Text messaging as a community-based survey tool: a pilot study

The Impact of Text Messaging to Promote Patient Reported Outcome Measures (PROMs) Completion in Orthopedic Practice: Findings From a Randomized Controlled Study

It is difficult to achieve high response rates to Patient Reported Outcome Measures (PROMs) surveys collected as part of clinical care. However, they are operationally and clinically important. To understand the impact of text message reminders on response rates to PROMs collected via email as part of routine care for hip or knee replacement surgery, initial nonresponders were randomized to receive a text reminder or not at 7 and 12 days, if needed. At day 7, the overall survey response rate was 63%. Model-derived estimates for survey return after this point were 51.1% (95% confidence interval [CI], 48.0%-54.2%) in the text arm compared to 34.5% (95% CI, 31.6%-37.6%) in the no text arm. The effect of text messages on response rates did not vary by subpopulations considered nor were there differences in rates of key outcomes between the 2 groups, suggesting that it did not impact any underlying response bias. Given the relative low cost of text messages, they can be an efficient means to increase response rates.

Acceptability and Feasibility of Text Message Interface to Assess Parents' Real-time PICU Experiences

INTRODUCTION

Parents of children in the pediatric intensive care unit (PICU) experience substantial stress; a parent's perception of their child's illness severity, more than objective measures, predicts psychological outcomes. No tools exist to assess parents' real-time experiences. This pilot study evaluated the feasibility and acceptability of a text-based tool to measure parental experience.

METHODS

Inclusion criteria included PICU stay >48 h, physician approval, smartphone access, and English-speaking caregiver. Eligible parents received a text-based baseline survey and surveys every other day while hospitalized regarding their mood/experiences and optional open-ended questions regarding stressors. They received post-discharge follow-up surveys at 1 week and 1, 3, and 6 months. Follow-up surveys assessed mood and symptoms of depression, anxiety, and post-traumatic stress. Interviews and surveys about the interface were conducted 1 week and 3 months following discharge. Feasibility was assessed by descriptive statistics (eg, response rates), and acceptability was assessed by descriptive statistics (survey results) and thematic analyses of interviews.

RESULTS

Of 20 enrolled participants, the first 5 were excluded due to technical issues. Of the 15 included, results demonstrated feasibility and acceptability. Most participants (86%) completed all surveys during the PICU stay and continued to complete surveys at a high rate: 79%-94% 3 months post-discharge. All participants agreed that the system was easy to use and were satisfied with the system at discharge, and 91% remained satisfied 3 months post-discharge. Additionally, 76% reported comfort, and 69% reported benefit. From the interviews, participants lauded the system's convenience and applicability of content. Some proposed changes to improve ergonomics. Many suggested this interface could help teams better support families.

CONCLUSIONS

A text-based interface for measuring experience in the PICU is feasible and acceptable to parents. Further research can explore how this could identify parents most at risk of adverse psychological sequelae and lead to earlier supportive interventions.

Adolescent and Young Adult Perspectives on Quality and Value in Health Care

OBJECTIVE

To describe adolescent and young adult (AYA) perspectives on defining quality and value in health care and to gain understanding of their knowledge of value-based payment.

METHODS

A text message-based survey was sent to a convenience sample of AYAs aged 14 to 24 in 2019. Participants were asked 4 open-ended questions: 1) how they would define "good health care," 2) what factors to consider in rating doctors, 3) whose opinions should matter most when rating doctors, and 4) the best ways to collect AYA opinions on doctors, and one yes/no question on their awareness of value-based payment. Analyses included descriptive demographic statistics and an inductive thematic approach with multivariable models comparing adolescent (14-18) and young adult (19-24) responses.

RESULTS

Response rate was 61.0% (782/1283). Most participants were White (63.3%), female (53.3%), and adolescents (55.6%). Common themes from the first 2 questions included accessibility (specifically affordability), coverage benefits, and care experience (including compassion, respect, and clinical competence). Young adults more commonly mentioned affordability than adolescents (54.4% vs 43.3%, P = .001) and more commonly felt their opinion should matter more than their parents when rating doctors (80.6% vs 62.0%, P < .001). Only 21.0% of AYAs were familiar with the potential value-based link between physician payment and care quality.

