MIME-Version: 1.0
Content-Type: multipart/related; boundary="----=_NextPart_01D7B96B.8C3546E0"
Este documento é uma Página da Web de Arquivo Único, também conhecido como Arquivo Web. Se você estiver lendo essa mensagem, o seu navegador ou editor não oferece suporte ao Arquivo Web. Baixe um navegador que ofereça suporte ao Arquivo Web.
------=_NextPart_01D7B96B.8C3546E0
Content-Location: file:///C:/DE7559EC/1219-Outros-ENHTML.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
CELL PHONE TEXT MESSAGES TO SUPP=
ORT
HOME ISOLATION OF SUSPECTED CASES OF COVID-19
MENSAGENS DE TEXTO DE
CELULAR PARA SUPORTE AO ISOLAMENTO DOMICILIAR DE CASOS SUSPEITOS DE COVID-1=
9
Andressa Suelly Saturnino de Oliveira[1] * =
Katarina
Milly Pinheiro de Sousa[2] * =
Ana
de Almeida Luis[3]
* EduardaMaciel de Araujo[4] * Gilvan Ferreira Felipe[5]
* Ruth Carolina Queiroz Silvestre[6]
* Henrique de Souza Freitas[7]
RESUMO
Objetivo: Relatar a experiência de uma intervenç&atild=
e;o
educativa, usando mensagens de texto de telefonia celular, para suporte a
pacientes com síndrome gripal (casos leves, suspeitos de Covid-19), =
que
ensejam isolamento domiciliar. Métodos: Relato de experiência de
ação de extensão de universidade pública, execu=
tada
de outubro de 2020 a julho de 2021, no Ceará. Trata-se de uma
intervenção educativa, realizada com 50 pessoas, usando o Short Message Service de telefonia
móvel. O relato descreve a criação de banco de mensage=
ns
de texto de telefonia celular e o envio das mensagens para suporte ao
isolamento domiciliar. Resultados: Elaborou-se 10 mensagens de texto, com
informações sobre quando e como utilizar máscaras,
higienizar as mãos, cuidados com objetos pessoais, limpeza de
superfícies, comportamento intradomicílio, descarte de lixo e
agravamento dos sintomas. O envio das mensagens ocorreu nas primeiras 48 ho=
ras
depois do comparecimento à unidade de saúde, sendo 5 a cada d=
ia,
com intervalo de 2 horas entre elas. No 7º dia, o paciente recebeu
ligação telefônica, avaliando os cuidados em
relação ao isolamento domiciliar adotados. Orientou-se, em
seguida, sobre as fragilidades identificadas. Considerações
finais: As mensagens de texto foram úteis para oferecer suporte
às pessoas que necessitam permanecer em isolamento domiciliar, por s=
erem
casos suspeitos de Covid-19. Pela necessidade de diminuir a transmiss&atild=
e;o
da doença, oferecer informações corretas aos pacientes,
para autogerenciamento do isolamento, parece ser estratégia que se s=
oma
às orientações dadas nas unidades de saúde, dur=
ante
as consultas e/ou por teleatendimento.
Palavras-chave: Covid-19; Envio de Mensagens de
Texto; Isolamento de Pacientes; Educação em Saúde;
Telemedicina.
ABSTRACT
Objective: To report the experie=
nce
of an educational intervention, using cell phone text messages, to support
patients with flu-like illness (mild cases, suspected of Covid-19), who
experience home isolation. Methods: Experience report of an extension actio=
n of
a public university, carried out from October 2020 to July 2021, in
Ceará. It is an educational intervention, carried out with 50 people,
using the Short Message Service of mobile telephony. The report describes t=
he
creation of a cell phone text message bank and the sending of messages to
support home isolation. Results: 10 text messages were elaborated, with
information about when and how to use masks, hand hygiene, care with person=
al
objects, cleaning surfaces, intra-household behavior, garbage disposal and
worsening of symptoms. Messages were sent within the first 48 hours after a=
ttending
the health unit, 5 each day, with an interval of 2 hours between them. On t=
he
7th day, the patient received a phone call, evaluating the care taken in
relation to home isolation. Then, he was guided on the identified weaknesse=
s.
