The Impact of Text Message Reminders on Adherence to Antimalarial Treatment in Northern Ghana: A Randomized Trial

Abstract

BackgroundLow rates of adherence to artemisinin-based combination therapy (ACT) regimens increase the risk of treatment failure and may lead to drug resistance, threatening the sustainability of current anti-malarial efforts. We assessed the impact of text message reminders on adherence to ACT regimens.MethodsHealth workers at hospitals, clinics, pharmacies, and other stationary ACT distributors in Tamale, Ghana provided flyers advertising free mobile health information to individuals receiving malaria treatment. The messaging system automatically randomized self-enrolled individuals to the control group or the treatment group with equal probability; those in the treatment group were further randomly assigned to receive a simple text message reminder or the simple reminder plus an additional statement about adherence in 12-hour intervals. The main outcome was self-reported adherence based on follow-up interviews occurring three days after treatment initiation. We estimated the impact of the messages on treatment completion using logistic regression.Results1140 individuals enrolled in both the study and the text reminder system. Among individuals in the control group, 61.5% took the full course of treatment. The simple text message reminders increased the odds of adherence (adjusted OR 1.45, 95% CI [1.03 to 2.04], p-value 0.028). Receiving an additional message did not result in a significant change in adherence (adjusted OR 0.77, 95% CI [0.50 to 1.20], p-value 0.252).ConclusionThe results of this study suggest that a simple text message reminder can increase adherence to antimalarial treatment and that additional information included in messages does not have a significant impact on completion of ACT treatment. Further research is needed to develop the most effective text message content and frequency.Trial RegistrationClinicalTrials.gov NCT01722734

Impact of a Text-Messaging Program on Adolescent Reproductive Health: A Cluster–Randomized Trial in Ghana

“…10 Text-messaging programs offer a promising new platform to improve sexual and reproductive health, in particular among adolescents, by providing information in a private and confidential way. The past decade has seen a rapid rise in text-messaging programs that aim to improve health [11][12][13] ; however, systematic reviews have consistently found a dearth of high-quality peer-reviewed studies examining outcomes of these programs in LMICs. [14][15][16][17] Despite a large number of recent projects leveraging mobile technology among adolescent populations in LMICs, none of these employs a randomized trial design to provide evidence of effectiveness.…”

Can Rapid Diagnostic Testing for Malaria Increase Adherence to Artemether–Lumefantrine?: A Randomized Controlled Trial in Uganda

“…private retail sector. 8,18,45 (There was no evidence that adherence increased over the course of the study, which suggests that Hawthorne effects were relatively minor in this sample.) We also found that a positive result on the RDT did not significantly increase adherence to AL, not even among young children for whom the risk of malaria mortality is highest.…”

“…For example, patients may not understand how to correctly take the medication, 45,56-60 they may forget to take their pills, 18,56,58,59 they may be saving some pills for a future malaria episode, 45,56 or they may stop taking the medication once they feel better. 61,62 In our study, we found no relationship between literacy or education and adherence, and we also found that 91% of patients took the first two doses of AL with the correct number of pills at approximately the correct time (data not shown).…”

“…[13][14][15][16] A variety of interventions have been tested to increase adherence rates to ACTs with moderate degrees of success across different contexts. [17][18][19][20] We hypothesized that an important driver of nonadherence is diagnostic uncertainty, as few patients with suspected malaria receive diagnostic confirmation of malaria via blood test. 1,21,22 At the time of the study, malaria diagnostic testing was available in 35% of public health facilities in Uganda (4% had rapid diagnostic tests [RDTs]), 47% of private facilities, and 4% of private drug shops.…”

Mobile phone use among female entertainment workers in Cambodia: an observation study

“…mHealth, or mobile health, projects have shown to be increasingly successful in developing countries. Collecting health data (8)(9)(10), increasing access to health knowledge (11)(12)(13)(14), promoting provider quality (15)(16)(17), and increasing medication/appointment adherence (18)(19)(20) are a few ways in which mobile phones have successfully been used in developing countries to support health. In addition, rigorous evaluations have demonstrated mobile phone messages to be successful in supporting preventative healthcare (8,14,18,21,22) such as chronic disease prevention in Seychelles (23).…”