BackgroundAdequate antenatal care is important to both the health of a pregnant woman and her unborn baby. Given South Africa’s high rate of cellphone penetration, mobile health interventions have been touted as a potentially powerful means to disseminate health information. This study aimed to increase antenatal health knowledge and awareness by disseminating text messages about clinic procedures at antenatal visits, and how to be healthy during pregnancy.MethodsParticipants recruited were pregnant women attending a primary health care facility in Cape Town. A controlled clinical trial was carried out where the intervention group (n = 102) received text messages staggered according to the week of pregnancy at the time of recruitment. The control group (n = 104) received no text messages. These text messages contained antenatal health information, and were delivered in English, Xhosa or Afrikaans, according to the preference of each participant. A baseline knowledge questionnaire with nine questions was administered prior to the intervention. The same questionnaire was used with added health-related behaviour questions for the intervention group at exit. A modified intention-to-treat analysis was done. To compare the control and intervention group’s knowledge, Fisher’s exact tests and two-sample t-tests tests were carried out for binary and continuous outcomes, respectively. A focus group of seven participants from the intervention group was then conducted to gain more insight into how the text messages were perceived.ResultsThere was substantial loss to follow-up during the study with only 57% of the participants retained at exit. No statistically significant difference was detected between the control and intervention group in any of the nine knowledge questions at exit (all p > 0.05). Responses from the focus group indicated that the text messages acted as a welcome reminder and a source of positive motivation, and were perceived as extended care from the health care provider.ConclusionsWhile the intervention failed to improve antenatal health knowledge, evidence from self-reported behaviour and the focus group suggests that text messages have the potential to motivate change in health-seeking behaviour. One should be mindful of loss to follow-up when rolling out mobile health interventions in developing country settings.Trial registrationPan African Clinical Trials Registry PACTR201406000841188. Registered 3 June 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-284) contains supplementary material, which is available to authorized users.
Background In the U.S., where coronary heart disease (CHD) is the leading cause of mortality, CHD risk assessment is a priority and accurate blood pressure (BP) measurement is essential. Methods Hypertension estimates in the National Longitudinal Study of Adolescent Health (Add Health), Wave IV (2008)—a nationally-representative field study of 15,701 participants aged 24–32—was referenced against NHANES (2007–2008) participants of the same age. We examined discordances in hypertension, and estimated the accuracy and reliability of blood pressure in the Add Health study. Results Hypertension rates (BP ≥ 140/90 mm Hg) were higher in Add Health compared with NHANES (19% versus 4%), but self-reported history was similar (11% versus 9%) among adults aged 24–32. Survey weights and adjustments for differences in participant characteristics, examination time, use of anti-hypertensive medications, and consumption of food/caffeine/cigarettes before blood pressure measurement had little effect on between-study differences in hypertension estimates. Among Add Health participants interviewed and examined twice (full and abbreviated interviews), blood pressure was similar, as was blood pressure at the in-home and in-clinic exams conducted by NHANES III (1988–1994). In Add Health, there was minimal digit preference in blood pressure measurements; mean bias never exceeded 2 mm Hg; and reliability (estimated as intra-class correlation coefficients) was 0.81 and 0.68 for systolic and diastolic BPs, respectively. Conclusions The proportion of young adults in NHANES reporting a history of hypertension was twice that with measured hypertension, whereas the reverse was found in Add Health. Between-survey differences were not explained by digit preference, low validity, or reliability of Add Health blood pressure data, or by salient differences in participant selection, measurement context, or interview content. The prevalence of hypertension among Add Health Wave IV participants suggests an unexpectedly high risk of cardiovascular disease among U.S. young adults and warrants further scrutiny.
