title: Barriers to using text message appointment reminders in an HIV clinic.
abstract: BACKGROUND
  Failure to attend medical appointments among persons living with human immunodeficiency virus (HIV) has been associated with poor health outcomes. Text message appointment reminders are a novel tool to potentially improve appointment attendance, but the feasibility of this tool among persons living with HIV in the United States is unknown.
  
  
  METHODS
  We conducted a randomized, controlled trial of text message reminders in a large HIV clinic. Patients who declined enrollment were asked for reasons for declining. For all patients randomized, demographic and clinical data were collected from medical records.
  
  
  RESULTS
  Of 94 patients screened for the study, 42 (45%) did not elect to participate; the most common reason for declining participation was the lack of either a cell phone or text messaging service. Cost, comfort with text messaging, and privacy were other major barriers to study enrollment. Among the 25 subjects randomized to receive text messages, 6 (24%) had their phones disconnected prior to the appointment reminder date. Ultimately, there were no differences in clinic attendance rates between the group that received text reminders versus the group that did not (72% versus 81%, p=0.42) in an intention-to-treat analysis.
  
  
  CONCLUSIONS
  Although text message reminders may be successful in certain groups of patients, barriers must be addressed before they are used as a universal approach to improve clinic attendance.
authors.affiliation: 1 Division of Infectious Diseases and International Health, Duke University Medical Center , Durham, North Carolina.
authors.forename: Brianna L
authors.initials: BL
authors.lastname: Norton
authors.forename: Anna K
authors.initials: AK
authors.lastname: Person
authors.forename: Catherine
authors.initials: C
authors.lastname: Castillo
authors.forename: Christopher
authors.initials: C
authors.lastname: Pastrana
authors.forename: Melanie
authors.initials: M
authors.lastname: Subramanian
authors.forename: Jason E
authors.initials: JE
authors.lastname: Stout
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D003219:Confidentiality; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017010:Reminder Systems / Q000295:instrumentation*; D012959:Socioeconomic Factors; D060145:Text Messaging; D014481:United States