CONCLUSIONS

When considering quality and value in health care, AYAs expressed their desired agency in rating the quality of their care and clinicians. AYAs' perspectives on health care quality, including the importance of care accessibility and affordability, should be considered when designing youth-centered care delivery and value-based payment models.

Mobile phone access, willingness, and usage for HIV-related services among young adults living in informal urban settlements in Kenya: A cross-sectional analysis

BACKGROUND

Mobile phone-based health (mHealth) interventions have the potential to improve HIV outcomes for high-risk young adults living in informal urban settlements in Kenya. However, less is known regarding young adults' differential access to mobile phones and their willingness and use of mobile phone technologies to access HIV prevention, care, and treatment services. This is important as young adults make up the largest demographic segment of impoverished, informal urban settlements and are disproportionately impacted by HIV.

METHODS

This study used observational survey data from 350 young adults, aged 18-22, who were living informal urban settlements in Nairobi, Kenya. Respondent driven sampling methods were used to recruit and enroll eligible youth. Using descriptive statistics and logistical regressions, we examined the prevalence of mobile phone access, willingness, and use for HIV services. We also assessed associated demographic characteristics in the odds of access, willingness, and use.

RESULTS

The mean age of participants was 19 years (±1.3). 56% were male. Mobile phone coverage, including text messaging and mobile internet, was high (>80%), but only 15% of young adults had ever used mobile phones to access HIV services. Willingness was high (65%), especially among those who had individual phone access (77%) compared to lower willingness (18%) among those who shared a phone. More educated (OR = 1.84, 95 %CI:1.14-2.97) and employed (OR = 1.70, 95 %CI:1.02 = 2.83) young adults were also more willing to use phones for HIV services. In contrast, participants living in large households (OR = 0.47, 95 %CI:0.24-0.921), were religious minorities (OR = 0.56, 95 %CI:0.32-0.99), partnered/married (OR = 0.30, 95 %CI:0.10-0.91), or female (OR = 0.29, 95 %CI:0.16-0.55) were significantly less likely to have mobile phone access or usage, limiting their potential participation in HIV-related mHealth interventions. Given the low usage of mobile phones currently for HIV services, no differences in demographic characteristics were observed.

CONCLUSION

Mobile health technologies may be under-utilized in HIV services for at-risk youth. Our findings highlight the importance of preliminary, formative research regarding population differences in access, willingness, and use of mobile phones for HIV services. More efforts are needed to ensure that mHealth interventions account for potential differences in preferences for mobile phone-based HIV interventions by gender, age, religion, education, and/or employment status.

Supporting population mental health and wellness during the COVID-19 pandemic in Canada: protocol for a sequential mixed-method study

INTRODUCTION

The global COVID-19 pandemic has reported to have a negative impact on the mental health and well-being of individuals around the world. Mental health system infrastructure, primarily developed to support individuals through in-person care, struggled to meet rising demand for services even prior to COVID-19. With public health guidelines requiring the use of physical distancing during the pandemic, digital mental health supports may be one way to address the needs of the population. Despite this, barriers exist in promoting and supporting access to existing and emerging digital resources. Text messaging may address some of these barriers, extending the potential reach of these digital interventions across divides that may separate some vulnerable or disadvantaged groups from essential mental health supports. Building on an existing knowledge synthesis project identifying key digital resources for improved mental health, this research will establish low-tech connections to assess need and better match access to services for those who need it most. The aim of this study is to codesign a customised two-way texting service to explore need and better align access to mental health supports for Canadians located in Saskatchewan during the COVID-19 pandemic.

