非洲的双向短信干预与医疗保健结果：对随机试验进行系统评价并对预约就诊率和药物依从性进行荟萃分析

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

作者信息

Ødegård Emilie S, Langbråten Lena S, Lundh Andreas, Linde Ditte S

机构信息

Department of Clinical Research, University of Southern Denmark, Odense, Denmark.

Odense Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark.

出版信息

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

DOI:10.1371/journal.pone.0266717

PMID:35421134

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9009629/

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 Published and unpublished trials conducted in Africa comparing two-way text message interventions with standard care and/or one-way text message interventions were included.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.

摘要

背景

非洲地区手机普及率的不断提高，促使移动健康干预措施有所增加，其中双向短信干预的数量也在上升。然而，在非洲背景下，它们对医疗保健结果的影响尚不确定。本系统评价旨在梳理涉及双向短信干预的随机试验，并评估其对医疗保健结果的影响。

方法

我们检索了Medline、Embase、Cochrane对照试验中心注册库、全球健康图书馆（截至2021年8月12日）以及试验注册库（截至2020年4月24日）。纳入在非洲进行的、比较双向短信干预与标准护理和/或单向短信干预的已发表和未发表试验。对报告了医疗预约就诊率和/或药物依从性二分效应估计值的试验进行偏倚风险评估，并纳入荟萃分析。其他结果以描述性方式报告。

结果

我们纳入了31项试验（28563名参与者），所有试验均在撒哈拉以南非洲地区进行，涉及多种临床情况。总体而言，主要荟萃分析纳入了10项不同的试验，其中两项试验同时提供了药物依从性和预约就诊率的数据。另外两项试验纳入敏感性分析。在纳入的12项试验中，三项被判定为总体偏倚风险低，九项被判定为总体偏倚风险高。双向短信并未提高预约就诊率，RR：1.03；95%CI：0.95 - 1.12，I² = 53%（5项试验，4374名参与者），但与标准护理相比，提高了药物依从性，RR：1.14，95%CI：1.07 - 1.21，I² = 8%（6项试验，2783名参与者）。