Implementation of a patient reminder system in Haiti in a socio-political crisis context: evaluation of outcomes.

BACKGROUND: In Haiti, patient's adherence to treatment and compliance with medical appointments are very challenging due to different local factors. We aimed to assess the effectiveness of a reminder system implemented in health facilities in Haiti in a context of socio-political crisis. METHODS: We used appointment data from patients aged 15 years and older between January 2021 and November 2023 from four healthcare centers in the Port-au-Prince metropolitan area. We performed descriptive analysis, crossing covariates with appointment attendance. We performed Pearson's Chi-squared test, and multivariate regression analysis using a mixed-effect logistic regression model in order to explore the association between sending reminders and appointment attendance, with and without adjustment for other patient-level covariates. RESULTS: A total of 14 108 appointments were registered on the reminder systems, with 2 479 (17.6%) attendances. Among those to whom reminders were sent, the number of attendances was 167 (17.4%) for email recipients only, 199 (36.7%) for SMS recipients only, and 19 (42.2%) for both SMS and email recipients - versus 2 094 (16.7%) for non-reminders. After adjusting on all other covariates, we found that patients to whom a reminder was sent via email (aOR: 1.45; CI: 1.08, 1.94), SMS (aOR: 2.95; CI: 2.41, 3.60), and both SMS and email (aOR: 2.86, CI: 1.37, 5.96) were more likely to show up on their appointment day compared to those who did not receive any reminder. Other socio-demographic factors such as being 50 years and older (aOR: 1.31; CI: 1.10, 1.56) compared to under 30 years, living as couple (aOR: 1.23; CI: 1.10, 1.37), and not having children (aOR: 1.21; CI: 1.07, 1.37) were significantly associated with appointment attendance. CONCLUSIONS: Our study suggests that patient reminder systems may be used to reduce non-attendance in Haiti, even in a context of socio-political crisis.

Validación de mensajes persuasivos para intervención de actividad física en mujeres de una universidad colombiana / Validation of persuasive messages for intervention in Physical Activity in women at Colombian Universities / Validação de mensagens persuasivas para a intervenção na atividade física das mulheres numa universidade colombiana

Resumen En la actualidad, a nivel global, se observan bajos niveles de cumplimiento en lo que respecta a la realización de actividad física, lo que conduce a un aumento significativo en la adopción de comportamientos sedentarios durante largos períodos de tiempo. Esta tendencia representa un importante problema de salud pública que afecta al 60 % de la población mundial. En este contexto, la Organización Mundial de la Salud ha propuesto un conjunto de intervenciones técnicas, enmarcadas en los Objetivos de Desarrollo Sostenible), con el objetivo de fomentar la práctica de actividad física. Estas intervenciones incluyen medidas como la promoción de la conservación ambiental, la estimulación de la innovación y el uso de soluciones digitales. Objetivo: diseñar y validar los mensajes con modalidad persuasiva en mujeres que participan en una intervención en actividad física en una universidad colombiana. Metodología: validez de contenido de mensajes con modalidad persuasiva. Inicialmente se diseñaron los contenidos de acuerdo con los procesos de cambio conductual del modelo transteórico, después se realizó la validez de contenido a través de expertos y prueba estadística. Y, por último, se enviaron los mensajes a mujeres que participaron de una intervención en el marco de "AcTICvate en casa" durante el año 2021 en la ciudad de Manizales. Resultados: se obtienen 24 mensajes validados en tres líneas, relacionados con teorías del comportamiento para promover la práctica de actividad física. Conclusión: el diseño de los mensajes y la validación del índice de contenido a través de expertos soportan una relación positiva para el cambio de comportamiento sedentario en mujeres.

Abstract Currently, at a global level, we observe low levels of compliance regarding physical activity, leading to a significant increase in the adoption of sedentary behaviors for extended periods of time. This trend represents a significant public health issue affecting 60% of the world's population. In this context, the World Health Organization (WHO) has proposed a set of technical interventions framed within the Sustainable Development Goals (SDGs) aimed at promoting physical activity. These interventions encompass measures such as environmental conservation promotion, innovation stimulation, and the utilization of digital solutions. Objective: Design and validate messages with persuasive modality in women participating in physical activity intervention at a Colombian University. Methodology: Message content validity with persuasive modality. Firstly, the content was designed according to the behavioral change processes of the Transtheoretical Model. Afterward, the content was validated by experts. Finally, the messages were sent to women who were part of an intervention in the framework of "AcTICvate en casa" during the year 2021 in the city of Manizales. Results: You obtain 24 validated messages in three lines related to behavioral theories for promoting physical activity. Conclusions: The message design and the validation of the table of contents through experts, support a positive relationship for changing sedentary behavior in women.

Resumo Atualmente, a nível global, observam-se baixos níveis de cumprimento no que diz respeito à prática de atividade física, o que leva a um aumento significativo na adoção de comportamentos sedentários por longos períodos de tempo. Essa tendência representa um importante problema de saúde pública que afeta 60% da população mundial. Nesse contexto, a Organização Mundial da Saúde (OMS) propôs um conjunto de intervenções técnicas, inseridas nos Objetivos de Desenvolvimento Sustentável (ODS), com o objetivo de promover a prática de atividade física. Essas intervenções incluem medidas como a promoção da conservação ambiental, o estímulo à inovação e o uso de soluções digitais. Objetivo: Conceber e validar mensagens com modalidade persuasiva em mulheres que participam em intervenções de atividade física numa Universidade Colombiana. Metodologia: Validade do conteúdo da mensagem com uma modalidade persuasiva. Em primeiro lugar, o conteúdo foi concebido de acordo com os processos de mudança comportamental do Modelo Transtoretical. Posteriormente, o conteúdo foi validado por peritos. Finalmente, as mensagens foram enviadas a mulheres que faziam parte de uma no âmbito da "AcTICvate en casa" durante o ano de 2021 na cidade de Manizales. Resultados: Você obtém 24 mensagens validadas em três linhas relacionadas a teorias comportamentais para promover a prática de atividade física. Conclusões: A concepção da mensagem e a validação do índice através de especialistas, apoiam uma relação positiva para a mudança do comportamento sedentário nas mulheres.

