Mobile appointment reminders in patient-centered care: Design and evaluation

Reminder systems have great potential to enhance healthcare outcome if it can facilitate collaborative appointment management with accessible mobile communication technology in patient-centered care. Yet, Current appointment reminder systems are effective but not optimal (McLean, et al. 2016). Following the design science process delineated by Peffers et al. (2007) and other requirements, this study proposes a design of reciprocal reminder system that automates the process of appointment rescheduling for healthcare providers and patients in addition to confirmation and cancellation. Based on the premises of media synchronicity theory, media naturalness theory and stakeholder theory as kernel theories, this study develops a design theory that covers platform design, communication design and service design. Design principles of new mobile appointment reminders are proposed to cater to the different requirements of provider and patient users. Situation adaptivity and privacy sensitivity are identified as the major design features that need to strike a balance between different user requirements. An experiment investigates how the variation in design may influence user behavior, and the findings suggest that situation adaptivity and privacy sensitivity have positive effects on users’ system experiences in terms of performance expectancy, effort expectancy and subjective consonance. Further survey results on the final design confirm that the reciprocal reminder system adaptive to patient situations and sensitive to privacy concerns has the expected effects on user behavior

Cataract surgery and non-attendance: RCT to determine the effect of a SMS reminder system and financial impact in a developing country

AIMS: Missed cataract surgical appointments are an important cause of inefficiency, with delays in appropriate treatment, loss of continuity of care, and wasted resources. This study was conducted to determine if an SMS reminder system will reduce the failure to attend (FTA) rate by our patients who are booked for cataract surgery. METHODS: A randomised controlled trial was conducted at Groote Schuur Hospital between June 2015 and June 2016. Eligible patients were randomised into one of two study groups: either the "NO reminder control group "or the "SMS reminder intervention group". Patients in the SMS reminder group were entered into a secure web platform from which the automated SMS reminder system dispatched an SMS reminder one month, four days and one day pre-operatively between 10am and 12am. The message contained the following: "Dear "Mr/Mrs name", this is to confirm your cataract surgery at Groote Schuur Hospital, booked for "date". Please phone 021 404 3541 if any queries." RESULTS: 234 patients were enrolled into this study, and 15 patients were excluded. Of the remaining 219 patients, 111 were randomised into the NO reminder group (control) and 108 into the SMS reminder group (intervention). SMS reminders reduced the FTA rate by 52.6% from 11.7% to 5.6% (p=0.11). Transport problems were identified as the most common reason for non-attendance. CONCLUSION: An SMS reminder system aids in the reduction of non-attendance for booked cataract surgery. With an estimated cost of only 54 cents for three SMS reminders, this affordable intervention results in an improved efficiency of clinical service delivery

Investigating mobile graphic-based reminders to support compliance of tuberculosis treatment

The phenomenon of rapid increment of the mobile phones can be utilized through supporting patients, such as those who have tuberculosis, for treatment adherence. This utilization will enable these patients to directly communicate their needs and requirements or receive health information such as reminder messages from healthcare facilities. However, the current mobile interventions, such as text messaging and speech reminder systems have limited use for people with low literacy levels. To overcome these challenges, this study proposed that the mobile graphic-based reminders be used to support tuberculosis patients to improve compliance with treatment regimens, especially for semi-literate and illiterate patients. A review of the literature and initial investigation study were carried out. The findings from the review were useful in understanding both the current practice of tuberculosis treatment regimens and the patients' needs and requirements. These findings, in addition, were referred in the choices of the components of the mobile graphic-based reminders to be implemented. A visual aid for communication theory was applied to the design and development of graphic-based reminder prototypes. An application prototype was implemented for the Android platform. Experiments were conducted to investigate the effects of an application prototype in supporting tuberculosis treatment. To measure the effect, the recovery rate was measured based on the effect of: (1) the graphic-based reminder group versus the control group; and (2) the graphic-based reminder group versus the speech-based reminder group. Data was collected using application event logs, interviews, field notes and audio recordings. It was found that treatment adherence of patients in the graphic-based group was higher than in the speech-based or in the control groups. It was further noted that the number of reminder responses in the graphic-based group was higher than in the speech-based group. Additionally, it was observed that patients in the graphic-based group responded sooner after receiving reminder messages compared to those in the speech-based group. The qualitative feedback also indicated that most patients not only found graphic-based reminders more useful to supporting their treatment than speech-based reminders and traditional care but believed that the application met their needs. This study provides empirical evidence that graphic-based reminders, designed for and based on patients' needs and requirements, can support the treatment of tuberculosis for patients of all literacy levels

An exploration of the strengths and weaknesses of using text messaging as a tool for self-report data collection in psychological research

