Using behavioural insights to increase HIV self‐sampling kit returns: a randomized controlled text message trial to improve England's HIV self‐sampling service

Abstract

ObjectivesThe aim of the study was to determine whether behaviourally informed short message service (SMS) primer and reminder messages could increase the return rate of HIV self‐sampling kits ordered online.MethodsThe study was a 2 × 2 factorial design randomized control trial. A total of 9585 individuals who ordered a self‐sampling kit from http://www.freetesting.hiv different SMS combinations: 1) standard reminders sent days 3 and 7 after dispatch (control); 2) primer sent 1 day after dispatch plus standard reminders; 3) behavioural insights (BI) reminders (no primer); or 4) primer plus BI reminders. The analysis was restricted to individuals who received all messages (n = 8999). We used logistic regression to investigate independent effects of the primer and BI reminders and their interaction. We explored the impact of sociodemographic characteristics on kit return as a secondary analysis.ResultsThose who received the primer and BI reminders had a return rate 4% higher than that of those who received the standard messages. We found strong evidence of a positive effect of the BI reminders (odds ratio 1.13; 95% confidence interval 1.04–1.23; P = 0.003) but no evidence for an effect of the primer, or for an interaction between the two interventions. Odds of kit return increased with age, with those aged ≥ 65 years being almost 2.5 times more likely to return the kit than those aged 25–34 years. Men who have sex with men were 1.5–4.5 times more likely to return the kit compared with other sexual behaviour and gender identity groups. Non‐African black clients were 25% less likely to return the kit compared with other ethnicities.ConclusionsAdding BI to reminder messages was successful in improving return rates at no additional cost.

Online self-sampling kits to screen multipartner MSM for HIV and other STIs: participant characteristics and factors associated with kit use in the first 3 months of the MemoDepistages programme, France, 2018

“…The acceptance process is crucial in defining the profile of participants, as it was strongly associated with individual sociodemographic characteristics. As previously found, a young age and high school diploma were associated with a better overall participation rate [7,12]. Men aged under 30 years had a better acceptance rate in our study, which impacts their overall participation, even if they returned the kit at the same rate as older participants.…”

“…Several studies have analyzed the factors associated with HIV SSKs use, showing that users have a higher education level, better income, and are younger [7,9] than those who do not use it. Compared to heterosexual men, MSM also tend to be more willing to use such services [7,[9][10][11][12][13][14][15]. Most SSKs propose blood sampling for HIV screening or local sampling for Ct/Ng screening.…”

Pre-notification and reminder SMS text messages with behaviourally informed invitation letters to improve uptake of NHS Health Checks: a factorial randomised controlled trial

“…The most effective combination was the behaviourally informed primers and reminders compared to standard remindersa 4 percentage point increase was observed. But, like the present study, despite a primer (or pre-notification) being included in the most effective combination, further analysis demonstrated that only the behaviourally informed reminders were independently effective and not the primers [38].…”

“…Reminders also suggest proactive behaviour to book an appointment whereas there are no direct actions associated with pre-notifications. The authors of another recent factorial study explored combinations of behaviourally informed pre-notification and reminder texts to increase return of self-sampling HIV kits [38]. The most effective combination was the behaviourally informed primers and reminders compared to standard remindersa 4 percentage point increase was observed.…”

An exploratory randomised controlled trial evaluating text prompts in Lebanon to encourage health‐seeking behaviour for hypertension

“…However, when the reminder prompts should be sent and what the reminder prompts should say is debated. Other studies suggest that reminder prompts that prime positive social norms 36 or that increase people's knowledge of supportive information 37 may encourage health behaviour better than text messages without such behaviourally informed content. What the reminder prompt should say in each study could be decided after considering the specific barriers of and facilitators to the desired behaviour using a diagnostic tool, like the COM‐B model 38 …”