Family-Based WhatsApp Intervention to Promote Healthy Eating Behaviors Among Amazonian School Children: Protocol for a Randomized Controlled Trial.

BACKGROUND: Stunting and micronutrient deficiencies have persistently affected children in the Brazilian Amazon for decades. However, in recent years, a notable increase in childhood overweight prevalence has been observed, particularly in the context of heightened food insecurity exacerbated by the COVID-19 pandemic. Despite the limited number of effective solutions proposed to tackle this problem, digital interventions have shown great promise worldwide in preventing obesity and promoting healthy diets. OBJECTIVE: This study aims to describe the protocol of a family-based WhatsApp intervention, specifically designed to investigate the efficacy of multimedia messaging in preventing excessive weight gain and improving healthy eating practices among school-aged children in the Amazon region. METHODS: This study protocol outlines a theory-driven randomized controlled trial based on the cognitive theory of multimedia learning and the social cognitive theory. A total of 240 parents or caregivers of children enrolled in the Maternal and Child Health and Nutrition Cohort Study in Acre (MINA-Brazil) will be recruited by phone and social media. The intervention group will receive persuasive multimedia messages through WhatsApp over 19 weeks, while the waitlist control group will remain in the usual care. The primary outcome is a change in children's BMI in z score. Secondary outcomes are changes in dietary intake and biochemical indicators of the children. Outcome measures will be assessed at baseline and 5 months after randomization in comparison to usual care. The analysis will use an intent-to-treat approach and will be conducted using the statistical package Stata (version 18.0), with a significance level set at P<.05. Paired and unpaired 2-tailed t tests will be applied to compare mean changes in the outcomes. RESULTS: Data collection started in June 2023, and final measurements are scheduled to be completed in December 2023. The results of the main analysis are expected to be available in 2024. CONCLUSIONS: This innovative multimedia message intervention holds significant potential for fostering behavioral changes among Amazonian children. TRIAL REGISTRATION: Brazilian Clinical Trials Registry RBR-5zdnw6t; https://ensaiosclinicos.gov.br/rg/RBR-5zdnw6t. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54446.

Construção e validação de tecnologia educacional para o manejo da sede pré-operatória / Construction and validation of educational technology for the management of preoperative thirst

RESUMO Objetivo construir e validar imagens com mensagens educativas para telefones móveis na adesão do manejo da sede pré-operatória. Métodos estudo metodológico, realizado em três fases: 1) coleta de informações dos pacientes com sede pré-operatória; 2) elaboração das imagens com mensagens educativas; 3) evidências de validade de conteúdo e aparência das imagens pelos experts. Calculou-se o Índice de Validade de Conteúdo e aplicou-se o teste binomial. Resultados foram confeccionadas 27 imagens com mensagens educativas para telefones móveis que trazem informações frente à sede, em relação aos seus sinais e sintomas, fatores causais, métodos utilizados no seu alívio e seus mecanismos de ação. O índice geral de validade de conteúdo foi de 0,96 e o índice geral de validade de aparência de 0,94. Conclusão as imagens com mensagens educativas para telefones móveis encontram-se validadas em conteúdo e aparência. Contribuições para a prática: consistem em um importante recurso que auxiliará na adesão de manejo da sede.

ABSTRACT Objective to develop and validate images with educational messages for mobile phones to help with the management of preoperative thirst. Methods methodological study, carried out in three phases: 1) collection of information from patients with preoperative thirst; 2) development of images with educational messages; 3) evidence of the validity of the content and appearance of the images by the experts. The Content Validity Index was calculated and the binomial test was applied. Results a total of 27 images were produced with educational messages for mobile phones that provide information on thirst, its signs and symptoms, causal factors, methods used to relieve it, and its mechanisms of action. The overall content validity index was 0.96 and the overall appearance validity index was 0.94. Conclusion images with educational messages for mobile phones are validated in content and appearance. Contributions to practice: are an important resource that will help in the adherence of thirst management.

Effects of Virtual Health Messages on Maternal Therapeutic Adherence for Childhood Anemia

Introduction: Therapeutic adherence for childhood anemia is addressed in health services with unsatisfactory results. Therefore, the implementation of this strategy will favor greater adherence to treatment with ferrous sulfate. Objective: To evaluate the effect of virtual health messages on maternal therapeutic adherence for childhood anemia. Materials and Methods: A pre-experimental and longitudinal study was developed between November and December 2022, in which 24 mothers of children diagnosed with anemia participated. Adherence was determined using a test and inferential analysis through the Wilcoxon test. Results: The mothers were between 18 and 29 years old (50.0 %), of rural origin (66.7 %), who completed primary school (33.3 %), housewives (83.3 %), and cohabitants (79.2 %). In the pre-test, high adherence was observed in social factors (50 %), health personnel (75 %), illness (87.5 %), and person supplementing the ferrous sulfate and the patient (75.5 %). The overall adherence was medium in the pretest (50.0 %) and high in the post-test (100.0 %). Message reception was high for the overall test (62.6 %), reminder (79.2 %), informational (79.2 %), and motivational (75.0 %) messages. Conclusion: Virtual health messages have a positive effect on maternal therapeutic adherence for childhood anemia (p < 0.05) and their inclusion in primary health services will contribute favorably to obtaining optimal results.

