ABSTRACT
Missed Clinic appointments, defaulter rates, and failure show up after starting antiretroviral therapy (ART) are all normal in Africa. There are several techniques that can be used to increase clinic attendance, such as application of software that are designed to have appointment management alerts, application of automated or manual appointment systems that possess reminders. All these can be achieved through using SMS, phone calls, or emails.
Missed clinic appointments pose difficulties for healthcare staff all over the world. No-show rates for scheduled clinic appointments in healthcare settings could reach up to 42 percent globally.
The objective of this research study meant to assess the effectiveness of Short Messaging services reminders, commonly appreviated as SMS to clients of their clinic dates in reducing missed clinic appointments in HIV Clinic.
A randomized control trial was conducted at HIV clinic. Clients were randomized in intervention and control group. The study deployed a stratified random sampling to achieve the outlined objectives. There was application of questionnaires that were distributed to participants as they attended their clinic appointments. Data was coded and analyzed in Excel and SPSS. Non parametric method was used because the sample size was small and data was not normally distributed.
The results showed that sending reminder messages to clients to remind them of their clinic appointments increases clinic attendance rates (92%) when compared to those who were not sent reminder messages (74%). Out the reasons given for missing clinic forgetting was the highest with 44%. The results showed that that the quality of the system had a remarkable value on the application of mobile applications and also on user satisfaction. Information Quality showed that there is no significant value on the application of phone mobile, as well as in the satisfaction of users. Deployment of mobile applications often showed that there is value addition on the usage and the clients who are highly satisfied with the mobile application found value on using the application.
The study period was short because it was only one week (7days). The questionnaires were not all filled.
This study showed that use of short messaging service to remind clients of their clinic appointment dates is a promising intervention that can be used to increase HIV care compliance to clinic appointments. Clinic attendance rate would be increased if Clinic adopt the use of mobile applications to send reminder messages to clients on their clinic appointments.
This research would inform health care providers and other stakeholders in health care settings that use of short messaging service to remind clients of their clinic appointment dates would reduce missed clinic appointments.
Table of Contents
DECLARATION i
ACKNOWLDGEMENT ii
ABSTRACT iii
DEFINITION OF TERMS v
LIST OF ABBREVIATION AND ACRONYMS vi
LIST OF FIGURES AND CHARTS vii
LIST OF TABLES viii
CHAPTER 1
INTRODUCTION
1.0. Background of study 1
1.1 Problem Statement 2
1.2 Objectives of the Research 2
1.3 Significance of the study 3
1.4 Scope of the Study 3
1.5 Assumptions and Limitations of the study 3
CHAPTER 2
LITERATURE REVIEW
2.0 Overview of Missed Hospital Appointments 4
2.0.1 Missed Appointments in Outpatient Clinics 5
2.0.2 Missed Appointments in Pediatrics Clinic 6
2.0.3 Missed Appointments in HIV Clinics 6
2.1 Theoretical Framework 11
2.1.1 DeLone and McLean of Information Systems Success 11
2.2 Conceptual Framework 12
CHAPTER THREE
RESEARCH METHODOLOGY
3.1 Introduction 15
3.2 Research Design 15
3.3 Target population and Sampling Method 15
3.4 Data Collection Instruments 16
3.5 Data Collection Procedures 16
3.6 Data Analysis and Presentation 16
3.7 Ethical Issues 16
CHAPTER FOUR
4.0 DATA ANALYSIS AND RESULTS
4.1 Analysis of the Questionnaire 20
4.1.1 Gender 20
4.1.2 Reasons for missing Clinic 21
4.1.3 Section A: Information Quality 22
4.1.4 Section B: System Quality 22
4.1.5 Section C: System Usage 22
4.1.6 Section D: User Satisfaction 22
4.2 Hypothesis Testing 24
CHAPTER FIVE
5.0 : Summary, Conclusion and Recommendations
5.1 : Summary findings 27
5.2 : Conclusion 28
5.3 : Limitations of the study 28
5.4 : Recommendations for further Research 28
REFERENCES 30
APPENDICES: 33
PROJECT BUDGET 35
PROJECT SCHEDULE: 36
LIST OF ABBREVIATION AND ACRONYMS
HIV - Human Immuno-Deficiency Virus
SMS - Short messaging service
MHealth - Mobile Health
NMC - Naivasha Medical Centre
WHO - World Health Organization
LIST OF FIGURES AND CHARTS
Figure.1: Initial Information Systems Success Model (DeLone & McLean 1992) …….9
Figure.2: Updated IS Success Model (DeLone and McLean 2003) 10
Figure.3: Conceptual Framework… 11
Figure. 4: Study Procedure 18
Figure.5: Box Plot 23
Chart 4.1 Gender 16
Chart 4.2 Clinic Appointments 17
Chart 4.3 Cell Phones 17
