In-Depth Analysis of Patient-Clinician Cell Phone Communication during the WelTel Kenya1 Antiretroviral Adherence Trial
Open accessAbstract
BACKGROUND: The WelTel Kenya1 trial demonstrated that text message support improved adherence to antiretroviral therapy (ART) and suppression of HIV-1 RNA load. The intervention involved sending weekly messages to patients inquiring how they were doing; participants were required to respond either that they were well or that there was a problem. OBJECTIVES: 1) Describe problems participants identified through mobile phone support and reasons why participants did not respond to the messages; 2) investigate factors associated with indicating a problem and not responding; and 3) examine participant perceptions of the intervention. DESIGN: Secondary analysis of WelTel Kenya1 trial data. METHODS: Reasons participants indicated a problem or did not respond were extracted from the study log. Negative binomial regression was used to determine participant characteristics associated with indicating a problem and non-response. Data from follow-up questionnaires were used to describe participant perceptions of the intervention. RESULTS: Between 2007 and 2009, 271 participants generated 11,873 responses; 377 of which indicated a problem. Health issues were the primary reason for problem responses (72%). Rural residence (adjusted incidence rate ratio [IRR] 1.96; 95%CI 1.19-3.25; p=0.009 and age were associated with indicating a problem (adjusted IRR 0.63 per increase in age group category; 95%CI 0.50-0.80; p<0.001). Higher educational level was associated with a decreased rate of non-response (adjusted IRR 0.81; 95%CI 0.69-0.94; p=0.005). Of participants interviewed, 62% (n=129) stated there were no barriers to the intervention; cell phone issues were the most common barrier. Benefits included reminding patients to take medication and promoting a feeling that "someone cares". CONCLUSIONS: The WelTel intervention enabled frequent communication between clinicians and patients during the WelTel Kenya1 trial. Many patients valued the service for the support it provided, with health-related concerns comprising the majority of problems identified by participants. Few sociodemographic characteristics were associated with participant engagement in the intervention.
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Seven randomized controlled trials testing effects of SMS communication on various health outcomes reported positive effects.
“For the seven randomised controlled trials testing effects of SMS communication on various health outcomes had reported positive effects [16, 20, 32, 33, 44–49], while the remaining trial showed no effect of mobile alarm devices on treatment adherence for HIV patients [15].”
From Assessing the feasibility of eHealth and mHealth: a systematic review and analysis of initiatives implemented in Kenya (2017) · cites this paper as [47]
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Self-citation
- Authors
- van der Kop, M. L., Karanja, S., Thabane, L., Marra, C., Chung, M. H., Gelmon, L., Kimani, J., & Lester, R. T.
- Affiliations
- University of Manitoba (CA)
- McMaster University (CA)
- University of British Columbia (CA)
- University of Washington (US)
- University of Nairobi (KE)
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2012-09-25
- Volume
- 7
- Issue
- 9
- Pages
- e46033
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3457960
- OpenAlex
- W2126014465
- Cited by
- 58
- References
- 18
- Citations by year
- 2025: 4 · 2024: 3 · 2023: 2 · 2022: 1 · 2021: 3 · 2020: 6 · 2019: 5 · 2018: 2 · 2017: 7 · 2016: 6 · 2015: 9 · 2014: 5 · 2013: 5
- FWCI
- 10.79
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- University of Nairobi Research Archive (University of Nairobi) (submittedVersion)
- Greater South Information System
- Funders
- U.S. President’s Emergency Plan for AIDS Relief
- Centers for Disease Control and Prevention (5U62PS024510, U62PS024510)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Physical Sciences › Computer Science › Information Systems › ICT in Developing Communities
- Keywords
- text message support, antiretroviral therapy adherence, HIV, mobile health, patient-clinician communication, barriers to intervention, participant perceptions, sociodemographic factors, rural residence, educational attainment, medication reminders
- MeSH terms
- Adult, Female, Humans, Kenya, Male, Middle Aged, Anti-HIV Agents, Cell Phone, Medication Adherence, Young Adult, Text Messaging
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