Introducción: la adherencia terapéutica de anemia infantil es un tópico abordado en los servicios de salud, con resultados poco satisfactorios; por lo tanto, la implementación de esta estrategia favorecerá una mayor adherencia al tratamiento con sulfato ferroso. Objetivo: evaluar el efecto de los mensajes virtuales en salud sobre la adherencia terapéutica materna de anemia infantil. Materiales y Métodos: se desarrolló un estudio preexperimental y longitudinal entre noviembre y diciembre de 2022, en el cual participaron 24 madres de niños diagnosticados con anemia; la adherencia se determinó mediante un test y el análisis inferencial por medio de la prueba de Wilcoxon. Resultados: Las madres tenían entre 18 y 29 años (50,0 %), procedencia rural (66,7 %), primaria completa (33,3 %), amas de casa (83,3 %) y convivientes (79,2 %). En el pretest, se observó alta adherencia en factores sociales (50 %), personal de salud (75 %), enfermedad (87,5 %), persona que suplementa y paciente (75,5 %), y adherencia media en factores relacionados a la suplementación (54,2 %); en el postest, la adherencia alta se presentó en factores sociales (100,0 %), personal de salud (100,0 %), enfermedad (87,5 %), suplementación (95,8 %), persona que suministra el sulfato ferroso y paciente (100,0 %). La adherencia global fue media en el pretest (50,0 %) y alta en el postest (100,0 %). La recepción de mensajes fue alta para el test global (62,6 %), mensajes recordatorios (79,2 %), informativos (79,2 %) y motivacionales (75,0 %). Conclusión: los mensajes virtuales en salud tienen un efecto positivo en la adherencia terapéutica materna de anemia infantil (p < 0,05) y su inclusión en los servicios primarios de salud contribuirá favorablemente en la obtención de resultados óptimos.

Introdução: a adesão ao tratamento da anemia infantil é um tema abordado nos serviços de saúde, com resultados insatisfatórios; portanto, a implementação dessa estratégia favorecerá uma maior adesão ao tratamento com sulfato ferroso. Objetivo: avaliar o efeito das mensagens virtuais de saúde na adesão materna ao tratamento da anemia infantil. Materiais e método: foi realizado um estudo pré-experimental e longitudinal entre novembro e dezembro de 2022, do qual participaram 24 mães de crianças diagnosticadas com anemia; a adesão foi determinada por meio de um teste e a análise inferencial, por meio do teste de Wilcoxon. Resultados: as mães tinham entre 18 e 29 anos de idade (50 %), eram de áreas rurais (66,7 %), concluíram o ensino fundamental (33,3 %), eram donas de casa (83,3 %) e viviam juntas (79,2 %). No pré-teste, foi observada alta adesão em fatores sociais (50 %), equipe de saúde (75 %), doença (87,5 %), pessoa que suplementa e paciente (75,5 %), e adesão média em fatores relacionados à suplementação (54,2 %); no pós-teste, foi observada alta adesão em fatores sociais (100 %), equipe de saúde (100 %), doença (87,5 %), suplementação (95,8 %), pessoa que fornece sulfato ferroso e paciente (100 %). A adesão geral foi média no pré-teste (50 %) e alta no pós-teste (100 %). A recepção das mensagens foi alta para o teste geral (62,6 %), lembretes (79,2 %), mensagens informativas (79,2 %) e motivacionais (75 %). Conclusões: as mensagens virtuais de saúde têm um efeito positivo na adesão materna ao tratamento da anemia infantil (p < 0,05) e sua inclusão nos serviços de saúde primários contribuirá favoravelmente para a otimização dos resultados.

"Community members have more impact on their neighbors than celebrities": leveraging community partnerships to build COVID-19 vaccine confidence.

BACKGROUND: Vaccines are a strong public health tool to protect against severe disease, hospitalization, and death from COVID-19. Still, inequities in COVID-19 vaccination rates and health outcomes continue to exist among Black and Latino populations. Boston Medical Center (BMC) has played a significant role in vaccinating medically underserved populations, and organized a series of community-engaged conversations to better understand community concerns regarding the COVID-19 vaccine. This paper describes the themes which resulted from these community-engaged conversations and proposes next steps for healthcare leaders. METHODS: We accessed nine publicly available recordings of the community-engaged conversations which were held between March 2021 and September 2021 and ranged from 8 to 122 attendees. Six conversations prioritized specific groups: the Haitian-Creole community, the Cape Verdean community, the Latino community, the Black Christian Faith community, guardians who care for children living with disabilities, and individuals affected by systemic lupus erythematosus. Remaining conversations targeted the general public of the Greater Boston Area. We employed a Consolidated Framework for Implementation Research-driven codebook to code our data. Our analysis utilized a modified version of qualitative rapid analysis methods. RESULTS: Five main themes emerged from these community-engaged conversations: (1) Structural factors are important barriers to COVID-19 vaccination; (2) Mistrust exists due to the negative impact of systemic oppression and perceived motivation of the government; (3) There is a desire to learn more about biological and clinical characteristics of the COVID-19 vaccine as well as the practical implications of being vaccinated; (4) Community leaders emphasize community engagement for delivering COVID-19 information and education and; (5) Community leaders believe that the COVID-19 vaccine is a solution to address the pandemic. CONCLUSION: This study illustrates a need for community-engaged COVID-19 vaccine messaging which reflects the nuances of the COVID-19 vaccine and pandemic without oversimplifying information. In highlighting common concerns of the Greater Boston Area which contribute to a lack of confidence in the COVID-19 vaccine, we underscore important considerations for public health and healthcare leadership in the development of initiatives which work to advance health equity.