Chart 4.4 Clinic attendance comparison of Intervention and Control groups 19
LIST OF TABLES
Table 1: Operationalization of Constructs 13
Table 2: Proportion of Gender 20
Table 3: Reasons for Missing clinic 21
Table 4: Response table 22
Table 5: Results of all the Variables 22
CHAPTER 1
INTRODUCTION
1.0. Background of the study
According to a 2017 International Telecommunication Union survey, there were nearly 7.7 billion cell phones in use worldwide. Furthermore, with the involvement of mobile phones, there have been several studies reporting that people have greatly been influenced by it, through how they interact and how health care providers think about service delivery (Fang et al.,2018). Non- attendance at appointments causes delays in diagnosis and treatment initiation, as well as drug dosage adjustment. There are several techniques that can be used to increase clinic attendance. Majorly, these techniques can be boosted by the application of SMS, phone calls or emails, and they include the application of appointment management or automatic or manual appointment systems.
One of preliminary study conducted in November 2014 revealed that approximately 70 HIV patients out of 307 (23%) who had been scheduled to have an outpatient appointment either in hospitals or clinic ended up not attend the appointment (Zebina et al 2019).
Missed appointments, defaulter rates, and failure familiarize with the schedules after starting antiretroviral therapy (ART) are all normal occurrences in most hospitals found across Africa. According to Teshale et al (2020), the rate forgetting to make proper follow up was found to be at the pick in most youths, laborers, and ambulatory patients.
The majority of studies concerning mobile involvement in health care has concentrated on tactics that would improve behavioral aspects and also the act of reminding other studies that have been on the forefont research have been the mobile communication and computer technology that especially relates to healthcare provision (Fang et al.,2018). Mobile Health apps can also help patients remember their appointments.
1.1 Problem Statement
Missed clinic appointments pose difficulties for healthcare staff all over the world. Nonattendance at clinic appointment rates was calculated by dividing the actual figure of the appointment that were not attended by the overall actual figure of appointments that were expected to be attended. No-show rates for scheduled clinic appointments in healthcare settings worldwide could reach up to 42 percent.
If health provisions manage to come up with strategy that reduces the rates of appointment that were missed, it would help in increasing the quality of preventive services provided by healthcare providers as well as patient health outcomes. The rate of missed hospital appointment would be minimized through advising those expected to turn up for their upcoming medical appointments prior to the clinic day (Joseph, et al., 2016). This research will evaluate the impact of SMS text appointment reminders in an HIV Clinic Nakuru County.
1.2 Objectives of the Research
1. In order to determine components that influence mobile application of information system access
2. To determine the effectiveness of using mobile phones in achieving health outcomes
3. To Evaluate the effectiveness of SMS reminders in reducing missed clinic appointments in HIV Clinic
1.3 Significance of the study
1.This research will inform health care providers and other stakeholders in medical settings based on the results whether there is any difference on clinic attendance between the patients who received text reminder and the control group (those who did not receive).
2. There will be understanding of the benefits of Mobile health applications in this case short message service (SMS reminders).
3.This research will provide information on the need of more research on mobile applications in medical settings.
1.4 Scope of the Study
This study intends to be centered on patients attending clinic in the specific period of study.
All the patients who were sent SMS reminders on their clinic day for the specified period will be included and also those who were not sent the messages.
1.5 Assumptions and Limitations of the study
The assumption was that the respondents gave valid information for the study. The study period was limited.
1.6 DEFINITION OF TERMS
Hospital - A hospital is a facility that offers medical and surgical services as well as nursing care to people who are ill or wounded.
Clinic appointment - scheduled day and time for an individual to be treated by a physician or other licensed health care professional.
Missed Clinic appointment - A clinic appointment that was not attended by a patient.
Lost to Follow up - This is a patient who has missed clinic appointment three months and above.
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