Feasibility of SMS booster for alcohol reduction in injury patients in Tanzania
Open accessAbstract
Alcohol use is associated with 3 million annual deaths globally. Harmful alcohol use, which is associated with a high burden of disease in low- and middle-income countries (LMICs), often increases the probability of traumatic injury. Treatments for harmful alcohol use in LMICs, such as Tanzania, lack trained personnel and adequate infrastructure. The aim of this study was to assess the feasibility of using SMS boosters to augment a hospital based brief negotiational intervention (BNI) in this low resourced setting. We conducted a three stage, four arm feasibility trial of a culturally adapted BNI for injury patients with harmful and hazardous drinking admitted to Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. Post hospital discharge, two of the four arms included patients receiving either a standard or personalized short message service (SMS) booster to enhance and or perpetuate the effect of the in-hospital BNI. Text messages were sent weekly throughout a 3-month follow-up period. SMS feasibility was assessed according to the TIDier checklist evaluating what, when, how much, tailoring processes, modifications and how well (intervention fidelity). Data was collected with SMS logs and short answer surveys to participants. A total of 41 study participants were assigned to each receive 12 SMS over a three-month period; 38 received messages correctly, 3 did not receive intended messages, and 1 received a message who was not intended to. Of the 258 attempted texts, 73% were successfully sent through the messaging system. Of the messages that failed delivery, the majority were not able to be sent due to participants traveling out of cellular service range or turning off their phones. Participants interviewed in both booster arms reported that messages were appropriate, and that they would appreciate the continuation of such reminders. At 6-month follow-up, 100% (n = 11) of participants interviewed believed that the boosters had a positive impact on their behavior, with 90% reporting a large impact. This study demonstrated feasibility and acceptability of the integration of SMS mobile health technology to supplement this type of nurse-led BNI. SMS booster is a practical tool that can potentially prolong the impact of a brief hospital based intervention to enact behavioral change in injury patients with AUD.
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In global settings, mobile health technology is widely available and promising, but its impact must be balanced by process complexity, feasibility and equitable access.
“In global settings, mobile health technology is widely available and promising, but the impact of this technology must be balanced by the process complexity, feasibility and equitable access [17,18].”
From Effectiveness of a brief intervention and text-based booster in the emergency department to reduce harmful and hazardous alcohol use: A pragmatic randomized adaptive clinical trial in Moshi, Tanzania (2025) · cites this paper as [18]
The Discussion section, “Feasibility of the SMS process” (page unavailable), describes phones as ubiquitous in this Tanzanian setting and reports acceptable SMS delivery, while noting that more complex procedures reduced correct delivery. This supports the claim’s availability, promise, feasibility, and complexity points in the studied setting, but the paper does not address equitable access or establish availability across global settings. (LLM, conf=0.87)
Experimental — accuracy not yet measuredIn Tanzania, at 6-month follow-up, 85% of eligible participants agreed to be interviewed, 91% reported large positive effect, 90% reported satisfaction with the timing, 10% could not remember about the intervention, and only 4% opted to stop receiving the SMS booster over the 6 months period.
“At 6 months follow up- 85% of eligible participants agreed to be interviewed 91% reported large positive effect90% reported satisfaction with the timing due to the opportunity to read the messages. 10% could not remember about the intervention. Only 4% opted to stop receiving the sms booster over the 6 months period.”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [93]
The Results (SMS system feasibility; page unavailable) support the 85% interview rate and the 91% reporting a large positive impact, but those percentages use different denominators: 39 eligible participants and 11 respondents, respectively. The 90% satisfied and 10% unable to remember refer to the 10 people who gave timing feedback; the latter did not say they forgot the intervention. The paper reports that four participants opted out by the six-month follow-up, not that 4% opted out. (LLM, conf=0.93)
Experimental — accuracy not yet measuredIn Tanzania, at 6-month follow-up, 90% of those in the standard booster and 81% in the personalized messages arm remained in treatment.
“Follow up at 6 months- 90% of those in standard booster and 81 in personalized messages remained in treatment.”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [93]
The Results (SMS system feasibility; page unavailable) report that 33 of 39 eligible SMS recipients (85%) agreed to six-month follow-up interviews. The paper studies standard and personalized booster arms, but the cited passages do not give 90% and 81% arm-specific retention rates or say participants remained in treatment. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn Tanzania, out of 41 participants, 38 received the messages correctly; 52% of expected messages were attempted to be sent; only 34% of messages were delivered during the intended period; 33% of messages had failed delivery.
“Out of 41, 38 received the messages correctly. 52% of expected messages were attempted to be sent. Majority of those not sent was due to system error. Only 34% of messages were delivered during the intended period; 33% of messages had failed delivery.”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [93]
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Cited by
Sorted by citations
A scoping review of substance use brief interventions in Africa
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“Participants in the PPKAY+ Standard Booster group underwent the PPKAY intervention as previously described and also received weekly text messages for one year [18,19].”
Self-citation
- Authors
- Staton, C. A., Minnig, M. C., Phillips, A. J., Kozhumam, A. S., Pesambili, M., Suffoletto, B., Mmbaga, B. T., Ngowi, K., & Vissoci, J. R. N.
- Affiliations
- Duke University (US)
- Kilimanjaro Christian Medical Centre (TZ)
- Stanford Medicine (US)
- Corresponding author
- Staton, Catherine A.
- ORCID
- Venue
- PLOS Global Public Health
- Publisher
- Public Library of Science (PLoS)
- Published
- 2022-11-29
- Volume
- 2
- Issue
- 11
- Pages
- e0000410
- ISSN
- 2767-3375 (ISSN-L)
- PMC
- PMC10022354
- OpenAlex
- W4310359062
- Cited by
- 4
- References
- 39
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1
- FWCI
- 0.54
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLOS Global Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- PsyArXiv (OSF Preprints) (submittedVersion)
- PsyArXiv (OSF Preprints) (submittedVersion, cc-by)
- Funders
- Fogarty International Center (K01- TW010000-01A1)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Health › Social Media in Health Education
- Keywords
- alcoholism, mobile health, SMS reminders, hospital discharge, nurse-led intervention, intervention feasibility, acceptability, harm reduction, Tanzania
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