Use of smartphone messaging applications to increase diagnostic efficiency in veterinary diagnostic laboratories / Uso de aplicativos de mensagens de smartphones para aumentar a eficiência diagnóstica em laboratórios de diagnóstico veterinário

Many inconclusive diagnoses have been reported in studies carried out in veterinary diagnostic laboratories (VDLs). These inconclusive diagnoses are often associated with field veterinarians sending tissue samples and carcasses for histopathological examination. The use of social media in care has the potential as a tool for improvements in animal health. We evaluated the improvement in the rate of conclusive diagnoses in the VDL when using a messaging application for smartphones as a guidance tool for field veterinarians to refer animals and sample tissues for necropsy and histopathology. Veterinarians contacted the VDL team via a messaging app and forwarded videos, images, and clinical-epidemiological history. Based on this information, guidelines were created in real-time for contacting professionals about methods for collecting samples during necropsy and making diagnoses and scheduling visits to properties. The data obtained showed that smartphone messaging applications could be useful tools to expand the performance of VDLs and improve their diagnostic efficiency, especially when sending samples of animals that died is impossible due to certain sanitary conditions.

Muitos diagnósticos inconclusivos têm sido relatados em estudos realizados em laboratórios de diagnóstico veterinário (LDVs). Esses diagnósticos inconclusivos são frequentemente associados a veterinários de campo que enviam amostras de tecidos e carcaças para exame histopatológico. O uso das mídias sociais com cuidado tem potencial como ferramenta para melhorias na saúde animal. Avaliamos a melhora na taxa de diagnósticos conclusivos no LDV ao utilizar um aplicativo de mensagens para smartphones como ferramenta de orientação para veterinários de campo encaminharem animais e amostras de tecidos para necropsia e histopatologia. Os veterinários entraram em contato com a equipe do L por meio de um aplicativo de mensagens e encaminharam vídeos, imagens e histórico clínico-epidemiológico. Com base nessas informações, foram criadas orientações em tempo real para contato dos profissionais sobre métodos de coleta de amostras durante a necropsia e realização de diagnósticos, além do agendamento de visitas às propriedades. Os dados obtidos mostraram que os aplicativos de mensagens para smartphones podem ser ferramentas úteis para ampliar o desempenho dos VDLs e melhorar sua eficiência diagnóstica, principalmente quando o envio de amostras de animais que morreram é impossível devido a determinadas condições sanitárias.

Telephone messages regarding preventive measures against COVID-19 / Mensajes telefónicos frente a las medidas preventivas contra el COVID-19 / Mensagens telefônicas frente às medidas preventivas contra COVID-19

ABSTRACT Objective: To analyze the evidence of content validity of telephone messages regarding preventive measures against COVID-19. Method: Methodological study, in which messages containing text and image were developed through a narrative literature review and whose content was evaluated by eight judges in terms of clarity, practical relevance, theoretical relevance and vocabulary. The content validity index (CVI) was calculated, and messages that reached levels above 90% were considered to have adequate evidence of validity. Results: Eighteen text messages/images were developed containing information about COVID-19, hand hygiene, use and handling of masks and the importance of social distancing. After second round of evaluation, a content validity index above 90% was obtained in all evaluated indicators. Conclusion: The telephone messages were developed and showedadequate evidence of content validity.

RESUMEN Objetivo: Analizar las evidencias de validez de contenido de los mensajes telefónicos frente a las medidas preventivas frente al COVID-19. Método: Estudio metodológico, en el cual se desarrollaron mensajes que contiene en texto e imagen a través de una revisión de literatura narrativa y cuyo contenido fue evaluado por ocho jueces en términos de claridad, relevancia práctica, relevancia teórica y vocabulario. Se calculó el índice de validez de contenido (IVC), y se consideró que los mensajes que alcanzaban niveles superiores al 90% tenían evidencia adecuada de validez. Resultados: Se desarrollaron 18 mensajes de texto/imágenes con información sobre COVID-19, higiene de manos, uso y manejo de mascarillas y la importancia del distanciamiento social. Luego de la segunda ronda de evaluación, se obtuvo un índice de validez de contenido superior al 90% en todos los indicadores evaluados. Conclusión: Los mensajes telefónicos fueron desarrollados y presentaron evidencia adecuada de validez de contenido.

RESUMO Objetivo: Analisar as evidências de validade de conteúdo de mensagens telefônicas frente as medidas preventivas contra a COVID-19. Método: Estudo metodológico, em que as mensagens contendo texto e imagem foram desenvolvidas por meio de uma revisão narrativa de literatura e que tiveram seu conteúdo avaliado por oito juízes em relação a clareza, pertinência prática, relevância teórica e vocabulário. Calculou-se o índice de validade de conteúdo (IVC), e considerou-se com adequadas evidências de validade, as mensagens que alcançaram índices acima de 90%. Resultados: Foram desenvolvidas 18 mensagens de texto/imagens contendo informações sobre a COVID-19, higienização das mãos, uso e manuseio das máscaras e a importância do distanciamento social. Após a segunda rodada de avaliação obteve-se um índice de validade de conteúdo acima de 90% em todos os indicadores avaliados. Conclusão: As mensagens telefônicas foram desenvolvidas e apresentaram adequadas evidências de validade de conteúdo.

Amblyopic patient adherence under patching treatment / Adesão de pacientes amblíopes sob uso de oclusores

ABSTRACT Objective: To evaluate the effectiveness of text messaging in improving adherence to occlusion therapy for amblyopia. The secondary objective was to correlate the responses given in a self-reporting questionnaire with treatment outcome (improvement in visual acuity). Methods: This is a prospective, randomized, blinded clinical trial. The patients' parents or legal guardians in the intervention group received text messages reminding them of the importance of patching. The control group received no text messages. At final evaluation, after a period of three to six months, the patients' parents or legal guardians answered a self-reporting questionnaire to evaluate adherence to treatment. Results: The study included 34 patients with an average age of 5.35 years, 20 in the intervention group and 14 in the control group. According to the results of the self-reporting questionnaire, 50% of the study population was considered as having low adherence to treatment, 29% as having medium adherence, and 21% as having good adherence. There was no significant difference between trial groups. The comparison between an improvement in visual acuity and the mean value obtained in the self-reporting questionnaire showed a significant association between this improvement and adherence to treatment (p=0.03). Conclusion: The present study did not find a correlation between text messaging and an improvement in adherence to occlusion therapy, as shown by previous studies for different treatments. A statistically significant association was identified between an improvement in visual acuity and a good therapeutic adherence, as measured by the self-reporting questionnaire. This finding allows us to recommend using a self-reporting questionnaire as a simple method to measure adherence to treatment and help decisions about therapeutic strategies to be adopted in the patient's continuing treatment.

