Use of text messages to communicate clinical recommendations to health workers in rural China: a cluster-randomized trial

Chen, Yaolong; Yang, Kun; Ji, Tao; Tian, Jinhui; Shen, Xiping; Xie, Changchun; Ma, Bin; Liu, Ya Li; Yao, Liang; Cao, Xiaoyuan

doi:10.2471/blt.13.127076

Cited by 39 publications

(92 citation statements)

References 22 publications

(19 reference statements)

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“…Evidence points to low-cost implications and higher acceptability with SMS-based mCDSS. A Chinese study found that compared with standard paper formats, text messages were about 280 times cheaper for stimulating guideline use [57]. Although there was agreement on the ease of its use, most respondents found that the messages, which were received once daily three times a week, were too short and infrequent.…”

Section: Discussionmentioning

confidence: 99%

mHealth for Clinical Decision-Making in Sub-Saharan Africa: A Scoping Review

Adepoju¹,

Albersen²,

Brouwere³

et al. 2017

JMIR Mhealth Uhealth

123

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BackgroundIn a bid to deliver quality health services in resource-poor settings, mobile health (mHealth) is increasingly being adopted. The role of mHealth in facilitating evidence-based clinical decision-making through data collection, decision algorithms, and evidence-based guidelines, for example, is established in resource-rich settings. However, the extent to which mobile clinical decision support systems (mCDSS) have been adopted specifically in resource-poor settings such as Africa and the lessons learned about their use in such settings are yet to be established.ObjectiveThe aim of this study was to synthesize evidence on the use of mHealth for point-of-care decision support and improved quality of care by health care workers in Africa.MethodsA scoping review of 4 peer-reviewed and 1 grey literature databases was conducted. No date limits were applied, but only articles in English language were selected. Using pre-established criteria, 2 reviewers screened articles and extracted data. Articles were analyzed using Microsoft Excel and MAXQDA.ResultsWe retained 22 articles representing 11 different studies in 7 sub-Saharan African countries. Interventions were mainly in the domain of maternal health and ranged from simple text messaging (short message service, SMS) to complex multicomponent interventions. Although health workers are generally supportive of mCDSS and perceive them as useful, concerns about increased workload and altered workflow hinder sustainability. Facilitators and barriers to use of mCDSS include technical and infrastructural support, ownership, health system challenges, and training.ConclusionsThe use of mCDSS in sub-Saharan Africa is an indication of progress in mHealth, although their effect on quality of service delivery is yet to be fully explored. Lessons learned are useful for informing future research, policy, and practice for technologically supported health care delivery, especially in resource-poor settings.

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Section: Discussionmentioning

confidence: 99%

mHealth for Clinical Decision-Making in Sub-Saharan Africa: A Scoping Review

Adepoju¹,

Albersen²,

Brouwere³

et al. 2017

JMIR Mhealth Uhealth

123

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“…In recent years, text messaging has emerged as an important communication tool in healthcare settings. The effectiveness of mobile phone text messaging interventions on health workers’ knowledge was assessed in a clinical trial in China, which showed transmitting medical information by text messages was effective in improving health workers’ knowledge and changing prescription practices …”

Section: Discussionmentioning

confidence: 99%

“…The effectiveness of mobile phone text messaging interventions on health workers' knowledge was assessed in a clinical trial in China, which showed transmitting medical information by text messages was effective in improving health workers' knowledge and changing prescription practices. 9 The most convenient form of prescribing education is the dissemination of printed materials, such as newsletters and standard treatment protocols. 10 In a meticulous review of the literature, printed material was reported to be ineffective in all controlled studies, whereas other uncontrolled studies reported several positive effects.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of pharmacist‐based interventions to optimise utilisation of parenteral paracetamol in a teaching hospital in Iran

