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. 2022 Apr 14;17(4):e0266717.
doi: 10.1371/journal.pone.0266717. eCollection 2022.

Two-way text message interventions and healthcare outcomes in Africa: Systematic review of randomized trials with meta-analyses on appointment attendance and medicine adherence

Emilie S Ødegård  1 , Lena S Langbråten  1 , Andreas Lundh  2   3   4 , Ditte S Linde  1   5
Affiliations

Two-way text message interventions and healthcare outcomes in Africa: Systematic review of randomized trials with meta-analyses on appointment attendance and medicine adherence

Emilie S Ødegård et al. PLoS One. .

Abstract

Background: The growing access to mobile phones in Africa has led to an increase in mobile health interventions, including an increasing number of two-way text message interventions. However, their effect on healthcare outcomes in an African context is uncertain. This systematic review aims to landscape randomized trials involving two-way text message interventions and estimate their effect on healthcare outcomes.

Methods: We searched Medline, Embase, Cochrane Central Register of Controlled Trials, The Global Health Library (up to 12 August 2021) and trial registries (up to 24 April 2020). Published and unpublished trials conducted in Africa comparing two-way text message interventions with standard care and/or one-way text message interventions were included. Trials that reported dichotomous effect estimates on healthcare appointment attendance and/or medicine adherence were assessed for risk of bias and included in meta-analyses. Results of other outcomes were reported descriptively.

Results: We included 31 trials (28,563 participants) all set in Sub-Saharan Africa with a wide range of clinical conditions. Overall, ten different trials were included in the primary meta-analyses, and two of these had data on both medicine adherence and appointment attendance. An additional two trials were included in sensitivity analyses. Of the 12 included trials, three were judged as overall low risk of bias and nine as overall high risk of bias trials. Two-way text messages did not improve appointment attendance, RR: 1.03; 95% CI: 0.95-1.12, I2 = 53% (5 trials, 4374 participants) but improved medicine adherence compared to standard care, RR: 1.14, 95% CI: 1.07-1.21, I2 = 8% (6 trials, 2783 participants).

Conclusion: Two-way text messages seemingly improve medicine adherence but has an uncertain effect on appointment attendance compared to standard care.

Systematic review registration: PROSPERO CRD42020175810.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram.
From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097. For more information, visit www.prisma-statement.org.
Fig 2
Fig 2. Overview of two-way text message trials in Africa according to clinical area and trial status.
Fig 3
Fig 3. Risk of bias assessment*.
*Empty cell: No risk of bias assessment—Attrition bias was not assessed for trials that only reported “appointment attendance” as an outcome as incomplete data is an integral part of this outcome.
Fig 4
Fig 4. Effect of two-way text messages versus standard care on appointment attendance.
Fig 5
Fig 5. Effect of two-way text messages versus standard care on medicine adherence.
See this image and copyright information in PMC

References

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