RESUMO Objetivo: Avaliar a eficácia do envio de mensagens de texto na melhora da adesão ao tratamento oclusivo da ambliopia. O objetivo secundário foi correlacionar as respostas dadas no questionário autorreportado e os resultados obtidos no tratamento (melhora da acuidade visual). Métodos: Ensaio clínico prospectivo, mascarado e randomizado. Os pais ou responsáveis legais dos pacientes no grupo intervenção receberam mensagens de texto para lembrar a importância dos oclusores. O grupo controle não recebeu mensagens. Na avaliação geral após 3 a 6 meses, os responsáveis responderam a um questionário autorreportado para avaliar a aderência ao tratamento. Resultados: Foram incluídos 34 pacientes com idade média de 5,35 anos; 20 eram do grupo intervenção. A população do estudo foi considerada 50% pouco aderente ao tratamento, 29% com aderência média e 21% com boa aderência, de acordo com resultado do questionário autorreportado. Não houve diferença significativa entre os grupos estudados. Quando comparada a relação entre a melhora da acuidade visual com o valor médio do questionário autorreportado, foi observada associação significativa da melhora com a adesão ao tratamento (p=0,03). Conclusão: Este estudo não mostrou melhora da aderência ao tratamento oclusivo com o envio de mensagens de texto, como tinha sido observado em estudos anteriores para outros tratamentos. Foi identificada uma relação estatisticamente significativa entre a melhora na acuidade visual e boa aderência terapêutica medida pelo questionário autorreportado. Isso permite recomendar o uso do questionário autorreportado como uma forma simples de mensurar aderência ao tratamento e auxiliar nas decisões sobre estratégias a serem adotadas na continuidade do seguimento do paciente.

How Mexicans' Emotional Responses to Non-Alcoholic Fatty Liver Disease Can Help Inform Culturally Congruent Health Care.

INTRODUCTION: This article aims to increase understanding of how Mexican immigrants respond to learning about non-alcoholic fatty liver disease (NAFLD), a spectrum disease with a heavy burden among Mexican-origin people. METHODOLOGY: This article presents findings from qualitative interviews (n = 26) that formed part of a mixed-methods study of foreign-born Mexican immigrants carried out in 2019 to 2020 in southern Arizona to assess NAFLD awareness. RESULTS: We documented common experiences of surprise, fear, and hope during study participation, all of which motivated research participants to reduce their NAFLD risk by seeking additional information, sharing it with others, and making lifestyle changes. DISCUSSION: Understanding how these emotional experiences are tied to cultural and historical factors-including Mexico's high rates of liver disease, participant's limited access to health care, and the ability to address the NAFLD risk with lifestyle changes-may promote the development of more effective and culturally congruent care in this population.

Text messaging interventions to support smoking cessation among hospitalized patients in Brazil: a randomized comparative effectiveness clinical trial.

OBJECTIVE: A clinical trial carried out in patients hospitalized for clinical and surgical conditions. This study evaluated the effectiveness of text messaging interventions (TM) versus telephone counseling (TC) to promote smoking cessation among hospitalized smokers in a middle-income country. Seven-day abstinence was measured during follow-up phone calls one month after discharge. The comparative cost of the two interventions considered the cost of calls, time spent on phone calls and sending SMS and cost of the professional involved in the approaches. RESULTS: Past 7-day tobacco abstinence was not statistically different between groups (30.5% in TM group and 26% in TC, p = 0.318). Costs were significantly lower in the TM group (U$9.28 × U$19.45- p < 0,001). Continuous abstinence was reported by 26% of TM participants and 24.5% of TC participants (p = 0.730). In the 3-month follow-up, 7-day abstinence was 23% in the TMI and 27% in the TC (p = 0.356) group. Continuous abstinence was reported by 20% of TM participants and 24% of TC participants (p = 0.334). TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03237949 Registred on: 30th May 2017.

A Psycholgical Intervention Delivered by Automated Mobile Phone Messaging Stabilized Hip and Knee Function During the COVID-19 Pandemic: A Randomized Controlled Trial.

BACKGROUND: We conducted a randomized controlled trial to evaluate the effectiveness of acceptance and commitment therapy (ACT) delivered via a mobile phone messaging robot to patients who had their total hip arthroplasty or total knee arthroplasty procedures postponed due to the COVID-19 pandemic. METHODS: Ninety patients scheduled for total hip arthroplasty or total knee arthroplasty who experienced surgical delay due to the COVID-19 pandemic were randomized to the ACT group, receiving 14 days of twice daily automated mobile phone messages, or the control group, who received no messages. Minimal clinically important differences (MCIDs) in preintervention and postintervention patient-reported outcome measures were utilized to evaluate the intervention. RESULTS: Thirty-eight percent of ACT group participants improved and achieved MCID on the Patient-Reported Outcome Measure Information System Physical Health compared to 17.5% in the control group (P = .038; number needed to treat [NNT] 5). For the joint-specific Hip Disability and Osteoarthritis Outcome Score Joint Replacement and Knee Disability and Osteoarthritis Outcome Score Joint Replacement (KOOS JR), 24% of the ACT group achieved MCID compared to 2.5% in the control group (P = .004; NNT 5). An improvement in the KOOS JR was found in 29% of the ACT group compared to 4.2% in the control group (P = .028; NNT 5). Fourteen percent of the ACT group participants experienced a clinical important decline in the KOOS JR compared to 41.7% in the control group (P = .027; NNT 4). CONCLUSION: A psychological intervention delivered via a text messaging robot improved physical function and prevented decline in patient-reported outcome measures in patients who experienced an unexpected surgical delay during the COVID-19 pandemic. LEVEL OF EVIDENCE: 1.

