Using Short Message System (SMS) to Improve Health Care Quality and Outcomes Among HIV-Positive Men (North Carolina)

Project Final Report (PDF, 2.36 MB)

Project Details - Ended

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Summary:

This project, one of the Agency for Healthcare Research and Quality's Accelerating Change and Transformation in Organizations and Networks (ACTION) contracts, developed, implemented, and evaluated a short message service (SMS) intervention. The intervention targeted HIV-positive men who have sex with men (MSM) and who were at least 25-years-old. The aim of the messages was to: improve adherence to medication regimens; improve attendance at appointments; reduce risk-taking behaviors; enhance social support, general health and well-being; and increase involvement of individuals with their health care.

The main objectives of the project were to:

  • Conduct a thorough review of existing literature, paying close attention to work that has been completed on innovative uses of text messaging in health communication strategies.
  • Develop and implement an SMS-based intervention to improve health care quality and outcomes by providing tailored health communication messages to HIV-positive patients who are treated in ambulatory care settings.
  • Conduct a process evaluation on implementation and determine the feasibility and potential for implementing the intervention in other ambulatory care settings.
  • Conduct an outcome evaluation that focuses on patient satisfaction and the impact of the intervention on targeted knowledge, attitudes, beliefs, intentions and behaviors, health care quality, and outcomes measures.

A total of 52 men were enrolled in the study, 46 of whom completed the intervention and the followup survey. During the study, 6,888 messages were sent via SMS to participants. The majority of messages in the study were one-way and noninteractive. SMS messages from study participants included 708 messages in response to process evaluation questions, and another 317 acknowledgement messages from participants with items such as "thanks." Participants were strongly receptive to the messages and intervention. There were four areas in which a statistically significant change was noted during the study, including adherence to medication, knowledge of HIV, social support, and a reduction in the number of sexual partners. Additionally, a significant decrease in viral load was noted, as was a marginally significant increase in CD4 counts, which is an indication of the number of white blood cells which fight infections and their count indicates the stage of HIV or AIDS in a patient.

In its final report, the project team made recommendations for future research, including a larger study with a larger sample, extending the length of the study, adding a control group, using multiple sites, and including men under age 25. In addition, they recommended increasing messaging to include HIV-negative MSM, heterosexuals, and developing couples-based messaging.

Using Short Message System (SMS) to Improve Health Care Quality and Outcomes Among HIV-Positive Men - 2011

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Contract Number: 
    290-06-0001-7
  • Project Period: 
    March 2009 - March 2011
  • AHRQ Funding Amount: 
    $399,950
  • PDF Version: 
    (PDF, 193.31 KB)

Summary: Mobile phone use is widespread throughout the world, including in the United States; among the general U.S. population, 83 percent of adults own a mobile phone. People who frequently have higher rates of cell phone use include younger adults, less-educated young adults, people who rent or move frequently, and individuals who demonstrate health-compromising behaviors.

Short message service (SMS) - or text messaging - is the most widely used data application in the world, and is a quick, convenient way to deliver targeted and timely information via mobile phone. The pervasiveness, low-cost, and convenience of cell phone technology make SMS messaging an effective way to communicate with and give patients health-related messages.

This project studied the potential of SMS to support the adoption and maintenance of healthy behavior among people who live with HIV/AIDS and are treated in ambulatory care settings. Dr. Jennifer Uhrig and her research team developed, implemented, and evaluated an SMS intervention to assist HIV-positive men who have sex with men (MSM) from the Chicago, Illinois area in better managing their disease and well-being. The intervention used text messaging to promote medication adherence and appointment attendance, reduce risk-taking behaviors, and enhance social support, general health and well-being, and patient involvement.

The clinical and systemic goals were to develop an intervention that was straightforward, relatively inexpensive, and easily implemented in ambulatory HIV/AIDS care settings. The intervention also had to be acceptable and useful to people living with HIV/AIDS and have a positive influence on health care quality and outcomes. The project team evaluated the implementation process and outcomes.

Project Objectives:

  • Conduct a thorough review of existing literature, paying close attention to work that has been completed on innovative uses of text messaging in health communication strategies. (Achieved)
  • Develop and implement an SMS-based intervention to improve health care quality and outcomes by providing tailored health communication messages to HIV-positive patients who are treated in ambulatory care settings. (Achieved)
  • Conduct a process evaluation on implementation and determine the feasibility and potential for implementing the intervention in other ambulatory care settings. (Achieved)
  • Conduct an outcome evaluation that focuses on patient satisfaction and the impact of the intervention on targeted knowledge, attitudes, beliefs, intentions and behaviors, health care quality, and outcomes measures. (Achieved)

2011 Activities: The focus of activity was on completing data analysis and developing the final report. The project was completed in March 2011.

Impact and Findings: The project successfully designed and implemented a low-cost, high-impact health communication and information technology. The study enrolled 52 HIV-positive MSM patients from the Howard Brown Health Center in Chicago, Illinois into the 3-month SMS intervention. Forty-six patients completed the intervention, including a pre- and post-intervention assessment survey. The implementation and outcomes of the intervention were evaluated using qualitative interview data from study patients and providers, and data collected from study surveys, the SMS system, and the study team.