Laali

Ghorbani

Najafi

et al. 2020

Pharmacy Practice and Res

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This study clarified the effect of pharmacist‐led interventions to decrease the cost and inappropriate prescribing of parenteral paracetamol (PP). The prescribing pattern of PP was assessed at baseline and after pharmacist‐led interventions (educational and protocol interventions) in a teaching hospital in Tehran, Iran. Comparison of appropriate dosage form between baseline and postintervention assessments indicated a significant difference (55.6% vs 77.6%, respectively; p < 0.001). Educational intervention significantly improved the appropriate duration of PP administration from baseline to postintervention (29% vs 41.7%, respectively; p = 0.006), but had no significant effect on the appropriateness of dosing. The mean monthly number of vials used decreased considerably following the educational and protocol interventions (25% (p = 0.002) and 59% (p < 0.001) reductions, respectively). Thus, incorporating educational and protocol interventions could promote the appropriate prescription and rational use of PP and aid in reducing its financial burden.

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“…This supports SMS as a tool for distance learning, at least when focused narrowly. [24] A third very small pilot study compared textbooks vs. SMS on knowledge of breast cancer screening practices. This also found a small improvement among the SMS participants at endline.…”

Section: Discussionmentioning

confidence: 99%

The mCME Project: A Randomized Controlled Trial of an SMS-Based Continuing Medical Education Intervention for Improving Medical Knowledge among Vietnamese Community Based Physicians’ Assistants

et al. 2016

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BackgroundCommunity health workers (CHWs) provide critical services to underserved populations in low and middle-income countries, but maintaining CHW’s clinical knowledge through formal continuing medical education (CME) activities is challenging and rarely occurs. We tested whether a Short Message Service (SMS)-based mobile CME (mCME) intervention could improve medical knowledge among a cadre of Vietnamese CHWs (Community Based Physician’s Assistants–CBPAs) who are the leading providers of primary medical care for rural underserved populations.MethodsThe mCME Project was a three arm randomized controlled trial. Group 1 served as controls while Groups 2 and 3 experienced two models of the mCME intervention. Group 2 (passive model) participants received a daily SMS bullet point, and were required to reply to the text to acknowledge receipt; Group 3 (interactive model) participants received an SMS in multiple choice question format addressing the same thematic area as Group 2, entering an answer (A, B, C or D) in their response. The server provided feedback immediately informing the participant whether the answer was correct. Effectiveness was based on standardized examination scores measured at baseline and endline (six months later). Secondary outcomes included job satisfaction and self-efficacy.Results638 CBPAs were enrolled, randomized, and tested at baseline, with 592 returning at endline (93.7%). Baseline scores were similar across all three groups. Over the next six months, participation of Groups 2 and 3 remained high; they responded to >75% of messages. Group 3 participants answered 43% of the daily SMS questions correctly, but their performance did not improve over time. At endline, the CBPAs reported high satisfaction with the mCME intervention, and deemed the SMS messages highly relevant. However, endline exam scores did not increase over baseline, and did not differ between the three groups. Job satisfaction and self-efficacy scores also did not improve. Average times spent on self-study per week did not increase, and the kinds of knowledge resources used by the CBPAs did not differ between the three groups; textbooks, while widely available, were seldom used.ConclusionsThe SMS-based mCME intervention, while feasible and acceptable, did not result in increased medical knowledge. We hypothesize that this was because the intervention failed to stimulate lateral learning. For an intervention of this kind to be effective, it will be essential to find more effective ways to couple SMS as a stimulus to promote increased self-study behaviors.Trial RegistrationClinicalTrials.gov NCT02381743

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Use of text messages to communicate clinical recommendations to health workers in rural China: a cluster-randomized trial

Cited by 39 publications

References 22 publications

mHealth for Clinical Decision-Making in Sub-Saharan Africa: A Scoping Review

mHealth for Clinical Decision-Making in Sub-Saharan Africa: A Scoping Review

Evaluation of pharmacist‐based interventions to optimise utilisation of parenteral paracetamol in a teaching hospital in Iran

The mCME Project: A Randomized Controlled Trial of an SMS-Based Continuing Medical Education Intervention for Improving Medical Knowledge among Vietnamese Community Based Physicians’ Assistants

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