Short Message Service (SMS) has immense potential for self-report data collection because it makes use of mobile phones that people already own, and allows researchers to communicate with participants regardless of physical location. Though interest in the possibilities of SMS as a tool for psychological research is slowly growing, to date, there has been no structured investigation of how this potential may be applied in psychological research. The research within this thesis examined the feasibility of using SMS as a tool for self-report psychological research, focussing on its strengths and weaknesses as a research mode. Across fifteen studies, this was investigated using a mixture of literature review, meta-analysis, surveys, and interviews. Participant samples varied from the broad (general population, university students) to specific (the elderly, the deaf). Strengths of SMS as a tool for self-report psychological research included growing interest in research community; positive perceptions of SMS as a research tool amongst potential sample; prompt responses and high response rate; suitability for frequent repeated sampling; and usefulness as a reminder prompt to support other modes of data collection. Weaknesses included a disconnect between stated willingness to participate and actual participation; response incompleteness; unsuitability for infrequent sampling; and some problems with psychometric equivalence in relation to other research modes like online or paper surveys. This was the first structured evaluation of SMS as a tool for self-report data collection in psychological research. Conclusions are limited by somewhat arbitrary design choices (such as the psychological topic within surveys) made in the absence of guiding background literature. Future research can refine these choices and use the logic presented here to guide further investigation into how SMS performs with more varied samples, different psychological topics, and as part of different research designs. This research has shown that while SMS has great potential as a tool for psychological self-report research, it has a number of weaknesses. Identifying these strengths and weaknesses, and some design choices which may mitigate the weaknesses, will open up possibilities for a wide range of future psychological research

Gestational diabetes self-management and remote monitoring mobile platform

There is a high prevalence of gestational diabetes (GD) in South Africa, which is continually growing. South African women with GD are not effectively managed or educated about selfcare, do not self-monitor frequently enough and, therefore, often succumb to various GD induced complications. The ineffective management of GD is largely due to financial and time constraints caused by the regularly required outpatient services. On the other hand, healthcare professionals do not monitor their patients frequently enough because of accessibility issues, which means they cannot intervene timeously to prevent diabetes complications. The aim of this project was to develop a mobile health (mHealth) platform for GD self-management and for remote monitoring to improve the GD cycle of care in South Africa. The objectives were to assess the current GD management practices in South Africa, to assess the existing mHealth solutions for GD and to design, develop and test a GD mHealth platform. The existing GD management practices and current GD mHealth solutions were investigated. The results of the investigation informed the design of low-fidelity and high-fidelity mock-ups of the platform. The high-fidelity mock-up underwent usability testing and the insights gained were used to develop a working prototype of the new mHealth platform, which was then ready for in-lab testing. It was found that GD had a prevalence of up to 25% in parts of South Africa. Over 70% of patients in both private and public healthcare sectors did not meet their diabetic goals, which directly correlated with diabetes induced complications. However, previous research found that using mHealth as an intervention caused a statistically significant decrease of 0.38 mmol/L (95% confidence interval (CI) 0.52 mmol/L to 0.23 mmol/L) in overall blood glucose levels during pregnancy when compared to a control group. There was a higher probability of vaginal deliveries in the intervention group than in the control group (risk ratio = 1.18). It was less likely for new-borns from the intervention group to be diagnosed with hypoglycaemia than new-borns from the control group (risk ratio = 0.67). Based on the research and usability studies conducted, an alpha version of the GD mHealth platform was developed, including a mobile app used to track the patient’s blood glucose levels via a Bluetooth-enabled glucose meter. The food intake, exercise and weight gain during pregnancy were manually captured by the patient. The app reminded the patient to take medication, measure glucose levels and attend appointments. A GD educational component was available for the patient throughout the pregnancy. The platform included a web app which allowed healthcare professionals to remotely monitor and communicate with their patients so that they could analyse trends in the data and intervene when necessary. The testing done on the prototype resulted in positive feedback with 60% of participants saying that they would use the GooDMoM mobile app to manage their GD and 70% of participants saying that they would use the GooDMoM web app to manage their patients with GD. This put the platform in a good position for beta development. The solution has the potential to benefit patients both financially and timewise, by reducing the frequency of hospital visits required. It also has the potential to positively impact the healthcare professionals by reducing the tediousness of their workload and allowing for remote monitoring of patients. The platform can, thus, optimise the GD management process in South Africa and worldwide

Improving Cervical Cancer Screening Rates among Hispanic Women in Rural Northern New Mexico Through SMS Text Messaging: A Quality Improvement Project