Final considerations: Text messages were useful to support people who need =
to
remain in isolation at home, as they are suspected cases of Covid-19. Due to
the need to reduce the transmission of the disease, offering correct
information to patients, for self-management of isolation, seems to be a
strategy that adds to the guidelines given in health units, during
consultations and/or through telecare.
Keywords: Covid-19; Text Messaging; Patient Isolation; Health
Education; Telemedicina
INTRODUCTION
The world lives in a scenario of ubiquity of cell phones. Thes=
e became
the main forms of distance communication for some time, due to the number of
people who have them and the ease of access. Thus, it is not difficult to
understand the reason for the interest in using these devices as a health
resource. Even before the Covid-19 Pandemic in 2020, mHealth was a reality.=
The World Health Organization (WHO) defines mHealth as a public
health practice supported by mobile devices. There is potential to facilita=
te
access to clinical diagnosis and treatment advice. Detailing the possibilit=
ies
of use, the following can be cited: support for clinical diagnosis and/or
decision making; improvement in the clinical outcomes of treatments, through
behavior change and increased patient compliance and treatment compliance;
acting as an autonomous digital therapy; and providing disease-related
education⁽¹⁾.
In addition, mHealth has the potential to reduce waiting time =
for
appointments and lessen the need to meet a health care provider face-to-fac=
e.
Consequently, mHealth interventions have the potential to reduce the worklo=
ad
of professionals, be more economical for clinical practice and encourage
self-care⁽²⁾.
One of the tools for implementing mHealth is the Short Message
Service (SMS), that is, sending text messages. Communication through this
service is straightforward and fast and does not require participants to
communicate simultaneously. It is a neutral form of communication, as it wo=
rks
on any cell phone, without the need for internet, making it easily accessib=
le
for many⁽³⁾.
In the context of the Covid-19 Pandemic, due to the need to re=
ach
many people, this technology can be used to support the care offered in hea=
lth
services. In this chapter, the intention is to share an experience of using=
SMS
to support home isolation of suspected Covid-19 cases identified in Primary
Care. This experience arose from the need for standardized and regular moni=
toring,
so that users would not be “abandoned” after leaving the health
unit.
It is verified, then, the relevance of the search for new stra=
tegies
to support the health education of people with Covid-19 to improve the rate=
s of
adherence to home isolation, in addition to disseminating successful
experiences in the use of these technologies, to encourage their incorporat=
ion
into the offering care. It is believed that mobile telephony can complement=
the
health care provided in health services, and can be integrated into the
traditional offer of health care⁽⁴⁾.
Based on these premises, this study was developed with the aim=
of
reporting the experience of an educational intervention, using cell phone t=
ext
messages, to support patients with flu-like illness (mild cases, suspected =
of
Covid-19), who lead to isolation home.
METHODS
This is an experience report of an extension action, linked to=
a
survey by the Health Sciences Institute of the University of International
Integration of Afro-Brazilian Lusophony (Unilab), carried out from October =
2020
to July 2021, in the municipality of interior of Ceará.
The action took place in a health unit where people who need
testing are referred, as they are suspected cases of Covid-19. While they do
not have laboratory confirmation, they are diagnosed with flu syndrome, a m=
ild
case, suspected of Covid-19. Although they are suspicious cases, such people
require monitoring by primary care health professionals, every 24 or 48 hou=
rs,
through telemonitoring, until the recommended period of home isolation is
completed (if the test is positive or until the test is negative be informe=
d).
This extension action was carried out by a team of ten people,
professors and students from Unilab, on a weekly basis. People who attended=
the
health unit were invited, who had: received a diagnosis of Flu Syndrome
(suspected Covid-19 / mild case), with indication of home isolation; age 18
years or older; literate; mobile device for personal use; could read text
messages from their cell phones.
It was decided to divide this report into two parts to facilit=
ate
the understanding of the educational intervention. It consists of: 1) Creat=
ing
a cell phone text message bank and 2) Sending text messages to support home
isolation.
