Acceptability and factors associated with willingness to receive short messages for improving antiretroviral therapy adherence in China

Abstract

This study aimed to understand the acceptability of short message service (SMS) as a reminder for improving antiretroviral therapy (ART) adherence and determine the factors associated with willingness to accept SMS among people living HIV (PLH) in China. A total of 801 adult patients were recruited in a cross-sectional survey. Factors associated with willingness in unadjusted analyses (α = 0.10) were included in a logistic regression model; 88.4% of the participants owned mobile phones, 49.6% read every short message and 16.2% read only if the phone number was familiar, 79.5% reported daily SMS to remind taking medicine would be helpful, and 68.9% were willing to receive them. In the final model, willingness to accept was positively associated with being young (odds ratio [OR] = 0.32; 95% confidence interval [CI]: 0.11-0.99; p = 0.048), living in the middle or north region (OR = 2.36; 95% CI: 1.24-4.50; p = 0.009, OR = 71.79; 95% CI: 21.53-239.37; p < 0.001, respectively), having primary or "junior or higher" education (OR = 5.80; 95% CI: 2.13-15.86; p = 0.001, OR = 3.20; 95% CI: 1.20-8.58; p = 0.021, respectively), having serious disease condition of stage (OR = 10.01; 95% CI: 2.12-47.30; p = 0.004), being a rural resident (OR = 2.96; 95% CI: 1.72-5.10; p < 0.001), having side effect (OR = 4.74; 95% CI: 1.24-18.03; p = 0.023), and taking a dose two or more hours late in the last 30 days (OR = 2.45; 95% CI: 1.26-4.78; p = 0.009). SMS as a reminder for improving ART adherence is acceptable. The survey results indicate that to be effective, messages need to be more acceptable to elderly patients, urban residents, individuals with earlier stage of HIV disease, and individuals not experiencing side effects. Nonetheless, these results suggest that for a high proportion of PLH in China, reminder messages through mobile phones would be useful for increasing compliance with HIV regimens.

Use of Technology to Improve Healthcare Outcomes is the Need of the Hour!

“…Those with education attainment above ordinary level (Form 4) (OR=2.2; p=0.13) were more likely to report a willingness to receive SMS reminders. These findings are consistent with what was reported by Xiaoab et. al.…”

“…38 Client satisfaction is a determinant of treatment uptake, adherence and retention, and an important health systems outcome. 34,35,36 Therefore, dissatisfaction with antiretroviral services could threaten attainment of anti-retroviral treatment objectives. 37 The provider needs to gain the confidence and trust of the client.…”

Meta-analysis on the effect of text message reminders for HIV-related compliance

“…Across multiple HIV clinics in Vietnam, 85% of patients used mobile phones, 79% found cell phone reminders an effective adherence aid, and 64 % expressed willingness-to-use the service with an average willingness-to-pay of $2.50 per month (Tran & Houston, 2012). In a cross-sectional survey of 801 Chinese people living with HIV, 88% of the participants owned mobile phones and 80% felt daily text reminders to take medication would be helpful (Xiao et al, 2014). …”

Cell Phone-Based and Adherence Device Technologies for HIV Care and Treatment in Resource-Limited Settings: Recent Advances

“…A large (N=301) study of caregivers of children with HIV in Cameroon (an acceptability study for the MORE CARE mHealth trial) similarly found high acceptability of SMS reminders for appointments [43]. Finally, a survey-based study from China found that SMS reminders would be acceptable and that, among other factors, participants who were younger and more highly educated were more accepting of the intervention [44].…”