Secondary prevention in coronary artery disease: development and content validity of educational messages for mobile phones / Prevenção secundária na doença arterial coronariana: desenvolvimento e validade de conteúdo de mensagens educativas para celulares / Prevención secundaria en la enfermedad de las arterias coronarias: desarrollo y validez de contenido de mensajes educativos para teléfonos móviles

ABSTRACT Objective: To identify information needs of patients with coronary artery disease and develop and validate the content of educational messages for mobile phones for these patients. Method: The study was carried out in three phases: 1) Identification of information needs in relation to coronary artery disease of patients hospitalized for an acute coronary event; 2) Development of templates containing text and pictures about the disease and treatment; 3) Content validity analysis of template evidence through the assessment of 10 experts. Templates were considered validated when the Content Validity Ratio (CVR) was equal to or greater than 0.80. Results: A total of 67 patients were included, and all the information that emerged about the disease was classified as important to very important. Thirty templates were developed (heart function, recommendations on nutrition and exercise, treatments and medications, and clinical signs related to the disease and risk factor control), and the CVR obtained was greater than 0.80. Conclusion: All information needs were categorized by patients as important or very important. The templates were developed and validated considering content and design.

RESUMO Objetivo: Identificar as informações sobre necessidades de pacientes com doença arterial coronariana e desenvolver e validar o conteúdo de mensagens educativas para celulares para esses pacientes. Método: O estudo foi realizado em três fases: 1) Identificação das informações sobre necessidades em relação à doença arterial coronariana de pacientes internados por evento coronariano agudo; 2) Desenvolvimento de templates contendo textos e imagens sobre a doença e tratamento; 3) Análise da validade de conteúdo das evidências do template por meio da avaliação de 10 especialistas. Os templates foram considerados validados quando a Razão de Validade de Conteúdo (RVC) foi igual ou superior a 0,80. Resultados: Foram incluídos 67 pacientes, e todas as informações que surgiram sobre a doença foram classificadas como importantes a muito importantes. Foram desenvolvidos 30 templates (função cardíaca, recomendações de nutrição e exercícios, tratamentos e medicamentos, sinais clínicos relacionados à doença e controle de fatores de risco), e a RVC obtida foi superior a 0,80. Conclusão Todas as necessidades de informação foram categorizadas pelos pacientes como importantes ou muito importantes. Os templates foram desenvolvidos e validados considerando conteúdo e design.

RESUMEN Objetivo: Identificar las necesidades de información de los pacientes con enfermedad de las arterias coronarias y desarrollar y validar el contenido de mensajes educativos para teléfonos celulares para estos pacientes. Método: El estudio se realizó en tres fases: 1) Identificación de necesidades de información sobre enfermedad de las arterias coronarias en pacientes hospitalizados por evento coronario agudo; 2) Desarrollo de templates que contienen textos e imágenes sobre la enfermedad y el tratamiento; 3) Análisis de la validez de contenido de la evidencia del template a través de la evaluación de 10 expertos. Los templates se consideraron validadas cuando el Razón de Validez de Contenido (RVC) fue igual o superior a 0,80. Resultados: Se incluyeron 67 pacientes y toda la información que surgió sobre la enfermedad se clasificó como importante a muy importante. Se desarrollaron 30 templates (función cardiaca, recomendaciones de nutrición y ejercicio, tratamientos y medicamentos, signos clínicos relacionados con la enfermedad y control de factores de riesgo), y la RVC obtenida fue superior a 0,80. Conclusión: Todas las necesidades de información fueron categorizadas por los pacientes como importantes o muy importantes. Los templates fueron desarrollados y validados considerando contenido y diseño.

Memorization of messages, satisfaction, and feasibility of a nutritional intervention using a mobile text messaging app among adolescents / Memorização de mensagens, satisfação e usabilidade de intervenção nutricional via aplicativo de envio de mensagens entre adolescentes

ABSTRACT Objective This study aimed to evaluate the memorization of messages that promote healthy eating, as well as satisfaction and feasibility of a nutritional intervention using a mobile text messaging app aimed at adolescents from public schools in the Federal District, Brazil. Methods The messages sent addressed aspects of healthy eating based on the Dietary Guidelines for the Brazilian Population. A self-reported questionnaire was applied with 94 students to assess the memorization of the messages received during the nutritional intervention, the level of satisfaction with the intervention, whether the messages were read and shared, the frequency of reading, and what was learned from the intervention. The association of memorization with satisfaction and with the frequency of reading the messages was also investigated. Results About 48% of participants reported remembering at least one message; 77.7% showed high ranges of satisfaction; 54.3% always read the messages; 66.0% did not share messages with other people. Most of the students reported positive learning or good impressions about the intervention. An association was found between memorization and satisfaction with the intervention (p=0.002), as well as between reading and memorization (p=0.005). Conclusion Although the memorization of the healthy eating messages sent in the nutritional intervention was less than expected, a great satisfaction and high frequency of reading the messages were reported by adolescents. Future studies should investigate the permanence of the results of long-term nutrition intervention, the main influencers of memorization, and how to improve it.