RESULTS AND DISCUSSI=
ON
Creating a cell phone
text message bank
The preparation of text messages took place in the second half=
of
2020. A survey was carried out, in a document published by the Ministry of
Health, of the information for this purpose. The document is the Coronaviru=
s Clinical
Management Protocol (Covid-19) in Primary Health Care - Version 9. In the
publication, there is a list of 17 measures of home isolation and home care=
for
all patients diagnosed with flu-like illness. they are divided into three
purposes: patient isolation, caregiver precautions and general
precautions⁽⁵⁾.
After this survey, the number of messages and the sending times
were discussed, so as not to overload the patient with information. There
should be enough time between messages for him to reflect on the information
received. In addition, the sending of messages should take place during
business hours (8-5 pm) and in the first days after attending the health
service, to take as much information as possible at the beginning of the
isolation period and enable the application of what was learned until the e=
nd
of this. Thus, it was decided to send 10 messages in the first 48 hours aft=
er
attending the health unit, 5 each day, with an interval of 2 hours between
them.
The elaboration of the messages proceeded, based on the guidel=
ines
contained in the Protocol, which was based on the WHO Technical Guidance -
Patient Management - Coronavirus Disease 2019⁽⁶⁾. The 17
constant measurements were grouped into 10 isolation instructions, which we=
re
transformed into text messages, which contained 160 characters, counting
spaces. All messages were preceded by a “Covid-19 research team”=
;,
so that the patient could recognize the sender of the messages, even if he =
had
not registered the telephone number in his electronic address book.
The messages elaborated were submitted to the appreciation of
three nurses, with a doctorate degree, professors of undergraduate courses =
in
health at a public university, who carry out research in primary care. In t=
he
evaluation, they verified whether the content of the messages contemplated
sufficient basic guidelines to maintain the isolation correctly and whether=
the
language was accessible to anyone. They requested the replacement of some w=
ords
by synonyms that were easier to understand. They also recommended numbering=
the
messages, so that the recipient could understand the order in which they we=
re
received, in case of delay in sending by the cell phone operator. All reque=
sted
adjustments have been made. The sending scheme and messages are presented in
Table 1.
=
=
&nb=
sp; Table
1 - Search text message bank. Acarape, Ceará, Brazil, 2021.=
(To be
continued)
DAY
TIME<=
/o:p>
MESSAGE
1
8h
[COVID-19 RESEARCH TEAM] 1. Avoid leaving the ho=
use,
receiving visitors and having contact with pets. If you do, wash your han=
ds
before and after contact.
10h
[COVID-19 RESEARCH TEAM] 2. Avoid contact with o=
ther
people indoors. Stay in the airy single room with the door closed.
12h
[COVID-19 RESEARCH TEAM] 3. Use a private bathro=
om.
If not, always clean it after use with bleach or alcohol.
14h
[COVID-19 RESEARCH TEAM] 4. Towels and personal
hygiene utensils should not be shared with others in your household.=
16h
[COVID-19 RESEARCH TEAM] 5. Avoid sharing objects
indoors. Used dishes and clothes should be washed as usual.
[COVID-19 RESEARCH TEAM] 6. Wash your hands
frequently with soap and water for 20 seconds or use alcohol gel.
10h
[COVID-19 RESEARCH TEAM] 7. Avoid touching your
eyes, nose and mouth with dirty hands. Everyone who lives with you should
enforce hand hygiene.
12h
[COVID-19 RESEARCH TEAM] 8. Wear a mask whenever=
you
come in contact with other people. When coughing or sneezing, cover your
mouth with your arm or a tissue, then throw in the trash.
14h
[COVID-19 RESEARCH TEAM] 9. Place all trash, inc=
luding
Kleenex and masks, in a bag and close it when full, then place it in anot=
her
tightly tied bag.
16h
[COVID-19 RESEARCH TEAM] 10. Watch for symptoms.=
In
case of aggravation, go to a health facility wearing a mask at all times.
Maintain all care for 14 days or until confirmation of negative test.
=
=
&nb=
sp; =
Source:The authors.
