mHealth intervention development to support patients with active tuberculosis

Iribarren, Sarah J.; Beck, Susan L.; Pearce, Patricia F.; Chirico, Cristina; Etchevarria, Mirta; Rubinstein, Fernando

doi:10.7309/jmtm.3.2.4

Cited by 20 publications

(14 citation statements)

References 36 publications

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“…This is so in particular to sustain the existing DOT, reduced in reality from “daily” to “weekly” or even fewer directly observed strategies. These suggestions are an addition to this study [ 19 ] and highlights steps, processes and considerations to take into account in order to develop an SMS-based intervention for promoting adherence to TB treatment.…”

Section: Discussionmentioning

confidence: 99%

SMS reminders to improve adherence and cure of tuberculosis patients in Cameroon (TB-SMS Cameroon): a randomised controlled trial

et al. 2018

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BackgroundIn Cameroon, the National Tuberculosis Control Program that applies selective directly observed treatments faces difficulties in its implementation for a lack of resources, leading to only 65% of patients with sputum smear-positive pulmonary tuberculosis being cured after 6 months of treatment. This study aimed to evaluate the effectiveness of daily Short Message Service reminders to increase adherence and the proportion of adult tuberculosis patients cured after 6 months of treatment.MethodsA simple blinded, randomised controlled, multicentre study carried out in 12 Treatment and Diagnostic Centres of Yaoundé. The patients included were randomly assigned to two groups: patients in the intervention group received daily SMS reminders in addition to the usual treatment; those in the control group received the usual treatment only. The primary outcomes were the number and proportion of treatment success at 5 months, and the number and proportion of patients cured at 6 months. Data analysis was by intention to treat.ResultsTwo hundred and seventy-nine participants were randomized into intervention group (n = 137) and control group (n = 142). At five months, there were 111 treatment success (81%) in the intervention group and 106 (74.6%) in the control group (OR = 1.45 [0.81, 2.56]; p = 0.203). At 6 months, there were 87 patients cured (63.5%) in the intervention group and 88 (62%) in the control group (OR = 1.06 [0.65, 1.73]; p = 0.791). The number of drop-outs at 6 months was 47 (34.3%) in intervention group, and 46 (32.4%) in the control group. 48.9% (23/47) and 39.1% (18/46) of these drop-outs were sputum-negative at 5 months. At three different appointments, there were no significant differences between the two groups in any secondary outcomes. Very high and similar satisfaction was found for general management of patients in both groups: 99.5 and 99.2% (p = 0.41).ConclusionsOur study suggests that SMS reminders do not increase treatment success and cure proportions. However, the low proportion of patients cured at 6 month may be an underestimation due to a high dropout rate between the fifth and the sixth months of treatment. Future trials should focus on reducing the dropout rate.Trial registrationThe trial was registered on the Pan-African Clinical Trials Registry (PACTR201307000583416 of 22 July 2013) and the protocol was published.

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Section: Discussionmentioning

confidence: 99%

SMS reminders to improve adherence and cure of tuberculosis patients in Cameroon (TB-SMS Cameroon): a randomised controlled trial

et al. 2018

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“…The TextTB intervention pilot study occurred from December 2011 through April 2013. Details of that study are reported elsewhere [ 30 , 34 ]. In brief, participants were randomized to the intervention group (TextTB, n=18) or control group (paper documentation, n=19) for the first 2 months of active TB treatment.…”

Section: Methodsmentioning

confidence: 99%

“…They received confirmation that their text messages were received, or they received query messages if they failed to send notifications. They also received twice weekly educational text messages that were based on the Information-Motivation-Behavior skills model [ 34 - 36 ]. The team members were the study principal investigator (PI), a regional TB director/pulmonologist, the lead regional TB social worker, a regional TB staff member, two TB-specialized clinic registered nurses (RNs), and the hospital TB program director/pulmonologist.…”

Section: Methodsmentioning

confidence: 99%

Qualitative Evaluation of a Text Messaging Intervention to Support Patients With Active Tuberculosis: Implementation Considerations

