Qualitative Analysis of Programmatic Initiatives to Text Patients with Mobile Devices in Resource-Limited Health Systems

Background

Text messaging is an affordable, ubiquitous, and expanding mobile communication technology. However, safety net health systems in the United States that provide more care to uninsured and low-income patients may face additional financial and infrastructural challenges in utilizing this technology. Formative evaluations of texting implementation experiences are limited. We interviewed safety net health systems piloting texting initiatives to study facilitators and barriers to real-world implementation.

Methods

We conducted telephone interviews with various stakeholders who volunteered from each of the eight California-based safety net systems that received external funding to pilot a texting-based program of their choosing to serve a primary care need. We developed a semi-structured interview guide based partly on the Consolidated Framework for Implementation Research (CFIR), which encompasses several domains: the intervention, individuals involved, contextual factors, and implementation process. We inductively and deductively (using CFIR) coded transcripts, and categorized themes into facilitators and barriers.

Results

We performed eight interviews (one interview per pilot site). Five sites had no prior texting experience. Sites applied texting for programs related to medication adherence and monitoring, appointment reminders, care coordination, and health education and promotion. No site texted patient-identifying health information, and most sites manually obtained informed consent from each participating patient. Facilitators of implementation included perceived enthusiasm from patients, staff and management belief that texting is patient-centered, and the early identification of potential barriers through peer collaboration among grantees. Navigating government regulations that protect patient privacy and guide the handling of protected health information emerged as a crucial barrier. A related technical challenge in five sites was the labor-intensive tracking and documenting of texting communications due to an inability to integrate texting platforms with electronic health records.

Conclusions

Despite enthusiasm for the texting programs from the involved individuals and organizations, inadequate data management capabilities and unclear privacy and security regulations for mobile health technology slowed the initial implementation and limited the clinical use of texting in the safety net and scope of pilots. Future implementation work and research should investigate how different texting platform and intervention designs affect efficacy, as well as explore issues that may affect sustainability and the scalability.

Full article at:   http://goo.gl/SAsnqs

By:  Sachin K. Garg, Courtney R. Lyles, Sara Ackerman, Margaret A. Handley, Dean Schillinger, Gato Gourley, Veenu Aulakh, and Urmimala Sarkar

Division of General Internal Medicine and Center for Vulnerable Populations at San Francisco General Hospital, University of California, San Francisco (UCSF), San Francisco, USA

Department of Social and Behavior Sciences, UCSF, San Francisco, USA

Center for Care Innovations, Oakland, USA

Department of Epidemiology and Biostatistics, UCSF, San Francisco, USA

Sachin K. Garg, Phone: (415) 353-7900, Email: ude.fscu@grag.nihcas.

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As Good As It Gets? Retention in Care of People Newly Diagnosed with HIV at the Sydney Sexual Health Centre

A retrospective review of all new HIV positive patients attending the Sydney Sexual Health Centre in 2012 and 2013 was performed to ascertain the retention in care rates, proportion that achieved viral suppression, number of SMS reminders sent and counselling uptake. 

• Ninety-six patients had a retention rate of 66%. 
• Thirty-three patients (34%) were not retained in care, 
• 16 (17%) were knowingly attending another healthcare service with 17 (18%) categorised as lost to follow up. 
• Counselling referrals had a 74% (71/96) uptake, with SMS reminders sent in 97% (93/96) of cases. 

Overall, the clinic performed well compared with international standards but the lost to follow-up rate remains a concern

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By:  Dominic Rowley A E, Amel Ahmed A, Anna McNulty A B, Lynne Wray A C and Vickie Knight A D 

A Sydney Sexual Health Centre, Nightingale Wing, Sydney Hospital, 8 Macquarie Street, Sydney, NSW 2000, Australia. B School of Public Health and Community Medicine, University of NSW Australia, Sydney, NSW 2052, Australia. C School of Women’s and Children’s Health, University of NSW Australia, NSW 2052, Australia. D The Kirby Institute, Wallace Wurth Building, University of NSW Australia, Sydney, NSW 2052, Australia. E Corresponding author. Email: dominicrowley@hotmail.com 

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Willingness to Receive Text Message Appointment Reminders among Patients with HIV Infection in China

BACKGROUND:

Wireless communication technologies are increasingly being used in the fields of healthcare, with platforms such as mobile health (mHealth) being widely implemented in HIV care. The rapid expansion of mobile technologies, including smartphone applications (apps), provides a unique opportunity to effectively remind patients about regular follow-up appointments, thereby ensuring patient retention and resulting in a higher quality of care for HIV patients.

PURPOSE:

This study examines mobile phone users' usage patterns, application usage, and challenges associated with the use of a mobile phone reminder system in order to improve retention in HIV care among patients.

METHODS:

A cross-sectional descriptive study was conducted to collect data on the usage and patterns of communication technologies from 405 patients.