RESUMO Objetivo Este estudo teve como objetivo avaliar a memorização de mensagens de promoção de alimentação adequada e saudável, a satisfação e a usabilidade de uma intervenção nutricional via aplicativo direcionada para adolescentes de escolas públicas do Distrito Federal. Métodos As mensagens enviadas abordavam aspectos sobre alimentação adequada e saudável com base no Guia Alimentar para a População Brasileira. Foi aplicado um questionário de autopreenchimento a 94 estudantes para avaliar a memorização das mensagens recebidas durante a intervenção nutricional, o nível de satisfação com a intervenção, se as mensagens eram lidas e compartilhadas, a frequência de leitura e quais foram os aprendizados decorrentes da intervenção. Investigou-se ainda a associação entre a memorização, a satisfação e a frequência de leitura das mensagens. Resultados Cerca de 48% dos participantes referiram lembrar de pelo menos uma mensagem da intervenção; 77,7% se mostraram satisfeitos com o estudo; 54,3% sempre liam as mensagens que recebiam e 66% não compartilhava as mensagens com outras pessoas. A maioria relatou aprendizados ou impressões positivas sobre a intervenção. Foi encontrada uma associação entre a memorização das mensagens e a satisfação com o estudo (p=0,002), bem como entre a leitura e a memorização das mensagens (p=0,005). Conclusão Apesar de a memorização das mensagens enviadas na intervenção nutricional ter sido aquém do esperado, foi referida grande satisfação e alta frequência de leitura pelos adolescentes. Futuros estudos devem investigar a permanência dos resultados de intervenções nutricionais a longo prazo, os principais influenciadores da memorização e como melhorá-la.

Efficacy and Safety of Text Messages Targeting Adherence to Cardiovascular Medications in Secondary Prevention: TXT2HEART Colombia Randomized Controlled Trial.

BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality worldwide, with a prevalence of approximately 100 million patients. There is evidence that antiplatelet agents and antihypertensive medications could reduce the risk of new vascular events in this population; however, treatment adherence is very low. An SMS text messaging intervention was recently developed based on behavior change techniques to increase adherence to pharmacological treatment among patients with a history of ASCVD. OBJECTIVE: This study aims to evaluate the efficacy and safety of an SMS text messaging intervention to improve adherence to cardiovascular medications in patients with ASCVD. METHODS: A randomized controlled clinical trial for patients with a prior diagnosis of cardiovascular events, such as acute myocardial infarction, unstable angina, cerebrovascular disease, or peripheral artery disease, in one center in Colombia was conducted. Patients randomized to the intervention arm were assigned to receive SMS text messages daily for the first 4 weeks, 5 SMS text messages on week 5, 3 SMS text messages each in weeks 6 and 7, and 1 SMS text message weekly from week 8 until week 52. In contrast, patients in the control arm received a monthly SMS text message reminding them of the next study appointment and the importance of the study, requesting information about changes in their phone number, and thanking them for participating in the study. The primary endpoint was the change in low-density lipoprotein cholesterol (LDL-C) levels, whereas the secondary endpoints were the changes in thromboxane B2 levels, heart rate, systolic and diastolic blood pressure, medication adherence, cardiac and noncardiac mortality, and hospitalization. Linear regression analyses and bivariate tests were performed. RESULTS: Of the 930 randomized patients, 805 (86.5%) completed follow-up and were analyzed for the primary endpoint. There was no evidence that the intervention changed the primary outcome (LDL-C levels; P=.41) or any of the secondary outcomes evaluated (all P>.05). There was also no evidence that the intervention was associated with adverse events. CONCLUSIONS: In this study, there was no evidence that a behavior modification intervention delivered by SMS text messaging improved LDL-C levels, blood pressure levels, or adherence at 12 months. More research is needed to evaluate whether different SMS text messaging strategies, including personalized messages and different timings, are effective; future studies should include mixed methods to better understand why, for whom, and in which context (eg, health system or social environment) SMS text messaging interventions work (or not) to improve adherence in patients with ASCVD. TRIAL REGISTRATION: ClinicalTrials.gov NCT03098186; https://clinicaltrials.gov/ct2/show/NCT03098186. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2018-028017.

Efficacy of tailored messages to improve behavioral intent to accept HPV vaccination among mothers may be moderated by sociodemographics.

We assessed differences in response to a tailored recommendation intervention for HPV vaccine by participants' sociodemographic characteristics in this exploratory sub-analysis of a larger web-based, randomized-controlled trial on tailored messaging among mothers with low intent to vaccinate their 11-14-year-old child against HPV. The intervention consisted of pre-recorded video messages tailored to 1-5 common concerns about HPV vaccine. In these exploratory analyses, we used generalized linear models to assess differences in post-intervention intent across intervention arms, stratified by sociodemographic characteristics among 496 trial participants. We found significantly higher post-intervention intent in the intervention participants versus the control group among mothers: 1) with younger children; 2) with white vs. black children; 3) with Non-Hispanic children; 4) who were younger; 5) with some college or vocational training; with household incomes of ≥$100,000; and 7) with 1-2 children. Our findings of effect modification by certain sociodemographic factors such as age, race/ethnicity, and household income should be considered when designing similar tailored messaging interventions.

Opinión del alumnado sobre el uso de WhatsApp en el aprendizaje de la histología durante COVID-19 / Students' views about using WhatsApp for learning histology during COVID-19

RESUMEN: La pandemia de COVID-19 ha provocado importantes retos para el sistema de enseñanza superior. Las medidas adoptadas para prevenir la transmisión comunitaria han desplazado la enseñanza presencial frente a la virtual. Las nuevas prácticas de enseñanza y aprendizaje adoptadas han planteado la necesidad de reforzar la dimensión social del aprendizaje. En este contexto, hemos implementado el uso de WhatsApp para interactuar y compartir contenidos académicos en un pequeño grupo de estudiantes de un curso de Histología. El objetivo de este estudio fue evaluar la percepción de los estudiantes sobre la eficacia de esta red social para facilitar la comunicación y compartir información educativa, su utilidad en el aprendizaje y su capacidad para modificar la dimensión afectiva durante el proceso de enseñanza-aprendizaje. Los resultados mostraron que los estudiantes tenían una actitud positiva hacia el uso de WhatsApp en el entorno de aprendizaje, de modo que facilitó la comunicación y la cohesión del grupo, favoreció el aprendizaje y redujo la ansiedad ante la evaluación. Así, las redes sociales deberían integrarse en el proceso de aprendizaje teniendo en cuenta las características del alumnado.

