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Table 4 Structured checklist systematically detailing intervention

From: Using the Medical Research Council framework for development and evaluation of complex interventions in a low resource setting to develop a theory-based treatment support intervention delivered via SMS text message to improve blood pressure control

TIDieR checklist for the SMS text Adherence suppoRt (StAR) intervention

1.

Brief name

Control Group

Information-only SMS intervention

Interactive SMS intervention

2.

Rationale or theory

Mobile phones are contextual tools which could deliver an ecological momentary intervention [6]. Use SMS text’s because of their widespread availability and use, and we focused on adapting existing technical skills rather than acquiring new skills. We drew on an integrated theory of behaviour change [2], alongside with evidence-based behaviour change techniques (BCT) [3]; messages should be available in participants’ preferred language. As from the literature the relative effect on clinical outcomes of an informational versus interactive system of SMS text messages was unclear we included two intervention arms, one with information only SMS text’s, and one which included an interactive component.

  

Infrequent non-health related SMS texts sent to all participants,

1. Maintain participant interest in the trial.

2. Make it less clear who was getting which intervention

3. Exclude receipt of “any SMS” as effecting health-related behaviour

   

Information-only SMS intervention

1. Timely, relevant, personalised information designed to address common challenges to adherence

2. Content focused on BCT of goals and planning, repetition and substitution, social support, natural consequences

3. Unidirectional SMS text messages

4. Messages designed to be polite, direct, signed off by named provider

Interactive SMS intervention

1. Timely, relevant, personalised information designed to address common challenges to adherence

2. Content focused on BCT of goals and planning, repetition and substitution, social support, natural consequences

3. Bidirectional SMS text messages

4. Messages designed to be polite, direct, signed off by named provider

3.

Materials

Health information leaflet in preferred language

4.

Procedures

1. Language and timing of messages selected by participant

2. Welcome SMS text

3. Happy birthday SMS text

4. Non-health related SMS text message sent at 6-weekly intervals (randomly selected)

1. Language and timing of messages selected by participant

2. Welcome SMS text

3. Happy birthday SMS text

4. Non-health related SMS text message sent at 6-weekly intervals (randomly selected)

5. Weekly SMS text message, randomly selected from library (with rule that ensured messages were not repeated)

6. SMS text message reminder to attend scheduled clinic appointment 48 h prior to date

7. SMS text message to either thank participant for attending appointment or alert participants about a missed appointment 48 h post date

1. Language and timing of messages selected by participant

2. Welcome SMS text

3. Happy birthday SMS text

4. Non-health related SMS text message sent at 6-weekly intervals (randomly selected)

5. Interactive-SMS to check timing and language of messages was acceptable (automated system to make change if required)

6. Weekly SMS text message, randomly selected from library (with rule that ensured messages were not repeated)

7. Interactive-SMS to remind participant of up-coming appointment and offer to reschedule if date no-longer convenient (48 h prior to appointment date)

8. Interactive-SMS thanking participant for attending appointment or offer to reschedule a missed appointment 48 h post date)

9. Interactive-SMS to trouble shoot common problems at the health facility (long queues, lost folders)

5.

Intervention provider

Automated SMS text delivery platform using open-source software

6.

Modes of delivery

Intervention delivered via 160 character SMS text sent to individual participant’s own handset

7.

Location where intervention occurred

Outside of health care facility, where ever participant and their phone were located (real world)

8.

Number of times intervention was delivered over what time period

SMS text message sent about once every 6 weeks for 12-months

SMS text message sent weekly for 12-months

SMS text message sent weekly for 12-months (with follow-up messages generated through user initiated dialogue)

9.

What, why, when, how intervention was personalised or adapted

1. Language and timing of messages selected by participant

2. Date of birth recorded for birthday message

1. Language and timing of messages selected by participant

2. Date of birth recorded for birthday message

3. Personalised timing of appointment reminders based on prospectively routinely collected computerised appointment data

1. Language and timing of messages selected by participant

2. Date of birth recorded for birthday message

3. Interactive-SMS to check timing and language of messages was acceptable (if not automated SMS-dialogue to change either language or timing)

4. Personalised timing of appointment reminders based on prospectively routinely collected computerised appointment data

5. Regular interactive-SMS to enable rescheduling of up-coming or missed appointments, and to troubleshoot common challenges at the health facility

10.

Modifications during the trial

Nil

Nil

Nil

11.

Planned intervention delivery

SMS text messages were sent using an automated system independent of trial and clinical staff. Participants were told that not everyone will be receiving the exact same messages. Participants will also be asked not to share the SMS text messages with others. Intervention fidelity was checked by confirming receipt at least of an initial “Welcome” SMS text message for all enrolled trial participants prior to randomisation. Message delivery reports were monitored throughout the trial to check the intervention was being delivered as planned. Messages not delivered (network unavailable etc) were resent up to three times

12.

Actual intervention delivery

8277 individual SMS text messages over 12-month period (457 participants)

40,333 individual SMS text messages over 12-month period (458 participants)

41,450 individual SMS text messages over 12-month period (458 participants)