METHODS AND ANALYSIS

This study will be completed in Saskatchewan, Canada. For this project, the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework will be used to support three phases of a sequential mixed-method study. An advisory committee of Saskatchewan residents will guide this work with the study team. A 10-week service will be launched to connect individuals with appropriately suited digital mental health interventions through the use of text messaging. In phase 1, implementation and prototyping will be conducted with collaborative codesign for key elements related to features of an enrolment survey and initial messaging content. Phase 2 will focus on advancing the effectiveness of the service using quantitative user data. In phase 3, an embedding approach will be used to integrate both qualitative and quantitative data collected to understand the overall acceptability, satisfaction and perceived benefit of the text messaging service. Thematic analysis and descriptive statistics will be used as analytic methods.

ETHICS AND DISSEMINATION

This study has received approval from the Research Ethics Board at the University of Saskatchewan. A knowledge dissemination plan has been developed that includes traditional academic approaches such as conference presentations, and academic publications, as well as mainstream approaches such as social media, radio and dissemination through the advisory committee.

A Case Study of an SMS Text Message Community Panel Survey and Its Potential for Use During the COVID-19 Pandemic

During the COVID-19 pandemic many traditional methods of data collection, such as intercept surveys or focus groups, are not feasible. This paper proposes that establishing community panels through SMS text messages may be a useful method during the pandemic, by describing a case study of how an innovative SMS text message community panel was used for the “Shisha No Thanks” project to collect data from young adults of Arabic-speaking background about their attitudes on the harms of waterpipe smoking. Participants were asked to complete an initial recruitment survey, and then subsequently sent 1 survey question per week. The study recruited 133 participants to the SMS text message community panel and the mean response rate for each question was 73.0% (97.1/133) (range 76/133 [57.1%] to 112/133 [84.2%]). The SMS text message community panel approach is not suited for all populations, nor for all types of inquiry, particularly due to limitations of the type of responses that it allows and the required access to mobile devices. However, it is a rapid method for data collection, and therefore during the COVID-19 pandemic, it can provide service providers and policymakers with timely information to inform public health responses. In addition, this method negates the need for in-person interactions and allows for longitudinal data collection. It may be useful in supplementing other community needs assessment activities, and may be particularly relevant for people who are considered to be more difficult to reach, particularly young people, culturally and linguistically diverse communities, and other groups that might otherwise be missed by traditional methods.

A telephone based assessment of the health situation in the far north region of Cameroon

BACKGROUND

In 2017, Field access was considerably limited in the Far North region of Cameroon due to the conflict. Médecins Sans Frontieres (MSF) in collaboration with Ministry of health needed to estimate the health situation of the populations living in two of the most affected departments of the region: Logone-et-Chari and Mayo-Sava.

METHODS

Access to health care and mortality rates were estimated through cell phone interviews, in 30 villages (clusters) in each department. Local Community Health Workers (CHWs) previously collected all household phone numbers in the selected villages and nineteen were randomly selected from each of them. In order to compare telephone interviews to face-to-face interviews for estimating health care access, and mortality rates, both methods were conducted in parallel in the town of Mora in the mayo Sava department. Access to food was assessed through push messages sent by the three main mobile network operators in Cameroon. Additionally, all identified legal health care facilities in the area were interviewed by phone to estimate attendance and services offered before the conflict and at the date of the survey.

RESULTS

Of a total of 3423 households called 43% were reached. Over 600,000 push messages sent and only 2255 were returned. We called 43 health facilities and reached 34 of them. In The town of Mora, telephone interviews showed a Crude Mortality Rate (CMR) at 0.30 (CI 95%: 0.16-0.43) death per 10,000-person per day and home visits showed a CMR at 0.16 (0.05-0.27), most other indicators showed comparable results except household composition (more Internally Displaced Persons by telephone). Phone interviews showed a CMR at 0.63 (0.29-0.97) death per 10,000-person per day in Logone-et-Chari, and 0.30 (0.07-0.50) per 10,000-person per day in Mayo-Sava. Among 86 deaths, 13 were attributed to violence (15%), with terrorist attacks being explicitly mentioned for seven deaths. Among 29 health centres, 5 reported being attacked and vandalized; 3 remained temporally closed; Only 4 reported not being affected.

