Barriers to Using Text Message Appointment Reminders in an HIV Clinic

Introduction: 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. Subjects and 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.