The format of the text messages followed the SMS policy for
members of the healthcare workforce. This policy defines the strategy as
sending 160-character text messages, via mobile phone or web-based interfac=
e,
to one or more mobile phone recipients. As an administrative precaution, the
shipment must be consented, documented and not contain the recipient's
first/last name in the body of the text. The policy defines as a good pract=
ice
the short and concise text, so that the 160 characters are kept, avoiding t=
ransition
to two messages⁽³⁾.
A test message was also prepared, to be sent at the time of
approaching the patient, to find out if he knew how to use the SMS from his=
own
cell phone and to provide him with the opportunity to save the research tea=
m's
telephone number, if he wished , which would send the 10 messages from the =
next
day. The message was "[COVID-19 RESEARCH TEAM] Test message for survey
participation."
Elaborated from the Protocol⁽⁵⁾, the 10 mess=
ages
have content intended to encourage the development of skills for
self-management of home isolation in a simple and effective way. The messag=
es
cover information about when and how to use masks, hand hygiene, care for
personal items, cleaning surfaces, indoor behavior, garbage disposal and
worsening of symptoms.
For patients with suspected Covid-19, as they are a mild case =
of
flu-like illness, it is important to encourage self-management of isolation=
, as
there will be no physical presence of the health professional until the end=
of
home isolation (except for monitoring phone calls every 24/48h). Thus, it is
necessary to use a care strategy that is centered on the person, so that th=
ey
can understand their participation in care, in order to avoid transmission =
of
the disease within the home or to other people outside the home. The messag=
es
provide knowledge in a non-invasive way, which integrates with what the pat=
ient
already knows and allows conscious decision-making. The scientific literatu=
re
recognizes that stimulating these skills leads to improved self-efficacy=
317;⁷⁾.
<=
/p>
Sending text message=
s to
support home isolation
Upon completing the flow of care at the health unit for people
with suspected Covid-19, the patients were approached by team members, who
invited them to participate. With the consent (registered and documented) i=
n a
reserved place, the participant answered a registration form with basic data
(name, cell phone number for contact, neighborhood of residence). The test
message was sent and the participant was asked to look for it on the cell p=
hone
and read it.
Still at the health unit, the member of the action team talked=
to
the participant about the care in relation to home isolation adopted since =
the
symptoms started. The responses were registered in a pre-intervention
assessment instrument. As of June 2021, 50 people have responded to this
instrument.
The same person who approached the participant at the health u=
nit
sent the text messages, scheduling them to be received at the planned times=
. In
order to assess how care was being implemented and whether there was a need=
to
reinforce any information about care with home isolation, on the 7th day af=
ter
attending the health unit, a person other than the one who approached the
patient at the unit made a phone call for him, asking how he was feeling, h=
ow
were the days after attending the health unit and evaluating, again, the ca=
re
in relation to home isolation adopted, however, referring to the period aft=
er
the visit to the health service. After recording the answers on a form, the
team member explained the points he found not adopted by the participant.
It is important to emphasize that the intervention was also
intended to favor the dissemination of information. The call on the 7th day,
even when the isolation period ended for some people, served to clarify dou=
bts
and reinforce correct behaviors, which could be shared by them with other
people. This indirectly contributes to reducing the spread of the disease, =
as
it is correct information, which can be shared with family, friends, neighb=
ors
and in the work environment.=
It should be remembered that sending text messages is a support
strategy, not a substitute for the care offered at the UBS, in person or by
telephone service, on a spontaneous demand, after the appearance of the fir=
st symptoms.
Consultation with the health professional is still necessary, for evaluatio=
n,
diagnosis (of flu syndrome or Covid-19 confirmation) and for follow-up by p=
hone
calls, until the end of the recommended period of isolation in the home.
Every support strategy is added to the care offered at the UBS=
by
the Family Health teams. This is because individual clinical care remains
essential to guide suspected cases regarding isolation and recognition of
warning signs, identify patients who cannot be cared for at home, monitor s=
uspected
cases regarding clinical evolution, perform telecare for more complex cases=
and
request removal to a hospital unit when identifying signs of
aggravation⁽⁸⁾.