In general, the intervention resulted in improved health care quality and outcomes for HIV-positive MSM. Participants were receptive to and satisfied with the intervention and messaging. The intervention resulted in the following key outcomes:

  • Medication Adherence Improved. Patients who received SMS medication reminder messages had a significant decrease in missed doses from baseline to follow-up.
  • Viral Load Decreased. Overall, the average viral load of the study patients significantly decreased from baseline to follow-up.
  • HIV Knowledge Improved. Overall, the average HIV knowledge score among study patients increased from baseline to follow-up.
  • Increased Social Support. While many patients entered the study reporting good social support systems in place, there was a significant overall increase in social support from baseline to follow-up among all participants and among participants who received social support messaging.
  • Reduced Number of Sex Partners. The number of sex partners reported by patients decreased significantly from baseline to the 3-month follow-up. Specifically, the number of patients who reported having had sex with no one in the 3 months changed from zero to two from baseline to follow-up.

The results from this study indicate that when messaging is designed and customized for individual patients and patient populations, it can motivate behavior change to help HIV-positive MSM better manage their disease and stay healthy.

Target Population: Chronic Care*, HIV/AIDS, Men*

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patientcentered care, coordination of care across transitions in care settings, and use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

* This target population is one of AHRQ's priority populations.

Using Short Message System (SMS) to Improve Health Care Quality and Outcomes Among HIV-Positive Men - 2010

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Contract Number: 
    290-06-0001-7
  • Project Period: 
    May 2009 – March 2011
  • AHRQ Funding Amount: 
    $399,950
  • PDF Version: 
    (PDF, 277.41 KB)


Target Population: HIV/AIDS, Men*

Summary: More than 230 million cell phones were used in the United States in 2006. Those who frequently have higher rates of cell phone use include younger adults, socioeconomically disadvantaged populations, less-educated young adults, and people who rent or move frequently. Higher levels of use have also been associated with lower levels of self-reported health status and higher levels of participation in health-compromising behaviors. Given the pervasiveness, low cost, and convenience of cell phone technology, short message system (SMS) messages (i.e., text messaging) may be particularly well suited to achieve frequent communication with patients and health-related message delivery where and when these messages can be most effective.

This project studies the potential of SMS to support the adoption and maintenance of healthy behavior among people who live with HIV/AIDS and are treated in an ambulatory care setting. The research entails a thorough review of existing literature and the development and implementation of an SMS-based intervention that provides health communication messages tailored to an individual's medication and appointment adherence, risk-taking behaviors, social support, general health and wellness, and involvement in health care. The clinical and systemic goals are to develop an intervention that is straightforward, relatively inexpensive, and easily implemented in ambulatory HIV/AIDS care settings. The intervention must be acceptable and useful to people living with HIV/AIDS and must have a positive influence on health care quality and outcomes. The project will evaluate the implementation process and outcomes.

Project Objectives:
  • Conduct a thorough review of existing literature, paying close attention to work that has been completed on innovative uses of text messaging in health communication strategies. (Achieved)
  • Develop and implement an SMS-based intervention to improve health care quality and outcomes by providing tailored health communication messages to HIV-positive patients who are treated in ambulatory care settings. (Achieved)
  • Conduct a process evaluation on implementation and determine the feasibility and potential for implementing the intervention in other ambulatory care settings. (Ongoing)
  • Conduct an outcome evaluation that focuses on patient satisfaction and the impact of the intervention on targeted knowledge, attitudes, beliefs, intentions and behaviors, health care quality, and outcomes measures. (Upcoming)

2010 Activities: The project team developed and pre-tested the SMS intervention, and implementation began in July 2010. The first draft interim report was submitted to the Agency for Healthcare Research and Quality in August 2010 and the second draft interim report was submitted in November 2010. Since that time the focus of activities has primarily been on data collection. Data analysis that will inform the final report is expected to be completed in the first quarter of 2011.

Preliminary Impact and Findings: There are no findings to report at this time.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, coordination of care across transitions in care settings, and use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

*AHRQ Priority Population.

Communication-Focused Technologies: Health Messages for HIV-Positive Men Who Have Sex With Men - Final Report

Citation:
Uhrig JD, Harris J, Furberg R, et al. Communication-Focused Technologies: Health Messages for HIV-Positive Men Who Have Sex With Men - Final Report. (Prepared by RTI International, under Contract No. 290-06-0001-7). AHRQ Publication No. 11-0063-EF. Rockville, MD: Agency for Healthcare Research and Quality. June 2011. (PDF, 2.36 MB)
Principal Investigator: 
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This project does not have any related resource.

Patient Text Messaging Interview Guide

This is an interview guide designed to be conducted with patients in a home setting. The tool includes questions to assess user's perceptions of secure messaging.

Year of Survey: 
2011
Survey Link: 
Patient Text Messaging Interview Guide (PDF, 58.07 KB)
Document Type: 
Research Method: 
Population: 
Care Setting: 
Technology: 
Copyright Status: 
Permission has been obtained from the survey developers for unrestricted use of this survey; it may be modified or used as is without additional permission from the authors.
Organization: 
This project does not have any related project spotlight.
This project does not have any related survey.
This project does not have any related story.
This project does not have any related emerging lesson.