mHEALTH-INNOVATE (25) How do you use your phone to communicate with patients and families? (2)

17 April, 2022

Two-way text messaging between healthcare providers and clients in Africa 'seemingly improve medicine adherence but has an uncertain effect on appointment attendance', according to this new systematic review. Citation, abstract and comment from me below.

CITATION: Citation: Ødegård ES, Langbråten LS, Lundh A, Linde DS (2022) Two-way text message interventions and healthcare outcomes in Africa: Systematic review of randomized trials with meta-analyses on appointment attendance and medicine adherence. PLoS ONE 17(4): e0266717.


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 Published and unpublished trials conducted in Africa comparing two-way text message interventions with standard care and/or one-way text message interventions were included.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.

COMMENT (NPW): The above systematic review looks specifically at medicine adherence and appointment attendance. Both of these presumably are based on reminders and 'box-checking', and would represent only a fraction of the uses of mobile phones? I would be interested to hear about other ways in which healthcare providers communicate with individual patients and families. For example, to provide guidance in the event of illness? To arrange a visit? To pass on the results of a test? I look forward to hear about your experience and observations.

Best wishes, Neil

Neil Pakenham-Walsh, Global Coordinator HIFA,

Global Healthcare Information Network: Working in official relations with WHO

Joint Coordinator, HIFA mHEALTH-INNOVATE