SMS messages increase adherence to rapid diagnostic test results among malaria patients: results from a pilot study in Nigeria

Abstract

BackgroundThe World Health Organization now recommends parasitological confirmation for malaria case management. Rapid diagnostic tests (RDTs) for malaria are an accurate and simple diagnostic to confirm parasite presence in blood. However, where they have been deployed, adherence to RDT results has been poor, especially when the test result is negative. Few studies have examined adherence to RDTs distributed or purchased through the private sector.MethodsThe Rapid Examination of Malaria and Evaluation of Diagnostic Information (REMEDI) study assessed the acceptability of and adherence to RDT results for patients seeking care from private sector drug retailers in two cities in Oyo State in south-west Nigeria. In total, 465 adult participants were enrolled upon exit from a participating drug shop having purchased anti-malaria drugs for themselves. Participants were given a free RDT and the appropriate treatment advice based on their RDT result. Short Message Service (SMS) text messages reiterating the treatment advice were sent to a randomly selected half of the participants one day after being tested. Participants were contacted via phone four days after the RDT was conducted to assess adherence to the RDT information and treatment advice.ResultsAdherence to RDT results was 14.3 percentage points (P-val <0.001) higher in the treatment group who were sent the SMS. The higher adherence in the treatment group was robust to several specification tests and the estimated difference in adherence ranged from 9.7 to 16.1 percentage points. Further, the higher adherence to the treatment advice was specific to the treatment advice for anti-malarial drugs and not other drugs purchased to treat malaria symptoms in the RDT-negative participants who bought both anti-malarial and symptom drugs. There was no difference in adherence for the RDT-positive participants who were sent the SMS.ConclusionsSMS text messages substantially increased adherence to RDT results for patients seeking care for malaria from privately owned drug retailers in Nigeria and may be a simple and cost-effective means for boosting adherence to RDT results if and when RDTs are introduced as a commercial retail product.

Does Message-Based Communication Through Mobile Phones for Medication and Treatment Adherence Improve Health Outcomes? A Systematic Review

“…After four days the participants were called via phone to assess if they had adhered to the Rapid Examination of Malaria and Evaluation of Diagnostic Information (REMEDI) and treatment advice. There was higher adherence among the intervention group and more so on malaria treatment on which participants had been advised on [35]. Through a smart phone app, the study aimed at users' self-efficacy by encouraging the users to rehearse their weight loss goals and reinforce positive behavioural beliefs (about competence, confidence, and mastery).…”

Evaluation of SMS reminder messages for altering treatment adherence and health seeking perceptions among malaria care-seekers in Nigeria

“…One day after having a RDT administered, participants in the overarching RDT acceptability study were randomized to either (1) receive a basic SMS reminder repeating the RDT result and appropriate treatment actions as had been done in the prior Oyo State study (see Modrek et al 2014), (2) receive an expanded SMS reminder that additionally indicated that the ‘government might allow pharmacists/chemists to do RDTs’ or (3) a control arm that did not receive any SMS reminders. A 1-day lag was chosen to coincide with when most individuals would be taking the second dose of their anti-malarial drug if they had followed proper dosage instructions.…”

“…Recognizing the importance of replicability and concerns over the external validity of RCT interventions, we attempt to replicate a previous study focusing on malaria diagnosis and treatment, which examined patients’ use of artemisinin-based combination therapy (ACTs) after having been given a malaria rapid diagnostic test (RDT) when purchasing anti-malarial treatments at retail drug shops in Nigeria (Modrek et al 2014). The previous study took place in an urban and peri-urban area in Oyo State, among the wealthiest and most educated states in Nigeria (Nigeria and ICF International 2012), and included only adults.…”

“…Thus, message reminders for malaria treatment adherence after RDT diagnosis were first developed to reinforce behaviour change (i.e. away from presumptive treatment) and appropriate treatment behaviours in accordance with the diagnostic result (Modrek et al 2014). Further, given the policy consideration, understanding the acceptability of RDTs given by drug retailers is another important outcome that could be shaped by appropriate messaging.…”

“…This study was designed to directly build on our previous study in Oyo State (Isiguzo et al 2014, Modrek et al 2014) in three specific ways: (1) replicate the SMS reminder intervention that was piloted within a specific urban, adult population in a more generalizable setting (including rural areas), (2) expand the study population to include children and (3) test the effect of expanded message content that adds language about anticipated policy change for RDT availability on customers’ acceptance of drug retailers’ administration of RDTs. The overarching objective was to identify message content and frames that would both encourage treatment adherence across the general population and increase awareness of RDT diagnostic capabilities among frequented drug shop vendors in anticipation of policy change.…”