A Mobile Phone Informational Reminder to Improve Eyecare Adherence among Diabetic Patient in Rural China: A Randomized Controlled Trial

Tingting Chen; Wenhui Zhu; Bobby Tang; Ling Jin; Haoxiang Fu; Yuqun Chen; Congyao Wang; Guoshan Zhang; Jun Wang; Tiantian Ye; Di Xiao; Janardhan Vignarajan; Baixiang Xiao; Yogessan Kanagasingam; Nathan Congdon

doi:10.1016/j.ajo.2018.07.006

A Mobile Phone Informational Reminder to Improve Eyecare Adherence among Diabetic Patient in Rural China: A Randomized Controlled Trial

Tingting Chen, Wenhui Zhu, Bobby Tang, Ling Jin, Haoxiang Fu, Yuqun Chen, Congyao Wang, Guoshan Zhang, Jun Wang, Tiantian Ye, Di Xiao, Janardhan Vignarajan, Baixiang Xiao, Yogessan Kanagasingam, Nathan Congdon

School of Medicine, Dentistry and Biomedical Sciences

Research output: Contribution to journal › Article › peer-review

7 Citations (Scopus)

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Abstract

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.

Original language	English
Pages (from-to)	1-25
Journal	American Journal of Ophthalmology
Early online date	24 Jul 2018
DOIs	https://doi.org/10.1016/j.ajo.2018.07.006
Publication status	Early online date - 24 Jul 2018

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A Mobile Phone Informational Reminder to Improve Eyecare Adherence among Diabetic Patient in Rural China: A Randomized Controlled Tria
Copyright 2018 Elsevier. This manuscript is distributed under a Creative Commons Attribution-NonCommercial-NoDerivs License (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits distribution and reproduction for non-commercial purposes, provided the author and source are cited.
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Chen, T., Zhu, W., Tang, B., Jin, L., Fu, H., Chen, Y., Wang, C., Zhang, G., Wang, J., Ye, T., Xiao, D., Vignarajan, J., Xiao, B., Kanagasingam, Y., & Congdon, N. (2018). A Mobile Phone Informational Reminder to Improve Eyecare Adherence among Diabetic Patient in Rural China: A Randomized Controlled Trial. American Journal of Ophthalmology, 1-25. https://doi.org/10.1016/j.ajo.2018.07.006

Chen, Tingting ; Zhu, Wenhui ; Tang, Bobby ; Jin, Ling ; Fu, Haoxiang ; Chen, Yuqun ; Wang, Congyao ; Zhang, Guoshan ; Wang, Jun ; Ye, Tiantian ; Xiao, Di ; Vignarajan, Janardhan ; Xiao, Baixiang ; Kanagasingam, Yogessan ; Congdon, Nathan. / A Mobile Phone Informational Reminder to Improve Eyecare Adherence among Diabetic Patient in Rural China: A Randomized Controlled Trial. In: American Journal of Ophthalmology. 2018 ; pp. 1-25.

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title = "A Mobile Phone Informational Reminder to Improve Eyecare Adherence among Diabetic Patient in Rural China: A Randomized Controlled Trial",

abstract = "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.",

author = "Tingting Chen and Wenhui Zhu and Bobby Tang and Ling Jin and Haoxiang Fu and Yuqun Chen and Congyao Wang and Guoshan Zhang and Jun Wang and Tiantian Ye and Di Xiao and Janardhan Vignarajan and Baixiang Xiao and Yogessan Kanagasingam and Nathan Congdon",

year = "2018",

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day = "24",

doi = "10.1016/j.ajo.2018.07.006",

language = "English",

pages = "1--25",

journal = "American Journal of Ophthalmology",

issn = "0002-9394",

publisher = "Elsevier USA",

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Chen, T, Zhu, W, Tang, B, Jin, L, Fu, H, Chen, Y, Wang, C, Zhang, G, Wang, J, Ye, T, Xiao, D, Vignarajan, J, Xiao, B, Kanagasingam, Y & Congdon, N 2018, 'A Mobile Phone Informational Reminder to Improve Eyecare Adherence among Diabetic Patient in Rural China: A Randomized Controlled Trial', American Journal of Ophthalmology, pp. 1-25. https://doi.org/10.1016/j.ajo.2018.07.006

A Mobile Phone Informational Reminder to Improve Eyecare Adherence among Diabetic Patient in Rural China: A Randomized Controlled Trial. / Chen, Tingting; Zhu, Wenhui; Tang, Bobby; Jin, Ling; Fu, Haoxiang; Chen, Yuqun; Wang, Congyao; Zhang, Guoshan; Wang, Jun; Ye, Tiantian; Xiao, Di; Vignarajan, Janardhan; Xiao, Baixiang; Kanagasingam, Yogessan; Congdon, Nathan.

In: American Journal of Ophthalmology, 24.07.2018, p. 1-25.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - A Mobile Phone Informational Reminder to Improve Eyecare Adherence among Diabetic Patient in Rural China: A Randomized Controlled Trial

AU - Chen, Tingting

AU - Zhu, Wenhui

AU - Tang, Bobby

AU - Jin, Ling

AU - Fu, Haoxiang

AU - Chen, Yuqun

AU - Wang, Congyao

AU - Zhang, Guoshan

AU - Wang, Jun

AU - Ye, Tiantian

AU - Xiao, Di

AU - Vignarajan, Janardhan

AU - Xiao, Baixiang

AU - Kanagasingam, Yogessan

AU - Congdon, Nathan

PY - 2018/7/24

Y1 - 2018/7/24

N2 - 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.

AB - 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.

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DO - 10.1016/j.ajo.2018.07.006

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JO - American Journal of Ophthalmology

JF - American Journal of Ophthalmology

SN - 0002-9394

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