The SMARTscreen Trial: a randomised controlled trial investigating the efficacy of a GP-endorsed narrative SMS to increase participation in the Australian National Bowel Cancer Screening Program

Background Increasing participation in the Australian National Bowel Cancer Screening Program (NBCSP) is the most efficient and cost-effective way of reducing mortality associated with colorectal cancer by detecting and treating early-stage disease. Currently, only 44% of Australians aged 50–74 years complete the NBCSP. This efficacy trial aims to test whether this SMS intervention is an effective method for increasing participation in the NBCSP. Furthermore, a process evaluation will explore the barriers and facilitators to sending the SMS from general practice. Methods We will recruit 20 general practices in the western region of Victoria, Australia to participate in a cluster randomised controlled trial. General practices will be randomly allocated with a 1:1 ratio to either a control or intervention group. Established general practice software will be used to identify patients aged 50 to 60 years old who are due to receive a NBCSP kit in the next month. The SMS intervention includes GP endorsement and links to narrative messages about the benefits of and instructions on how to complete the NBCSP kit. It will be sent from intervention general practices to eligible patients prior to receiving the NBCSP kit. We require 1400 eligible patients to provide 80% power with a two-sided 5% significance level to detect a 10% increase in CRC screening participation in the intervention group compared to the control group. Our primary outcome is the difference in the proportion of eligible patients who completed a faecal occult blood test (FOBT) between the intervention and control group for up to 12 months after the SMS was sent, as recorded in their electronic medical record (EMR). A process evaluation using interview data collected from general practice staff (GP, practice managers, nurses) and patients will explore the feasibility and acceptability of sending and receiving a SMS to prompt completing a NBCSP kit. Discussion This efficacy trial will provide initial trial evidence of the utility of an SMS narrative intervention to increase participation in the NBCSP. The results will inform decisions about the need for and design of a larger, multi-state trial of this SMS intervention to determine its cost-effectiveness and future implementation. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12620001020976. Registered on 17 October 2020.

Effectiveness of mobile text reminder in improving adherence to medication, physical exercise, and quality of life in patients living with HIV: a systematic review

Background Mobile text reminder (SMS) system is considered a viable strategy for targeting/facilitating healthy behavioural change including adherence to prescribed physical exercises (PE) and medication (antiretroviral therapy-ART) which should improve the quality of life (Qol) in people living with HIV/AIDS(PLWHA). Thus, the literature was appraised for evidence of SMS effectiveness in improving ART and PE adherence behaviours and QoL in PLWHA. Methods Eight databases–AMED, CINAHL, Cochrane Library, EMBASE, EMCARE, Ovid MEDLINE, PsycINFO, and PubMed-were searched up to December 2020, using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol.This review included only randomised control trials (RCTs) investigating the effectiveness of SMS in improving QoL or PE or ART adherence behaviour or a combination of these variables in PLWHA >18 years. Two independent reviewers determined the eligibility of the studies. Data were extracted and the quality of the study was assessed with the Physiotherapy Evidence Database (PEDro) tool. The primary outcomes were ART and PE adherence behaviours while the secondary outcome was QoL. Result A pooled estimate of effect was not calculated due to the heterogeneity of methods and outcome measures. Therefore, a narrative synthesis of ten studies that met the inclusion criteria (n = 1621 participants at study completion) comprising males/females, aged ≥ 18 years, was done. There was a significant improvement in ART adherence behaviour except in three underpowered studies. Only the SMS interventions that were developed using the Starks 3-steps Adherence model was associated with positive outcome. The only study that evaluated QoL was underpowered and reported no significant change while there were no RCTs on PE. Conclusion Effects of SMS intervention trends towards a significant improvement in ART adherence behaviour in PLWHA. It is plausible that SMS reminders developed using the broader framework of the interpersonal health behaviour theory(ies) may have positive outcome. Nevertheless, the observed heterogeneity in the methods/outcome measures warrants a cautious interpretation of the findings. There is a lack/paucity of RCTs and therefore no evidence in support of the effectiveness of SMS intervention in improving PE adherence and QoL. Registration number NPLASY202060016.

The SMARTscreen Trial: A Randomised Controlled Trial Investigating The Efficacy of a GP-Endorsed Narrative SMS To Increase Participation in The Australian National Bowel Cancer Screening Program.

