Text messaging intervention to improve adherence for TB patients in Argentina

短信干预提高阿根廷结核病患者的依从性

• 批准号: 8201996
• 负责人: Sarah Jo Hannah Iribarren
• 金额: $ 3.56万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-15 至 2013-07-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8201996
• 关键词: Address; Adherence; Adopted; Algorithms; Americas; Applications Grants; Area; Argentina; Car Phone; Caring; Client; Clinic; Clinical; Clinical Management; Clinical Treatment; Collaborations; Communicable Diseases; Communication; Communications Media; Communities; Computer software; Computers; Consent; Control Groups; Data; Decision Making; Development; Discipline of Nursing; Disease; Disease Outcome; Education; Evaluation; Feedback; Feeling; Fellowship; Goals; Group Interviews; HIV; Health; Health Personnel; Healthcare; Hospitals; Human; Individual; Intervention; Interview; Knowledge; Mediating; Medical Care Team; Methods; Monitor; National Institute of Nursing Research; Nurses; Outcome; Outpatients; Participant; Patient Care Team; Patients; Pattern; Perception; Pharmaceutical Preparations; Phase; Physicians; Pilot Projects; Process; Protocols documentation; Provider; Province; Public Health; Randomized; Recommendation; Reporting; Research; Research Priority; Scientist; Self Administration; Services; Sputum; Stigmata; Structure; System; Technology; Text; Training; Treatment outcome; Tuberculosis; Visit; World Health Organization; base; combat; cost; design; effective therapy; follow-up; group intervention; improved; informant; innovation; medication compliance; new technology; prevent; programs; skills; social stigma; standard of care; success; tool; treatment adherence; tuberculosis treatment

DESCRIPTION (provided by applicant): The long term goal of this training grant application is to support development of the applicant as a nurse scientist with the knowledge and skills to conduct research focused on improving infectious disease outcomes internationally. The fellowship will concentrate on dissertation research focused on evaluating an innovative intervention developed in collaboration with a TB specialized healthcare team and patients to improve treatment outcomes related to tuberculosis. Tuberculosis (TB) is a challenging global public health problem. The World Health Organization (WHO) recommends direct observation of treatment (DOT), in which a trained health care worker witnesses the daily administration of medication, as the standard for treating TB. Use of DOT is challenging and when DOT is not feasible, patient self-administration (SAT) is often used. In Argentina, treatment success rates remain well below the WHO recommended rates. In 2007 of the reported sputum smear-positive cases 54% were documented to have received DOT countrywide and only 20% in the Province of Buenos Aires, moreover default rate (patient-interrupted treatment for at least two months) was 14.5%. A current objective to improve TB care outcomes is to heighten TB patients' involvement in their own care, and improve communication between patients and care team. A promising tool to build on these goals is the use of text messaging or SMS (Short Message Service) via mobile phones, an increasingly ubiquitous global communications medium. The proposed research is a mixed-method, phased design pilot study guided by a socio-technical approach. The first phase will include finalizing the intervention protocol (e.g. socially and culturally appropriate educational text messages and a clinical workflow algorithm to address and respond to text messaging issues or other potential situations) in collaboration with the TB-specialized healthcare team at the reference hospital in Argentina. Phase 2 is an exploratory pilot study using mixed methods to evaluate the feasibility and initial efficacy of the text messaging based intervention. Study aims are to: (1) develop and examine the efficacy of a text messaging computer-based system intervention on patient outcomes; (2) evaluate the structure and process of delivering the intervention; and (3) explore perceptions of acceptance, feasibility, and how to optimize the intervention from the perspective of TB patients. Forty eligible and consented participants will be randomized to a control group receiving standard of care self administration of treatment (SAT) or to an intervention group receiving SAT plus the text messaging intervention. In-depth individual or group interviews will be conducted at the end of the two month intensive TB treatment phase. Outcomes are medication adherence rates, sputum smear conversion rates, and acceptance and feasibility of intervention at the end of the two month intensive treatment phase. The SMS based intervention for TB management, addresses the National Institute of Nursing Research's priorities to adopt new technologies for better health care outcomes and to promote health and prevent disease. PUBLIC HEALTH RELEVANCE: Effective treatment of tuberculosis is critical to protect the health of the public world-wide. Mobile phone text messaging interventions have the potential to improve tuberculosis treatment outcomes where the direct observation of treatment is not available. Developing an intervention with healthcare workers who will be using it and obtaining feedback from patients is a necessary process in implementing and evaluating a new intervention.

描述（由申请人提供）：该培训补助金申请的长期目标是支持申请人作为护士科学家的发展，其知识和技能可以进行专注于改善国际传染病结果的研究。该奖学金将专注于论文研究，重点是评估与结核病专业医疗团队和患者合作开发的创新干预措施，以改善与结核病相关的治疗结果。结核病（TB）是一个具有挑战性的全球公共卫生问题。世界卫生组织（WHO）建议直接观察治疗（DOT），即由训练有素的卫生保健工作者见证每日用药，作为治疗结核病的标准。DOT的使用具有挑战性，当DOT不可行时，通常使用患者自我给药（SAT）。在阿根廷，治疗成功率仍远低于世卫组织建议的成功率。2007年，在全国范围内报告的痰涂片阳性病例中，有54%的病例接受了DOT治疗，而在布宜诺斯艾利斯省，这一比例仅为20%，此外，违约率（患者中断治疗至少两个月）为14.5%。目前改善结核病护理结果的一个目标是提高结核病患者对自身护理的参与度，并改善患者与护理团队之间的沟通。通过移动的电话这一日益普及的全球通信媒介使用文本信息或SMS（短信息服务）是实现这些目标的一个有希望的工具。拟议的研究是一个混合的方法，分阶段设计的试点研究的社会技术方法的指导下。第一阶段将包括与阿根廷参考医院的结核病专业医疗团队合作，最终确定干预方案（例如，社会和文化上适当的教育短信和临床工作流程算法，以解决和应对短信问题或其他潜在情况）。第2阶段是一项探索性试点研究，使用混合方法评估基于短信的干预的可行性和初步疗效。研究目的是：（1）开发和检查基于计算机的短信系统干预对患者结果的有效性;（2）评估提供干预的结构和过程;（3）从结核病患者的角度探索接受度、可行性以及如何优化干预。将40名合格且知情同意的受试者随机分配至接受标准护理自我给药治疗（SAT）的对照组或接受SAT加短信干预的干预组。在为期两个月的结核病强化治疗阶段结束时，将进行深入的个人或小组访谈。结果是药物依从率，痰涂片转换率，以及在两个月的强化治疗阶段结束时干预的接受和可行性。基于SMS的结核病管理干预措施解决了国家护理研究所的优先事项，即采用新技术以获得更好的医疗保健成果，并促进健康和预防疾病。 公共卫生相关性：有效治疗结核病对保护全球公众健康至关重要。移动的电话短信干预措施有可能改善无法直接观察治疗情况的结核病治疗结果。与将使用它的医疗保健工作者一起制定干预措施并从患者那里获得反馈是实施和评估新干预措施的必要过程。