CONCLUSION

Telephone interviews are feasible in areas with limited access, although special attention should be paid to the initial collection of phone numbers. The use of text messages to collect data was not satisfactory is not recommended for this purpose. Mortality in Logone-et-Chari and Mayo-Sava was under critical humanitarian thresholds although a considerable number of deaths were directly related to the conflict.

Feasibility of Assessing Economic and Sexual Risk Behaviors Using Text Message Surveys in African-American Young Adults Experiencing Homelessness and Unemployment: Single-Group Study

Background

Text messages offer the potential to better evaluate HIV behavioral interventions using repeated longitudinal measures at a lower cost and research burden. However, they have been underused in US minority settings.

Objective

This study aims to examine the feasibility of assessing economic and sexual risk behaviors using text message surveys.

Methods

We conducted a single-group study with 17 African-American young adults, aged 18-24 years, who were economically disadvantaged and reported prior unprotected sex. Participants received a text message survey once each week for 5 weeks. The survey contained 14 questions with yes-no and numeric responses on sexual risk behaviors (ie, condomless sex, sex while high or drunk, and sex exchange) and economic behaviors (ie, income, employment, and money spent on HIV services or products). Feasibility measures were the number of participants who responded to the survey in a given week, the number of questions to which a participant responded in each survey, and the number of hours spent from sending a survey to participants to receiving their response in a given week. One discussion group was used to obtain feedback.

Results

Overall, 65% (n=11/17) of the participants responded to at least one text message survey compared with 35% (n=6/17) of the participants who did not respond. The majority (n=7/11, 64%) of the responders were women. The majority (n=4/6, 67%) of nonresponders were men. An average of 7.6 participants (69%) responded in a given week. Response rates among ever responders ranged from 64% to 82% across the study period. The mean number of questions answered each week was 12.6 (SD 2.7; 90% of all questions), ranging from 72% to 100%. An average of 6.4 participants (84%) answered all 14 text message questions in a given week, ranging from 57% to 100%. Participants responded approximately 8.7 hours (SD 10.3) after receiving the survey. Participants were more likely to answer questions related to employment, condomless sex, and discussions with sex partners. Nonresponse or skip was more often used for questions at the end of the survey relating to sex exchange and money spent on HIV prevention services or products. Strengths of the text message survey were convenience, readability, short completion time, having repeated measures over time, and having incentives.

Conclusions

Longitudinal text message surveys may be a valuable tool for assessing HIV-related economic and sexual risk behaviors.

Trial Registration

ClinicalTrials.gov NCT03237871; https://clinicaltrials.gov/ct2/show/NCT03237871

Youth Perspectives of Prescription Pain Medication in the Opioid Crisis

OBJECTIVE

To characterize current youth perspectives of prescription pain medication.

STUDY DESIGN

In total, 1047 youths aged 14-24 years were recruited by targeted social media advertisements to match national demographic benchmarks. Youths were queried by open-ended text message prompts about exposure and access to prescription pain medication, perceived safety of prescribed and nonprescribed medication, and associations with the word "opioid." Responses were analyzed inductively for emerging themes and frequencies.

RESULTS

Among 745 respondents (71.2% response rate), 439 identified as female (59.3%), 561 as white (75.8%), and mean age was 18.3 ± 3.2 years. Previous exposure to prescription pain medication was reported by 377 respondents (52.0%), most commonly related to dentistry (32.8%), surgery (19.2%), and injury (12.0%). Nonmedical sources of access to prescription pain medication were identified by 256 respondents (36.9%) and medical sources other than their doctor by an additional 111 respondents (16.0%). Three additional themes emerged from youth responses: (1) prescribed medication was thought to be safer than nonprescribed medication, based on trust in doctors; (2) risks of addiction and overdose were thought to be greater for nonprescribed medication; (3) respondents had a widely ranging understanding of the word "opioid," from historical to current events, medical to illicit substances, and personal to public associations.