Introduction Informed decision making has been highlighted as an important aspect of lung cancer screening programs. This study seeks to assess the efficacy of a web-based patient decision aid for lung cancer screening, www.shouldiscreen.com. Methods A before-and-after study (August through December 2014) was conducted where participants navigated a web-based decision aid that provided information about low-dose computed tomography lung cancer screening. Using an established prediction model, the decision aid computed baseline lung cancer risk and an individual’s chances of benefiting from, and risk of being harmed by, screening. Outcome measures included knowledge of lung cancer risk factors and lung cancer screening, decisional conflict, concordance, and acceptability of the decision aid. Data were collected from 60 participants who were current or former smokers, had no history of lung cancer, and had not received a chest computed tomographic scan in the previous year. Analysis took place in 2015. Results Knowledge increased after seeing the decision aid compared with before (p<0.001), whereas the score on the Decisional Conflict Scale decreased (p<0.001). Concordance between a participant’s preference to screen and the U.S. Preventive Services Task Force recommendation improved after seeing the decision aid (p<0.001). Risk perceptions among the screen-ineligible group changed (n=49), contrary to those who were eligible (n=11). Ninety-seven percent of the participants reported that the decision aid was likely useful for lung cancer screening decision making. Conclusions The web-based decision aid should be a helpful resource for individuals considering lung cancer screening, as well as for practitioners and health systems with lung cancer screening programs.
Introduction: The objective of this study was to investigate the association between state-level publicly expressed sentiment towards racial and ethnic minorities and birth outcomes for mothers who gave birth in that state. Methods: We utilized Twitter’s Streaming Application Programming Interface (API) to collect 1,249,653 tweets containing at least one relevant keyword pertaining to a racial or ethnic minority group. State-level derived sentiment towards racial and ethnic minorities were merged with data on all 2015 U.S. births (N=3.99 million singleton births). Results: Mothers living in states in the lowest tertile of positive sentiment towards racial/ethnic minorities had greater prevalences of low birth weight (+6%), very low birth weight (+9%), and preterm birth (+10%) compared to mothers living in states in the highest tertile of positive sentiment, controlling for individual-level maternal characteristics and state demographic characteristics. Sentiment towards specific racial/ethnic groups showed a similar pattern. Mothers living in states in the lowest tertile of positive sentiment towards blacks had an 8% greater prevalence of low birth weight and very low birth weight, and a 16% greater prevalence of preterm birth, compared to mothers living in states in the highest tertile. Lower state-level positive sentiment towards Middle Eastern groups was also associated with a 4–13% greater prevalence of adverse birth outcomes. Results from subgroup analyses restricted to racial/ethnic minority mothers did not differ substantially from those seen for the full population of mothers. Conclusions: More negative area-level sentiment towards blacks and Middle Eastern groups was related to worse individual birth outcomes, and this is true for the full population and minorities.
BackgroundThe use of mobile phones to deliver health care (mHealth) is increasing in popularity due to the high prevalence of mobile phone penetration. This is seen in developing countries, where mHealth may be particularly useful in overcoming traditional access barriers. Non-communicable diseases may be particularly amenable to mHealth interventions, and hypertension is one with an escalating burden in the developing world.ObjectiveThe objective of this study was to test whether the dissemination of health information via a short message service (SMS) led to improvements in health knowledge and self-reported health-related behaviors.MethodsA mixed methods study was carried out among a cohort of 223 hypertension clinic patients, in a resource-poor setting in Cape Town, South Africa, in 2012. Hypertensive outpatients were recruited at the clinic and administered a baseline questionnaire to establish existing knowledge of hypertension. Participants were then randomly assigned to intervention or control groups. The intervention group received 90 SMSes over a period of 17 weeks. Thereafter, the baseline questionnaire was readministered to both groups to gauge if any improvements in health knowledge had occurred. Those who received SMSes were asked additional questions about health-related behavior changes. A focus group was then conducted to obtain in-depth feedback about participants’ experience with, and response to, the SMS campaign.ResultsNo statistically significant changes in overall health knowledge were observed between the control and intervention groups. The intervention group had positive increases in self-reported behavior changes. These were reaffirmed by the focus groups, which also revealed a strong preference for the SMS campaign and the belief that the SMSes acted as a reminder to change, as opposed to providing new information.ConclusionsAlthough the content of the SMSes was not new, and did not improve health knowledge, SMSes were effective in motivating positive self-reported behavior change among hypertensive patients.Trial RegistrationPan African Clinical Trials Registry Number: PACTR201412000968462. Registered 18 December 2014 (Archived by WebCite at http://www.webcitation.org/6fhtyLRcO).
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