effectiveness of SMS reminders in improving immunisation coverage and timeliness in LMICs.MethodsPubMed, Embase, Scopus, Cochrane CENTRAL, CINAHL, CNKI, PsycINFO and Web of Science including grey literatures and Google Scholar were systematically searched for randomised controlled trials (RCTs) and non-RCTs that evaluated the effect of SMS reminders on childhood immunisation and timeliness in LMICs. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 assessment tool for RCTs and Cochrane Risk of Bias in Non-randomised Studies of Interventions tool for non-RCTs. Meta-analysis was conducted using random-effects models to generate pooled estimates of risk ratio (RR).Results18 studies, 13 RCTs and 5 non-RCTs involving 32 712 infants (17 135 in intervention groups and 15 577 in control groups) from 11 LMICs met inclusion criteria. Pooled estimates showed that SMS reminders significantly improved childhood immunisation coverage (RR=1.16; 95% CI: 1.10 to 1.21; I2=90.4%). Meta-analysis of 12 included studies involving 25 257 infants showed that SMS reminders significantly improved timely receipt of childhood vaccines (RR=1.21; 95% CI: 1.12 to 1.30; I2=87.3%). Subgroup analysis showed that SMS reminders are significantly more effective in raising childhood immunisation coverage in lower middle-income and low-income countries than in upper middle-income countries (p<0.001) and sending more than two SMS reminders significantly improves timely receipt of childhood vaccines than one or two SMS reminders (p=0.040).ConclusionCurrent evidence from LMICs, although with significant heterogeneity, suggests that SMS reminders can contribute to achieving high and timely childhood immunisation coverage.PROSPERO registration numberCRD42021225843.

The impact of text message (SMS) reminders on helmet use among motorcycle drivers in Dar es Salaam, Tanzania: A randomized, controlled trial (Preprint)

BACKGROUND Road traffic injury (RTI) is a pressing public health issue in Tanzania. Men are particularly at high risk of RTI because nearly all drivers of motorcycle taxis (“bodabodas,” in Kiswahili, or “bodas” for short), a major form of public transportation in the country, are men. Studies have shown that helmet use can significantly reduce disability and death resulting from road traffic injuries. Efforts have been made by the Tanzanian government to develop tighter helmet use laws. However, adherence to helmet use has remained dangerously low throughout the country. One promising intervention to promote helmet use is the introduction of persuasive short message service (SMS) reminders delivered to boda drivers. OBJECTIVE To evaluate the comparative impact of two different types text messages, also known as short message service (SMS) reminders, on motorcycle helmet use. METHODS Participants were 391 commercial motorcycle taxi drivers in Dar es Salaam, Tanzania. Participants were randomized into three groups, each receiving a different set of messages: 1) social-norming messages aimed at emphasizing society’s positive stance on helmet wearing, 2) fear appeal messages that emphasized the dangers of riding without a helmet, and 3) control group messages, which included basic road safety messages unrelated to helmet use. Every participant received the control messages. Adherence to helmet use was evaluated by self-report through surveys conducted at baseline, 3 weeks and 6 weeks. RESULTS At 6 weeks, the odds of self-reporting consistent helmet use was estimated to be 1.58 times higher in the social-norming group than in the control group (P=.043), though this difference is not significant after accounting for multiple testing. There was little difference between fear appeal and control group recipients (OR= 1.03, P=.466). Subgroup analysis suggests that both fear control and social-norming message types might have been associated with increased helmet use among participants who did not consistently wear helmets at baseline (OR= 1.66 & OR=1.84), but this was not significant (P=.109 & P=.071). Amongst those who were consistent wearers at baseline, the social-norming messages performed better than the fear appeal messages, and this difference reached traditional significance (P=.029), but is not significant after accounting for multiple testing. CONCLUSIONS The use of SMS reminders may improve helmet use among motorcycle drivers when framed as social-norming messages. Given that nearly half of the drivers in our sample did not consistently wear their helmets on every trip, strategies to increase consistent usage could be an important benefit to public safety. CLINICALTRIAL clinicaltrials.gov Identifier: NCT02120742 https://clinicaltrials.gov/ct2/show/NCT02120742