Tingting Chen1, Wenhui Zhu1, Bobby Tang2, Ling Jin3, Haoxiang Fu4, Yuqun Chen5, Congyao Wang3, Guoshan Zhang3, Jun Wang3, Tiantian Ye3, Di Xiao6, Janardhan Vignarajan6, Baixiang Xiao3, Yogessan Kanagasingam6, Nathan Congdon7. 1. Ophthalmology Department of the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. 2. Centre for Public Health, Queen's University Belfast, Belfast, Antrim, United Kingdom. 3. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. 4. The Ophthalmology Department of the Shaoguan Railway Hospital, Shaoguan, Guangdong, China. 5. The Ophthalmology Department of the Chenghai People's Hospital, Shantou, Guangdong, China. 6. The Australian e-Health Research Centre, CSIRO, Floreat, Australia. 7. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; Centre for Public Health, Queen's University Belfast, Belfast, Antrim, United Kingdom; ORBIS International, New York, New York, USA. Electronic address: ncongdon1@gmail.com.
Abstract
PURPOSE: To determine whether short message service (SMS) reminders improve adherence to scheduled ocular examinations among patients with diabetes in rural China. DESIGN: Randomized controlled trial. METHODS: This study enrolled consecutive patients with diabetes scheduled for eye examinations at 5 hospitals in low-income areas of Guangdong, China from March 1, 2015 to May 31, 2016. Participants were randomized (1:1) to receive automated SMS reminders containing information about diabetic retinopathy (DR) 1 week and 3 days prior to scheduled eye appointments (Intervention) or to appointments without reminders (Control). Regression models following intention-to-treat principles were used to estimate the association between the main outcome (attendance within ± 1 week of scheduled visit) and membership in the Intervention group, with and without adjustment for other potential predictors of follow-up. Secondary outcomes included change in DR knowledge score (1, worst; 5, best) and endline satisfaction with care (3, worst; 15, best). RESULTS: Among 233 patients, 119 (51.1%) were randomized to Intervention (age 59.7± 11.3 years, 52.1% men) and 114 (48.9%) to Control (58.7 ± 9.50 years, 49.1% men). All participants provided data for the main study outcome. Attendance at scheduled appointments for the Intervention group (51/119, [42.9%]) was significantly higher than for Controls (16/114, [14.0%], between-group difference 28.8% [95% confidence interval (CI) 17.9%, 39.8%], P < .001). Factors associated with attendance in multiple regression models included Intervention group membership (Relative Risk [RR] 3.04, 95% CI, 1.73-5.33, P < .001) and baseline DR knowledge (RR 1.47, 95% CI 1.21-1.78, P < .001). Improvement in Satisfaction (mean difference 1.08, 95% CI 0.70-1.46, P < .001) and DR knowledge (mean difference 1.30, 95% CI 0.96-1.63, P < .001) were significantly higher for the Intervention group. Total cost of the intervention was US$5.40/person. CONCLUSION: Low-cost SMS informational reminders significantly improved adherence to, knowledge about, and satisfaction with care. Additional interventions are needed to further improve adherence.
RCT Entities:
PURPOSE: To determine whether short message service (SMS) reminders improve adherence to scheduled ocular examinations among patients with diabetes in rural China. DESIGN: Randomized controlled trial. METHODS: This study enrolled consecutive patients with diabetes scheduled for eye examinations at 5 hospitals in low-income areas of Guangdong, China from March 1, 2015 to May 31, 2016. Participants were randomized (1:1) to receive automated SMS reminders containing information about diabetic retinopathy (DR) 1 week and 3 days prior to scheduled eye appointments (Intervention) or to appointments without reminders (Control). Regression models following intention-to-treat principles were used to estimate the association between the main outcome (attendance within ± 1 week of scheduled visit) and membership in the Intervention group, with and without adjustment for other potential predictors of follow-up. Secondary outcomes included change in DR knowledge score (1, worst; 5, best) and endline satisfaction with care (3, worst; 15, best). RESULTS: Among 233 patients, 119 (51.1%) were randomized to Intervention (age 59.7 ± 11.3 years, 52.1% men) and 114 (48.9%) to Control (58.7 ± 9.50 years, 49.1% men). All participants provided data for the main study outcome. Attendance at scheduled appointments for the Intervention group (51/119, [42.9%]) was significantly higher than for Controls (16/114, [14.0%], between-group difference 28.8% [95% confidence interval (CI) 17.9%, 39.8%], P < .001). Factors associated with attendance in multiple regression models included Intervention group membership (Relative Risk [RR] 3.04, 95% CI, 1.73-5.33, P < .001) and baseline DR knowledge (RR 1.47, 95% CI 1.21-1.78, P < .001). Improvement in Satisfaction (mean difference 1.08, 95% CI 0.70-1.46, P < .001) and DR knowledge (mean difference 1.30, 95% CI 0.96-1.63, P < .001) were significantly higher for the Intervention group. Total cost of the intervention was US$5.40/person. CONCLUSION: Low-cost SMS informational reminders significantly improved adherence to, knowledge about, and satisfaction with care. Additional interventions are needed to further improve adherence.
Authors: Stuart Keel; Pirindha Govender-Poonsamy; Alarcos Cieza; Hannah Faal; Ian Flitcroft; Kate Gifford; Mingguang He; Rajiv Khandekar; Kovin Naidoo; Matt Oerding; Kyoko Ohno-Matsui; Silvio Mariotti; Christine Wildsoet; James S Wolffsohn; Tien Y Wong; Sangchul Yoon; Andreas Mueller; Rosie Dobson Journal: Front Public Health Date: 2022-05-26
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