Background: Increasing participation in the Australian National Bowel Cancer Screening Program (NBCSP) is the most efficient and cost-effective way of reducing mortality associated with colorectal cancer by detecting and treating early-stage disease. Currently only 44% of Australians aged 50 -74 years complete the NBCSP. This efficacy trial aims to test whether this SMS intervention is an effective method for increasing participation in the NBCSP. Furthermore, a process evaluation will explore the barriers and facilitators to sending the SMS from general practice.Methods: We will recruit 20 general practices in the western region of Victoria, Australia to participate in a cluster randomised controlled trial. General practices will be randomly allocated with a 1:1 ratio to either a control or intervention group. Established general practice software will be used to identify patients aged 50 to 60 years old who are due to receive a NBCSP kit in the next month. The SMS intervention includes GP endorsement and links to narratives messages about the benefits of and instructions on how to complete the NBCSP kit. It will be sent from intervention general practices to eligible patients prior to receiving the NBCSP kit. We require 1400 eligible patients to provide 80% power with two-sided 5% significance level to detect a 10% increase in CRC screening participation in the intervention group compared to control group. Our primary outcome is the difference in the proportion of eligible patients who completed a faecal occult blood test (FOBT) between the intervention and control group for up to twelve months after the SMS was sent, as recorded in their electronic medical record (EMR). A process evaluation using interview data collected from general practice staff (GP, practice managers, nurses) and patients will explore the feasibility and acceptability of sending and receiving a SMS to prompt completing a NBCSP kit.Discussion: This efficacy trial will provide initial trial evidence of the utility of an SMS narrative intervention to increase participation in the NBCSP. The results will inform decisions about the need for and design of a larger, multi-state trial of this SMS intervention to determine its cost-effectiveness and future implementationTrial registration: Australian New Zealand Clinical Trials Registry: ACTRN12620001020976, 17th October 2020

TAILORING EVIDENCE-BASED INTERVENTIONS TO REDUCE METHAMPHETAMINE USE AMONG HIV-POSITIVE PATIENTS ON METHADONE IN HO CHI MINH, VIETNAM

This study evaluated the effectiveness of evidence-based intervention to reduce methamphetamine (MET) use among HIV-positive users in Ho Chi Minh. A total of 236 HIV-positive patients were screened, 71 (30.1%) met the inclusion criteria and 51 (71.8%) were enrolled. Of those enrolled, 49 completed 12 weeks of the intervention, most (?%) of whom used amphetamine-type substances at moderate or higher risk of dependence. The intervention reduced the rate of positive urine MET tests from 54.9% to 12.5%. Participants at intermediate risk for MET (93.1%) were significantly more likely to respond to positive behavior management during the first 6 weeks than participants at high-risk (6.9%, p=0.01). The responder group with positive behavioral management (n=29, 56.8%) received phone/SMS intervention during the latter six weeks of the study and were able to maintain negative urine drug tests. In the non-responder group (n=20), there was no significant difference between the group receiving the Matrix intervention and the group receiving the Matrix intervention in combination with positive behavior management. At the end of the study, 31% of responders and 35% of non-responders had viral loads below the detectable threshold. The results of the study suggest that an evidence-based intervention can reduce the MET use among HIV-positive methadone patients. More studies with larger sample size are needed to better evaluate the effectiveness of interventions as well as their feasibility for widespread adoption.

Patient-Physician Communication in Depression

Optimizing clinical communication between patients and health professionals is a major demand, particularly in mental health; the use of digital media is creating new opportunities in this field. Messaging services can be particularly useful to enhance communication with patients with depression, between consultations, allowing the delivery of supportive messages or reminders. This paper discusses this scenario and describes a four-stage study: (1) a diagnosis of perspectives and practices, (2) a six-week SMS intervention plan, (3) a prototype of a digital application to support patients' follow-up and interaction, (4) and a survey on physicians' digital experience and predisposition to use the prototype. Results underline the potential of using messaging systems to improve communication between health professionals and patients with depression, namely when these systems are part of blended-interventions. Further research is needed, particularly regarding the adjustment of these solutions to specific target groups.

Effectiveness of mobile short messaging services to improve parent’s knowledge, attitude and practice on drowning prevention in Bangladesh (Preprint)

BACKGROUND Drowning is the leading cause of death in children aged one year and over in Bangladesh. Drowning rates in Bangladesh are 10 to 20 times the rates of child drowning in developed countries. OBJECTIVE The aim of this to test the effectiveness of a mobile SMS intervention to improve the knowledge, attitude, and practices of parents of children aged under five concerning the prevention of drowning. METHODS Study Design: a cluster randomized community trial with 788 parents of children aged under five in a rural community of Bangladesh. Methods: Intervention: Mobile SMS intervention for parents of children under five years concerning the prevention of drowning. Outcome: differences in knowledge, attitude and practices of parents concerning the prevention of drowning between the baseline and immediate follow-up after the intervention, and after three months. RESULTS There was a significant improvement in knowledge in the intervention group compared to the control group at different time points [baseline: F(1, 787) = 0.33, ρ-value = 0.56; immediately after intervention: F(1, 772) = 2989.25, ρ-value = 0.001; 3-months after intervention F(1, 761) = 4591.33, ρ-value = 0.001]. Similarly, there was an improvement in the positive attitude and good practices of parents on prevention of drowning. There were significant main effect for group [F(1, 379) = 5084.81, ρ-value = 0.001], time [F(1, 379) = 5786.11, ρ-value = 0.001], and group and time interaction [F(1, 331) = 2425.33, ρ-value = 0.001] in terms of the drowning prevention knowledge of parents. Similarly, the main effects for group, time, and group and time interaction for drowning prevention attitude and drowning prevention practices of parents were also significant. CONCLUSIONS The mobile based SMS intervention developed was effective in improving the knowledge, attitude, and practices of parents of children aged under five concerning drowning prevention in a rural community of Bangladesh. CLINICALTRIAL ISRCTN13774693