Description of the Problem: Cervical Cancer Screening rates among Hispanic women are low compared with non-Hispanic white women (Cadet et al., 2017). The organization in which this improvement project will be implemented, whose primary population is Hispanic, had a significantly lower cervical cancer screening rate of approximately 19% in 2021 among its existing patients who meet the criteria for cervical cancer screenings. Aim and objectives: The aim of this quality improvement project was to increase cervical cancer screening rates among Hispanic female patients aged 23 – 65 years old in Rural Northern New Mexico using short messaging system (SMS)/text message. The culturally and linguistically tailored SMS/text message was developed in accordance with the Health Belief Model. Methods: The implementation of the project intervention consisted of a pre-planning phase and an intervention phase using the Model for Improvement (Langley et al., 2009). This included collaboration with stakeholders. The SMS/text messages were sent to the sample population (n= 263) using the study organization\u27s electronic health record platform. The satisfaction, acceptance, and attitude about the use of SMS/text messaging were evaluated using a patient survey. Findings: The baseline percentage adherence rate for those within the sample having completed a CCS was 25.2% before implementing the intervention. Post-implementation adherence rate was 30%, which was statistically significant (p=0.01). 82.35% (n=14) of survey respondents indicated that they were satisfied with the message

Exploring Strategies for Reducing Patient Failure to Keep Scheduled Appointments

High no-show rates in the ambulatory setting lead to underutilized resources, decreased clinic revenue, and lower productivity. The purpose of this single case study was to explore strategies that administrators used to maintain acceptable no-show rates and maintain the sustainability of the healthcare practice. The target population for this study included local chapter members of a professional healthcare organization that provided access to practice managers and administrators in the Las Vegas, Nevada regional area where there are a large number of practices that are not part of a health system; the sustainability of these practices is dependent on allocation of adequate resources. The conceptual framework for this study was Kotter\u27s 8-step change management model that uses 8 steps for successfully managing change within the organization and developing quality improvement initiatives. Data collection included semistructured interviews with 2 practice leaders, observation of the organization\u27s practice management and appointment scheduling systems, and a review of internal reports related to appointment trends and no-show rates. Based on the data analysis using deductive and open coding techniques, 3 distinctive themes emerged from the data: appointment booking strategies, appointment reminder strategies, and provider flexibility. The results of this study might positively affect positive social change by helping administrators improve access to care in an outpatient setting through improved appointment utilization and improve patient care outcomes with more appointment availability

E-Health Management System

Most of the reasons for implementing the EHMS (Electronic Health Management System) focus on improving medical care as a whole for Patient, Physicians and Doctors. However, achieving an excellent quality of best medical care through EMR (Electronic Medical Record) is neither low-cost nor easy. Based on our qualitative study on physician practices we have found that quality improvement depends heavily on doctors’ use of the EMRs, not use of papers for their daily tasks. I also identified Key barriers to physicians’ use of EMRs and also observed that EMR software becomes useless for doctors due to its complex interface. E-Health Management System for Outdoor patient is the complete comprehensive solution for hospitals and clinics. This solution caters the full life cycle of modern hospitals and clinics, using this system patients can take appointment form their homes and confirm the availability of particular doctors. A consultant can access the medical record of their patient, and prescribe to their patient using this system. In this FYP document, I have briefly described all the phase that it has gone through from its inception to the implementation. I have highlighted the key features of E-Health Management System for OPD (Outdoor Patients)

Developing an Asthma Self-management Intervention Through a Web-Based Design Workshop for People With Limited Health Literacy:User-Centered Design Approach

BACKGROUND: Technology, including mobile apps, has the potential to support self-management of long-term conditions and can be tailored to enhance adoption. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic). OBJECTIVE: The aim of this study is to develop and test a prototype asthma self-management mobile app tailored to the needs of people with limited health literacy through a web-based workshop. METHODS: We recruited participants from a primary care center in Malaysia. We adapted a design sprint methodology to a web-based workshop in five stages over 1 week. Patients with asthma and limited health literacy provided insights into real-life self-management issues in stage 1, which informed mobile app development in stages 2-4. We recruited additional patients to test the prototype in stage 5 using a qualitative research design. Participants gave feedback through a concurrent thinking-aloud process moderated by a researcher. Each interview lasted approximately 1 hour. Screen recordings of app browsing activities were performed. Interviews were audio-recorded and analyzed using a thematic approach to identify utility and usability issues. RESULTS: The stakeholder discussion identified four themes: individual, family, friends, and society and system levels. Five patients tested the prototype. Participants described 4 ways in which the app influenced or supported self-management (utility): offering information, providing access to an asthma action plan, motivating control of asthma through support for medication adherence, and supporting behavior change through a reward system. Specific usability issues addressed navigation, comprehension, and layout. CONCLUSIONS: This study proved that it was possible to adapt the design sprint workshop to a web-based format with the added advantage that it allowed the development and the testing process to be done efficiently through various programs. The resultant app incorporated advice from stakeholders, including sources for information about asthma, medication and appointment reminders, accessible asthma action plans, and sources for social support. The app is now ready to move to feasibility testing