CONCLUSIONS

Although youths are aware of the opioid crisis, they perceive less risk of prescription pain medication prescribed by a doctor, than from other sources. Policies should target education to youth in clinical and nonclinical settings, highlighting the risks of addiction and overdose with all opioids.

Using Text Messaging, Social Media, and Interviews to Understand What Pregnant Youth Think About Weight Gain During Pregnancy

BACKGROUND

The majority of pregnant youth gain more weight than recommended by the National Academy of Medicine guidelines. Excess weight gain during pregnancy increases the risk of dangerous complications during delivery, including operative delivery and stillbirth, and contributes to the risk of long-term obesity in both mother and child. Little is known regarding youth's perceptions of and knowledge about weight gain during pregnancy.

OBJECTIVE

The aim of this study was to describe the feasibility and acceptability of 3 novel data collection and analysis strategies for use with youth (social media posts, text message surveys, and semistructured interviews) to explore their experiences during pregnancy. The mixed-methods analysis included natural language processing and thematic analysis.

METHODS

To demonstrate the feasibility and acceptability of this novel approach, we used descriptive statistics and thematic qualitative analysis to characterize participation and engagement in the study.

RESULTS

Recruitment of 54 pregnant women aged between 16 and 24 years occurred from April 2016 to September 2016. All participants completed at least 1 phase of the study. Semistructured interviews had the highest rate of completion, yet all 3 strategies were feasible and acceptable to pregnant youth.

CONCLUSIONS

This study has described a novel youth-centered strategy of triangulating 3 sources of mixed-methods data to gain a deeper understanding of a health behavior phenomenon among an at-risk population of youth.

Implementation of genomics research in Africa: challenges and recommendations

BACKGROUND

There is exponential growth in the interest and implementation of genomics research in Africa. This growth has been facilitated by the Human Hereditary and Health in Africa (H3Africa) initiative, which aims to promote a contemporary research approach to the study of genomics and environmental determinants of common diseases in African populations.

OBJECTIVE

The purpose of this article is to describe important challenges affecting genomics research implementation in Africa.

METHODS

The observations, challenges and recommendations presented in this article were obtained through discussions by African scientists at teleconferences and face-to-face meetings, seminars at consortium conferences and in-depth individual discussions.

RESULTS

Challenges affecting genomics research implementation in Africa, which are related to limited resources include ill-equipped facilities, poor accessibility to research centers, lack of expertise and an enabling environment for research activities in local hospitals. Challenges related to the research study include delayed funding, extensive procedures and interventions requiring multiple visits, delays setting up research teams and insufficient staff training, language barriers and an underappreciation of cultural norms. While many African countries are struggling to initiate genomics projects, others have set up genomics research facilities that meet international standards.

CONCLUSIONS

The lessons learned in implementing successful genomics projects in Africa are recommended as strategies to overcome these challenges. These recommendations may guide the development and application of new research programs in low-resource settings.

MyVoice National Text Message Survey of Youth Aged 14 to 24 Years: Study Protocol

Background

There has been little progress in adolescent health outcomes in recent decades. Researchers and youth-serving organizations struggle to accurately elicit youth voice and translate youth perspectives into health care policy.

Objective

Our aim is to describe the protocol of the MyVoice Project, a longitudinal mixed methods study designed to engage youth, particularly those not typically included in research. Text messaging surveys are collected, analyzed, and disseminated in real time to leverage youth perspectives to impact policy.

Methods

Youth aged 14 to 24 years are recruited to receive weekly text message surveys on a variety of policy and health topics. The research team, including academic researchers, methodologists, and youth, develop questions through an iterative writing and piloting process. Question topics are elicited from community organizations, researchers, and policy makers to inform salient policies. A youth-centered interactive platform has been developed that automatically sends confidential weekly surveys and incentives to participants. Parental consent is not required because the survey is of minimal risk to participants. Recruitment occurs online (eg, Facebook, Instagram, university health research website) and in person at community events. Weekly surveys collect both quantitative and qualitative data. Quantitative data are analyzed using descriptive statistics. Qualitative data are quickly analyzed using natural language processing and traditional qualitative methods. Mixed methods integration and analysis supports a more in-depth understanding of the research questions.

