Cluster Randomized Trial of Text Message Reminders to Retail Staff in Tanzanian Drug Shops Dispensing Artemether-Lumefantrine: Effect on Dispenser Knowledge and Patient Adherence

Abstract

Artemisinin combination therapies are available in private outlets, but patient adherence might be compromised by poor advice from dispensers. In this cluster randomized trial in drug shops in Tanzania, 42 of 82 selected shops were randomized to receive text message reminders about what advice to provide when dispensing artemether-lumefantrine (AL). Eligible patients purchasing AL at shops in both arms were followed up at home and questioned about each dose taken. Dispensers were interviewed regarding knowledge of AL dispensing practices and receipt of the malaria-related text messages. We interviewed 904 patients and 110 dispensers from 77 shops. Although there was some improvement in dispenser knowledge, there was no difference between arms in adherence measured as completion of all doses (intervention 68.3%, control 69.8%, p [adjusted] = 0.6), or as completion of each dose at the correct time (intervention 33.1%, control 32.6%, p [adjusted] = 0.9). Further studies on the potential of text messages to improve adherence are needed.

Health Worker mHealth Utilization

“…Seven articles studied communication between a health worker and patients, with the emphasis on improving health worker efficiency by saving travel time and gaining work time 11,12,22,25–28 . Texts focused on increasing access to skilled attendants at birth 26 , patient medication adherence 22,25 , appointment reminders 22,26 , and tracking patients 11,12 .…”

“…Texts focused on increasing access to skilled attendants at birth 26 , patient medication adherence 22,25 , appointment reminders 22,26 , and tracking patients 11,12 . There was greater improvement in urban areas as compared to rural areas in health outcomes for patients after a text message reminder intervention 26 , but this was not the case in a program directed at pharmacists to help their patients increase adherence through text 25 . Fuel savings and travel time-savings were substantial for both health worker and patient 22,27 , and it became easier to enroll patients into programs 22 .…”

“…As mentioned above, maintenance costs were minimal and programs usually resulted in cost savings, even when initial investment was high 16,32,39–41 . One article found no improvement in medication adherence after intervention 25 .…”

Impact of Text Message Reminders on Caregivers’ Adherence to a Home Fortification Program Against Child Anemia in Rural Western China: A Cluster-Randomized Controlled Trial

“…Factors identified as leading to the programs' failure included limited phone access, privacy concerns, phone maintenance, and text message content. [30][31][32] A recent literature review of text messaging's effect on health concluded that most studies were not carried out systematically. 33 Using a cluster RCT design, we aimed to test whether text message reminders sent to caregivers' mobile devices would improve the effectiveness of a home micronutrient fortification program.…”

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

“…[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.…”