Department of Global Health, University of Washington, Seattle, WA, United States.
School of Nursing, University of Washington, Seattle, WA, United States.
JMIR Mhealth Uhealth. 2020 Mar 25;8(3):e15281. doi: 10.2196/15281.
Use of SMS for data collection is expanding, but coverage, bias, and logistical constraints are poorly described.
The aim of this study is to assess the use of SMS to capture clinical outcomes that occur at home and identify potential biases in reporting compared to in-person ascertainment.
In the PrEP Implementation in Young Women and Adolescents program, which integrated pre-exposure prophylaxis (PrEP) into antenatal care, postnatal care, and family planning facilities in Kisumu County, Kenya, HIV-negative women 14 years of age or older were offered oral HIV self-tests (HIVSTs) to take home to male partners. Women that brought a phone with a Safaricom SIM to the clinic were offered registration in an automated SMS system (mSurvey) to collect information on HIVST outcomes. Women were asked if they offered the test to their male partners, and asked about the test process and results. HIVST outcomes were collected via SMS (sent 2.5 weeks later), in-person (if women returned for a follow-up scheduled 1 month later), or using both methods (if women initiated PrEP, they also had scheduled follow-up visits). The SMS prompted women to reply at no charge. HIVST outcomes were compared between women with scheduled follow-up visits and those without (follow-up visits were only scheduled for women who initiated PrEP). HIVST outcomes were also compared between women reporting via SMS and in-person.
Among 2123 women offered HIVSTs and mSurvey registration, 486 (23.89%) accepted HIVSTs, of whom 359 (73.87%) were eligible for mSurvey. Additionally, 76/170 (44.7%) women with scheduled follow-up visits and 146/189 (77.3%) without scheduled follow-up visits registered in mSurvey. Among the 76 women with scheduled follow-ups, 62 (82%) had HIVST outcomes collected: 19 (31%) in-person, 20 (32%) by SMS, and 23 (37%) using both methods. Among the 146 women without scheduled visits, 87 (59.6%) had HIVST outcomes collected: 3 (3%) in-person, 82 (94%) by SMS, and 2 (2%) using both methods. SMS increased the collection of HIVST outcomes substantially for women with scheduled follow-up visits (1.48-fold), and captured 82 additional reports from women without scheduled follow-up visits. Among 222 women with reported HIVST outcomes, frequencies of offering partners the HIVST (85/95, 89% in-person vs 96/102, 94% SMS; P=.31), partners using the HIVST (83/85, 98% vs 92/96, 96%; P=.50), women using HIVST with partners (82/83, 99% vs 91/92, 99%; P=.94), and seeing partner's HIVST results (82/83, 99% vs 89/92, 97%; P=.56) were similar between women reporting in-person only versus by SMS only. However, frequency of reports of experiencing harm or negative reactions from partners was more commonly reported in the SMS group (17/102, 16.7% vs 2/85, 2%; P=.003). Barriers to the SMS system registration included not having a Safaricom SIM or a functioning phone.
Our results suggest that the use of SMS substantially improves completeness of outcome data, does not bias reporting of nonsensitive information, and may increase reporting of sensitive information. .
使用短信进行数据收集的情况越来越多，但对覆盖范围、偏差和后勤限制的描述却很少。
本研究旨在评估使用短信来获取在家中发生的临床结果，并确定与面对面确定相比在报告方面可能存在的偏差。
在肯尼亚基苏木县开展的 PrEP 实施于年轻女性和青少年项目中，该项目将暴露前预防（PrEP）纳入了产前护理、产后护理和计划生育机构，为年龄在 14 岁及以上的 HIV 阴性女性提供了带回家给男性伴侣的口腔 HIV 自我检测（HIVST）。到诊所时携带带有 Safaricom SIM 的手机的女性将被提供注册到自动短信系统（mSurvey）中，以收集关于 HIVST 结果的信息。女性被问到是否向男性伴侣提供了测试，以及测试过程和结果。HIVST 结果通过短信（在 2.5 周后发送）、面对面（如果女性返回预约 1 个月后的随访）或同时使用这两种方法（如果女性开始接受 PrEP，也有计划的随访）进行收集。女性回复短信是免费的。比较了有预约随访的女性和没有预约随访的女性（仅为开始接受 PrEP 的女性安排了随访）之间的 HIVST 结果。比较了仅通过短信报告的女性和仅通过面对面报告的女性之间的 HIVST 结果。
在 2123 名接受 HIVST 和 mSurvey 注册的女性中，486 名（23.89%）接受了 HIVST，其中 359 名（73.87%）符合 mSurvey 的条件。此外，在有预约随访的 76 名女性中，有 76 名（44.7%）注册了 mSurvey，而没有预约随访的 189 名女性中，有 146 名（77.3%）注册了 mSurvey。在有预约随访的 76 名女性中，有 62 名（82%）HIVST 结果被收集：19 名（31%）是面对面，20 名（32%）是通过短信，23 名（37%）是同时使用两种方法。在没有预约就诊的 146 名女性中，有 87 名（59.6%）HIVST 结果被收集：3 名（3%）是面对面，82 名（94%）是通过短信，2 名（2%）是同时使用两种方法。短信大大增加了有预约随访的女性 HIVST 结果的收集量（增加了 1.48 倍），并从没有预约随访的女性中额外收集了 82 份报告。在报告了 HIVST 结果的 222 名女性中，向伴侣提供 HIVST 的频率（95 名中的 85 名，面对面 89% vs 102 名中的 96 名，短信 94%；P=.31）、伴侣使用 HIVST 的频率（85 名中的 83 名，98% vs 102 名中的 92 名，96%；P=.50）、女性与伴侣一起使用 HIVST 的频率（83 名中的 82 名，99% vs 92 名中的 91 名，99%；P=.94）以及看到伴侣的 HIVST 结果的频率（83 名中的 82 名，99% vs 92 名中的 89 名，97%；P=.56）在仅通过面对面报告的女性与仅通过短信报告的女性之间相似。然而，通过短信报告的女性更常报告从伴侣那里经历伤害或负面反应的频率（102 名中的 17 名，16.7% vs 85 名中的 2 名，2%；P=.003）。短信系统注册的障碍包括没有 Safaricom SIM 或手机无法正常工作。
我们的结果表明，使用短信可以大大提高结果数据的完整性，不会对非敏感信息的报告产生偏差，并且可能会增加敏感信息的报告。