SUMMARY: The COVID-19 pandemic has caused significant challenges for the higher education system. The adopted measures to prevent community transmission have shifted face-to-face teaching to virtual education. The new adopted teaching and learning practices have raised the need for reinforcing the social dimension of learning. In this context, we have implemented the use of WhatsApp to interact and sharing academic contents in a small group of students in a Histology course. The aim of this study was to evaluate the students' perceptions about the effectiveness of this social network in facilitating communication and sharing educational information, its usefulness in learning, and its ability to modify the affective dimension during the teaching- learning process. The results showed that students had a positive attitude towards the use of WhatsApp in the learning environment, so that it facilitated communication and group cohesion, favored learning and reduced anxiety in the face of evaluation. Thus, social networks must be integrated in learning process considering students' characteristics.

Centennials, FOMO, and Loneliness: An Investigation of the Impact of Social Networking and Messaging/VoIP Apps Usage During the Initial Stage of the Coronavirus Pandemic.

The current COVID-19 pandemic has had obvious, well-documented devastating effects on people's physical health. In this research, we investigate its potential effects on people's mental health. Many people have experienced social isolation, as countries attempt to stem the spread of the disease through confinement and other forms of social distancing. Intuitively, such social isolation may increase feelings of loneliness, and people may take logical steps to reduce their feelings of social isolation and loneliness. One route is through the use of social networking apps (e.g., Facebook, Instagram) and messaging and VoIP apps (e.g., WhatsApp, iMessage). In this research, we investigate the effects of pandemic-induced social isolation on social networking and messaging apps, and potential related effects on loneliness. We surveyed young adults (N = 334) who are part of the Centennial cohort (born after 1995) from three different countries (Italy, Argentina, UK) and obtained their screen time usage data over a 4-week period starting from mid-March 2020. This sampling procedure allowed us to obtain data from respondents who were experiencing different degrees of mandated social isolation (lockdowns), which enabled us to determine whether social network and messaging app usage increased as a function of social isolation, and to test potential effects on levels of loneliness. Results showed that only social network usage increased in the initial stage of confinement as a function of lockdown initiation. Additionally, social network app usage was associated with increased feelings of loneliness, and this relation was mediated by fear of missing out (FOMO). In contrast, messaging app usage was associated with decreased feelings of loneliness, and was unrelated to FOMO. These results suggest that technology may be useful for mitigating the impact of loneliness during social isolation but that it is necessary to promote usage of messaging and VoIP apps, rather than social networking apps, because they are directly associated with decreases in loneliness without increasing FOMO.

Use of Text Messaging (SMS) for the Management of Side Effects in Cancer Patients Undergoing Chemotherapy Treatment: a Randomized Controlled Trial.

Cancer patients are often not sufficiently oriented to manage side effects at home. Sending text messages with self-care guidelines aimed managing side effects is the main objective of this randomized controlled trial. Patients who started outpatient chemotherapy treatment between March and December 2017 at a hospital in southern Brazil were invited to participate in this study and were allocated to the intervention or control group (ratio 1: 1). Each patient in the intervention group received a daily SMS (short message service) with some guidance on management or prevention of side effects. All text messages were sent to the intervention group patients in an automated and tailored way by our app called cHEmotHErApp. Side effects experienced by patients were verified using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30). Results showed intervention group patients experienced fewer side effects compared to the control group in cycle 1 (p < 0.05), in general. In addition, intervention group experienced less nausea in relation to the control group, in the cycle 1 and cycle 2 (p < 0.05). This study indicate text messaging may be a tool for supporting side effect management in patients receiving chemotherapy. This study was enrolled in ClinicalTrials.gov with the identification number NCT03087422. This research was performed in accordance with the Declaration of Helsinki.

Developing an SMS text message intervention on sexual and reproductive health with adolescents and youth in Peru.

BACKGROUND: Improved access to sexual and reproductive health (SRH) services and information is essential for supporting adolescents and youth in making informed decisions and optimizing each young person's outcomes related to their SRH, health and well-being and countries' current and future social and economic development. Mobile phones offer opportunities for young people to privately access SRH content and to be linked to SRH services. The objective of this study was to develop the content for an SMS (short message service or "text message") platform jointly with adolescents and youth in three regions in Peru (Lima, Ayacucho and Loreto) as part of the ARMADILLO (Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes) Study. METHODS: Content development was done in three stages. During Stage 1, we held community consultations with 13-17 year old adolescents, 18-24 year old youth and professionals who work with young people through the education and health sectors ("adult advisers") to identify and rate SRH topics of interest through group free- and guided-brainstorming activities and an individual written sharing activity. During Stage 2, the team developed the preliminary domains, sub-domains and content for the SMS platform. During Stage 3, we held focus groups with adolescents to validate the SMS content, including both individual scoring of and group feedback for each SMS. Group feedback asked about their general impressions and understanding and their thoughts about the language and usefulness of the SMS. RESULTS: A total of 172 adolescents and youth ages 13-24 and 20 adult advisers participated. Adolescents and youth brainstormed and rated SRH topics and sub-topics that led to the initial structure for the SMS platform, with 9 domains, 25 sub-domains and 146 draft SMS. Adolescents provided high scores for the SMS, with all sub-domains receiving average scores of 3.0 or higher (out of 4.0) for the SMS included. Adolescents also provided suggestions to optimize content, including improvements to unclear messages, resulting in SMS with adolescent-friendly content in simple, straightforward language. This process also revealed that adolescents lacked knowledge and had misconceptions related to contraceptive methods. CONCLUSION: This study details the systematic process used to develop relevant and accessible SRH information through a participatory approach. We document critical information about what young people know and how they think, enabling us to understand their perspective and literally speak their language. Results also provide future directions for programmatic, research and policy efforts with young people, in particular around gender norms, interpersonal violence, and access to SRH information and services, in similar settings.