Two-way text message interventions and healthcare outcomes in Africa: Systematic review of randomized trials with meta-analyses on appointment attendance and medicine adherence

Abstract

Background The growing access to mobile phones in Africa has led to an increase in mobile health interventions, including an increasing number of two-way text message interventions. However, their effect on healthcare outcomes in an African context is uncertain. This systematic review aims to landscape randomized trials involving two-way text message interventions and estimate their effect on healthcare outcomes. Methods We searched Medline, Embase, Cochrane Central Register of Controlled Trials, The Global Health Library (up to 12 August 2021) and trial registries (up to 24 April 2020). Published and unpublished trials conducted in Africa comparing two-way text message interventions with standard care and/or one-way text message interventions were included. Trials that reported dichotomous effect estimates on healthcare appointment attendance and/or medicine adherence were assessed for risk of bias and included in meta-analyses. Results of other outcomes were reported descriptively. Results We included 31 trials (28,563 participants) all set in Sub-Saharan Africa with a wide range of clinical conditions. Overall, ten different trials were included in the primary meta-analyses, and two of these had data on both medicine adherence and appointment attendance. An additional two trials were included in sensitivity analyses. Of the 12 included trials, three were judged as overall low risk of bias and nine as overall high risk of bias trials. Two-way text messages did not improve appointment attendance, RR: 1.03; 95% CI: 0.95–1.12, I2 = 53% (5 trials, 4374 participants) but improved medicine adherence compared to standard care, RR: 1.14, 95% CI: 1.07–1.21, I2 = 8% (6 trials, 2783 participants). Conclusion Two-way text messages seemingly improve medicine adherence but has an uncertain effect on appointment attendance compared to standard care. Systematic review registration PROSPERO CRD42020175810.

Feasibility and Acceptability of the Adherence Connection Counseling, Education, and Support (ACCESS) Proof of Concept: A Peer-Led, Mobile Health (mHealth) Cognitive Behavioral Antiretroviral Therapy (ART) Adherence Intervention for HIV-Infected (HIV+) Adolescents and Young Adults (AYA)

“…Four of these nine interventions used SMS text messaging, with initial evidence of efficacy shown in two studies [ 72 ]. Similarly, texting is commonly implemented for ART adherence support in Low and Middle-Income Countries (LMIC) (i.e., Sub-Saharan Africa) [ 73 , 74 ]. Multi-level interventions combining individual- and community-level targets are most likely to improve adherence in LMIC [ 74 ].…”

Centering healthcare workers in developing digital health interventions: usability and acceptability of a two-way texting retention intervention in a public HIV clinic in Lilongwe, Malawi

“…In Malawi, a recent public health survey found UNAIDS target achievement at 88-87-83 [2], demonstrating a gap in attainment of critical milestones. Evidence suggests digital health interventions for direct provider to client engagement with people living with HIV (PLHIV) are highly acceptable and contribute to improved adherence to antiretroviral therapy (ART) visits [3][4][5][6], an important component of engagement in care. However, not all mHealth interventions are effective for all populations at all times [7], and even well-designed, well-researched interventions might not be effective [8][9][10].…”

Self‐management program and Black women with hypertension: Randomized controlled trial substudy

“…With technological advances, individuals may use smartphones and applications to assist with self‐management of their chronic disease along with continuous monitoring and communication with health care providers to aid in improved health outcomes (Moses et al, 2021). Text messaging from a cellphone is a common form of communication used by individuals of all ages to engage in two‐way interactive messages between the sender and receiver (Ødegård et al, 2022). In the United States, 99% of Black adults and 97% of Whites adults own a cell phone, while 83% of Black adults and 85% of White adults own smartphones (Mobile Fact Sheet, 2021, April 7).…”