Results

We are currently recruiting and enrolling participants through in-person and online strategies. Question development, weekly data collection, data analysis, and dissemination are in progress.

Conclusions

MyVoice quickly ascertains the thoughts and opinions of youth in real time using a widespread, readily available technology—text messaging. Results are disseminated to researchers, policy makers, and youth-serving organizations through a variety of methods. Policy makers and organizations also share their priority areas with the research team to develop additional question sets to inform important policy decisions. Youth-serving organizations can use results to make decisions to promote youth well-being.

Real-Time Data Collection Using Text Messaging in a Primary Care Clinic

BACKGROUND

The use of text messaging is nearly ubiquitous and represents a promising method of collecting data from diverse populations.

INTRODUCTION

The purpose of this study was to assess the feasibility and acceptability of text message surveys in a clinical setting and to describe key lessons to minimize attrition.

METHODS

We obtained a convenience sample of individuals who entered the waiting room of a low-income, primary care clinic. Participants were asked to answer between 17 and 30 survey questions on a variety of health-related topics, including both open- and closed-ended questions. Descriptive statistics were used to characterize the participants and determine the response rates. Bivariate analyses were used to identify predictors of incomplete surveys.

RESULTS

Our convenience sample consisted of 461 individuals. Of those who attempted the survey, 80% (370/461) completed it in full. The mean age of respondents was 35.4 years (standard deviation = 12.4). Respondents were predominantly non-Hispanic black (42%) or non-Hispanic white (41%), female (75%), and with at least some college education (70%). Of those who completed the survey, 84% (312/370) reported willingness to do another text message survey. Those with incomplete surveys answered a median of nine questions before stopping. Smartphone users were less likely to leave the survey incomplete compared with non-smartphone users (p = 0.004).

DISCUSSION

Text-message surveys are a feasible and acceptable method to collect real-time data among low-income, clinic-based populations. Offering participants a setting for immediate survey completion, minimizing survey length, simplifying questions, and allowing "free text" responses for all questions may optimize response rates.

Advice given by community members to pregnant women: a mixed methods study

Background

Smoking and excess weight gain during pregnancy have been shown to have serious health consequences for both mothers and their infants. Advice from friends and family on these topics influences pregnant women’s behaviors. The purpose of our study was to compare the advice that community members give pregnant women about smoking versus the advice they give about pregnancy weight gain.

Methods

A survey was sent via text messaging to adults in a diverse, low-income primary care clinic in 2015. Respondents were asked what advice (if any) they have given pregnant women about smoking or gestational weight gain and their comfort-level discussing the topics. Descriptive statistics were used to characterize the sample population and to determine response rates. Open-ended responses were analyzed qualitatively using grounded theory analysis with an overall convergent parallel mixed methods design.

Results

Respondents (n = 370) were 77 % female, 40 % black, and 25 % reported education of high school or less. More respondents had spoken to pregnant women about smoking (40 %, n = 147) than weight gain (20 %, n = 73). Among individuals who had not discussed either topic (n = 181), more reported discomfort in talking about weight gain (65 %) compared to smoking (34 %; p < 0.0001). Advice about smoking during pregnancy (n = 148) was frequently negative, recommending abstinence and identifying smoking as harmful for baby and/or mother. Advice about weight gain in pregnancy (n = 74) revealed a breadth of messages, from reassurance about all weight gain (“Eat away” or “It’s ok if you are gaining weight”), to specific warnings against excess weight gain (“Too much was dangerous for her and the baby.”).

Conclusions

Many community members give advice to pregnant women. Their advice reveals varied perspectives on the effects of pregnancy weight gain. Compared to a nearly ubiquitous understanding of the harms of smoking during pregnancy, community members demonstrated less awareness of and willingness to discuss the harms of excessive weight gain. Beyond educating pregnant women, community-level interventions may also be important to ensure that the information pregnant women receive supports healthy behaviors and promotes the long-term health of both moms and babies.