RESULTS:

This study included 384 of the 405 eligible patients, resulting in a response rate of 94.8%. A majority of participants (73.3%) indicated their willingness to receive reminders via a text message regarding their upcoming HIV clinical appointments. After adjusting for sociodemographic and clinical variables, multiple logistic regression models indicated that the willingness to receive reminder messages was independently associated with having a college-level education (AOR = 2.06, 95% CI [1.05, 4.04]) and with having prior experience with using electronic reminders (AOR = 4.01, 95% CI [1.51, 10.66]).

CONCLUSIONS / IMPLICATIONS FOR PRACTICE:

Protection of personal information was identified as the most important factor that must be addressed in order to increase patient willingness to use a cell phone reminder system. Our findings suggest that mobile technologies are a widely used and an acceptable method for improving quality of care for HIV patients.

Abstract at:   http://goo.gl/btSRIN

By:  Pa YH1, Chen YC2, Hung CK3, Liu HY1, Lai YY1, Ko NY4.

• 1MSN, RN, HIV Case Manager, Department of Nursing, National Cheng Kung University Hospital, Taiwan, ROC.
• 2MSN, RN, Doctoral Student, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Taiwan, ROC.
• 3Undergraduate Program Student, Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan, ROC.
• 4PhD, RN, Professor, Department of Nursing, College of Medicine, National Cheng Kung University, and Deputy Director, Department of Nursing, National Cheng Kung University Hospital, Taiwan, ROC. nyko@mail.ncku.edu.tw. 
• Hu Li Za Zhi. 2016 Feb;63(1):59-67. doi: 10.6224/JN.63.1.59.

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The Acceptability and Perceived Usefulness of a Weekly Clinical SMS Program to Promote HIV Antiretroviral Medication Adherence in KwaZulu-Natal, South Africa

Short message service (SMS) text messages have been used to remind and encourage patients to take ART in research studies. However, few studies have assessed the feasibility and acceptability of SMS in routine clinical practice. 

We report patient perspectives on a weekly SMS adherence support program after implementation into clinical care at an HIV clinic in KwaZulu-Natal, South Africa. We conducted structured interviews with a cross-sectional convenience sample of 100 adult patients who were invited to join the program, 88 of whom had received a program SMS. 

Of these respondents, 81 (92 %) would recommend the program to a friend. Sixty-eight (77 %) felt the program helped them remember clinic appointments, a response associated with male gender [odds ratio (OR) 5.88, 95 % confidence interval (CI) 1.52-23.26, P = 0.011] and HIV disclosure outside the home [OR 3.40, 95 %CI 1.00-11.60, P = 0.050]. 

This clinical SMS adherence program was found to have high patient-perceived usefulness.

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By:  Georgette N1, Siedner MJ1,2,3, Zanoni B1,2,3, Sibaya T4, Petty CR5, Carpenter S6, Haberer JE7,8,9.

• 1Harvard Medical School, Boston, MA, USA.
• 2Center for Global Health, Massachusetts General Hospital, 100 Cambridge St, 15th Floor, Boston, MA, USA.
• 3Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
• 4University of KwaZulu-Natal, Durban, South Africa.
• 5Boston Children's Hospital, Boston, MA, USA.
• 6Don McKenzie Hospital, Botha's Hill, South Africa.
• 7Harvard Medical School, Boston, MA, USA. jhaberer@partners.org.
• 8Center for Global Health, Massachusetts General Hospital, 100 Cambridge St, 15th Floor, Boston, MA, USA. jhaberer@partners.org.
• 9Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. jhaberer@partners.org. 
• AIDS Behav. 2016 Jan 18.

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Willingness to Receive Text Message Medication Reminders among Patients on Antiretroviral Treatment in North West Ethiopia

Below:  Conceptual framework

A total of 415 (98 % response rate) respondents participated in the interview. The majority of respondents 316 (76.1 %) owned a cellphone, and 161(50.9 %) were willing to receive text message medication reminders. Positively associated factors to the willingness were the following: Younger age group (AOR = 5.18, 95 % CI: [1.69, 15.94]), having secondary or higher education (AOR = 4.61, 95 % CI: [1.33, 16.01]), using internet (AOR = 3.94, 95 % CI: [1.67, 9.31]), not disclosing HIV status to anyone other than HCP (Health Care Provider) (AOR = 3.03, 95 % CI: [1.20, 7.61]), availability of radio in dwelling (AOR = 2.74 95 % CI: [1.27, 5.88]), not answering unknown calls (AOR = 2.67, 95 % CI: [1.34, 5.32]), use of cellphone alarm as medication reminder (AOR = 2.22, 95%CI [1.09, 4.52]), and forgetting to take medications (AOR = 2.13, 95 % CI: [1.14, 3.96]).

A high proportion of respondents have a cell phone and are willing to use it as medication reminders. Age, educational status and using internet were the main factors that are significantly associated with the willingness of patients to receive text message medication reminders.

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