PURPOSE: To determine whether short message service (SMS) reminders improve adherence to scheduled ocular examinations among patients with diabetes in rural China.
DESIGN: Randomized controlled trial METHODS: This study enrolled consecutive patients with diabetes scheduled for eye examinations at 5 hospitals in low-income areas of Guangdong, China from 1 March 2015 to 31 May 2016. Participants were randomized (1:1) to receive automated SMS reminders containing information about diabetic retinopathy (DR) 1 week and 3 days prior to scheduled eye appointments (Intervention) or to appointments without reminders (Control). Regression models following intention-to-treat principles were used to estimate the association between the main outcome (attendance within ± 1 week of scheduled visit) and membership in the Intervention group, with and without adjustment for other potential predictors of follow up. Secondary outcomes included change in DR knowledge score (1 worst - 5 best) and endline satisfaction with care (3 worst - 15 best).
RESULTS: Among 233 patients, 119 (51.1%) were randomized to Intervention (age 59.7±11.3 years, 52.1% men) and 114 (48.9%) to Control (58.7±9.50 years, 49.1% men). All participants provided data for the main study outcome. Attendance at scheduled appointments for the Intervention group (51/119, [42.9%]) was significantly higher than for Controls (16/114, [14.0%], between-group difference 28.8% [95% Confidence Interval [CI] 17.9%, 39.8%], P<0.001).Factors associated with attendance in multiple regression models included Intervention group membership (Relative Risk[RR] 3.04, 95% CI, 1.73-5.33, P<0.001) and baseline DR knowledge (RR 1.47, 95% CI 1.21-1.78, P<0.001). Improvement in Satisfaction (mean difference 1.08, 95% CI 0.70-1.46, P<0.001) and DR knowledge (mean difference 1.30, 95% CI 0.96-1.63, P<0.001) were significantly higher for the Intervention group. Total cost of the intervention was USD$5.40/person.
CONCLUSION: Low-cost SMS informational reminders significantly improved adherence to, knowledge about and satisfaction with care. Additional interventions are needed to further improve adherence.