Iribarren¹,

Sward²,

Beck³

et al. 2015

JMIR mHealth uHealth

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BackgroundTuberculosis (TB) remains a major global public health problem and mobile health (mHealth) interventions have been identified as a modality to improve TB outcomes. TextTB, an interactive text-based intervention to promote adherence with TB medication, was pilot-tested in Argentina with results supporting the implementation of trials at a larger scale.ObjectiveThe objective of this research was to understand issues encountered during pilot-testing in order to inform future implementation in a larger-scale trial.MethodsA descriptive, observational qualitative design guided by a sociotechnical framework was used. The setting was a clinic within a public pulmonary-specialized hospital in Argentina. Data were collected through workflow observation over 115 days, text messages (n=2286), review of the study log, and stakeholder input. Emerging issues were categorized as organizational, human, technical, or sociotechnical considerations.ResultsIssues related to the intervention included workflow issues (eg, human, training, security), technical challenges (eg, data errors, platform shortcomings), and message delivery issues (eg, unintentional sending of multiple messages, auto-confirmation problems). System/contextual issues included variable mobile network coverage, electrical and Internet outages, and medication shortages.ConclusionsIntervention challenges were largely manageable during pilot-testing, but need to be addressed systematically before proceeding with a larger-scale trial. Potential solutions are outlined. Findings may help others considering implementing an mHealth intervention to anticipate and mitigate certain challenges. Although some of the issues may be context dependent, other issues such as electrical/Internet outages and limited resources are not unique issues to our setting. Release of new software versions did not result in solutions for certain issues, as specific features used were removed. Therefore, other software options will need to be considered before expanding into a larger-scale endeavor. Improved automation of some features will be necessary, however, a goal will be to retain the intervention capability to be interactive, user friendly, and patient focused. Continued collaboration with stakeholders will be required to conduct further research and to understand how such an mHealth intervention can be effectively integrated into larger health systems.

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“…Importantly, we utilized a multidisciplinary research team to design and test the GEM tool and intervention. Thus, although the GEM intervention was developed at a single site, we believe that the diverse training and perspectives of our team were key to developing a complex intervention that is widely applicable and has the potential to be implemented and easily tailored to other VA sites and other healthcare settings more broadly [ 83 , 84 ].…”

Section: Limitationsmentioning

confidence: 99%

Development of a 5As-based technology-assisted weight management intervention for veterans in primary care

Mateo

Berner

Ricci

et al. 2018

BMC Health Serv Res

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Background: Obesity is a worldwide epidemic, and its prevalence is higher among Veterans in the United States. Based on our prior research, primary care teams at a Veterans Affairs (VA) hospital do not feel well-equipped to deliver effective weight management counseling and often lack sufficient time. Further, effective and intensive lifestyle-based weight management programs (e.g. VA MOVE! program) are underutilized despite implementation of systematic screening and referral at all VA sites. The 5As behavior change model (Assess, Advise, Agree, Assist, Arrange) is endorsed by the United States Preventive Service Task Force for use in counseling patients about weight management in primary care and reimbursed by Medicare. In this paper, we describe the iterative development of a technology-assisted intervention designed to provide primary care-based 5As counseling within Patient-Centered Medical Homes without overburdening providers/healthcare teams. Methods: Thematic analyses of prior formative work (focus groups with patients [n = 54] and key informant interviews with staff [n = 25]) helped to create a technology-assisted, health coaching intervention called Goals for Eating and Moving (GEM). To further develop the intervention, we then conducted two rounds of testing with previous formative study participants (n = 5 for Round 1, n = 5 for Round 2). Each session included usability testing of prototypes of the online GEM tool, pilot testing of 5As counseling by a Health Coach, and a post-session openended interview.

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mHealth intervention development to support patients with active tuberculosis

Cited by 20 publications

References 36 publications

SMS reminders to improve adherence and cure of tuberculosis patients in Cameroon (TB-SMS Cameroon): a randomised controlled trial

SMS reminders to improve adherence and cure of tuberculosis patients in Cameroon (TB-SMS Cameroon): a randomised controlled trial

Qualitative Evaluation of a Text Messaging Intervention to Support Patients With Active Tuberculosis: Implementation Considerations

Development of a 5As-based technology-assisted weight management intervention for veterans in primary care

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