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

Project Final Report (PDF, 2.36 MB)

Project Details -
Completed

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.