FINAL CONSIDERATIONS
In the experience report presented, it was found that the SMS =
was
a useful tool to support people who need to remain in home isolation, as th=
ey
are suspected cases of Covid-19. Due to the need to reduce the transmission=
of
the disease, to offer correct information to patients, so that they can make
conscious decisions for self-management of isolation, it seems to be a stra=
tegy
that adds to the guidelines given in health units, during consultations and=
/or
via telecare.
The text message bank created reflects the content of the
guidelines contained in a document published by the Ministry of Health, but=
is
not intended to replace the care offered in primary care for patients with
suspicion or confirmation of Covid-19. Serves exclusively for support. It
consists of 10 text messages, which deal with how to use masks, sanitize ha=
nds,
care for personal objects, cleaning surfaces, indoor behavior, garbage disp=
osal
and symptoms.
Although its use is limited, in this experience, only in the
context of primary care, it is believed that its use can occur in any health
scenario in which information for respiratory symptomatic patients who need
home isolation need to be reinforced. Another limitation is the natural his=
tory
of the disease, which is still ongoing. Information contained in the messag=
es
may need to be adjusted in the future in case of changes in the recommendat=
ions
of national and international health agencies. However, for the Covid-19
Pandemic situation known so far, the contents of text messages contribute to
preventing the spread of the disease and, therefore, its control.
REFERENCES
1. Rowland SP, Fitzgerald JE, Ho=
lme
T, Powell J, McGregor A. What is the clinical value of mHealth for patients=
?.
Npj Digital Medicine [Internet]. 2020 [cited 2021 Aug 25];3(4):1-6. Availab=
le
from: https://doi.org/10.1038/s41746-019-0206-x
2. Rathbone AL, Prescott J. The =
Use
of Mobile Apps and SMS Messaging as Physical and Mental Health Intervention=
s:
Systematic Review. Journal of Medical Internet Research [Internet]. 2017 [c=
ited
2021 Aug 25];19(8):1-13. Available from: https://doi.org/10.2196/jmir.7740
4. Bobrow K, Brennan T, Springer=
D,
Levitt NS, Rayner B, Namane M, et al. Efficacy of a text messaging (SMS) ba=
sed
intervention for adults with hypertension: protocol for the StAR (SMS
Text-message Adherence suppoRt trial) randomised controlled trial. BMC Publ=
ic
Health [Internet]. 2014 [cited 2021 Aug 25];14(28) Available from: <=
span
lang=3DPT style=3D'font-size:12.0pt;font-family:"Times New Roman",serif'>https://doi.org/10.1186/1471-2458-14-28
7. Dineen-Griffin S, Garcia-Card=
enas
V, Williams K, Benrimoj SI. Helping patients help themselves: A systematic
review of self-management support strategies in primary health care practic=
e.
PLoS ONE [Internet]. 2019 [cited 2021 Aug 25];14(8):1-29. Available from: <=
/span>https://doi.org/10.1371/journal.pone.0220116<=
/span>
8. Daumas RP, Silva GA, Tasca R, Leite IC, Brasil P, G=
reco
DB, et al. O papel da atenção primária na rede de
atenção à saúde no Brasil: limites e possibilid=
ades
no enfrentamento da COVID-19. Cadernos de Saúde Pública [Inte=
rnet].
2020 [cited 2021 Aug 25];36(6) Available from: http://dx.doi.org/10.1590/0102-311X00104120=
Corresponding author
Andressa Suelly Saturnino de Oliveira
Address: street Deputado João Pontes, 900, apartament 204A, bair=
ro
Fátima, Fortaleza, Ceará, Brasil, CEP: 60.040-430
[1=
] Un=
iversidade
da Integração Internacional da Lusofonia Afro-Brasileira
(Unilab), Redenção, Brasil. ORCID: <=
span
style=3D'mso-ansi-font-size:9.0pt;mso-bidi-font-size:9.0pt;mso-fareast-font=
-family:
Calibri;color:black;mso-color-alt:windowtext'>https://orcid.org/0000-0002-2675-5159<=
/span>