3.4.1 Survey resultsThe Americas and European Regions had the highest percentage of Member States reportingappointment reminder initiatives (58% and 53%, respectively). Responding Member States in the African(31%), Eastern Mediterranean (36%), and South-East Asia (38%) Regions reported the lowest percentageof appointment reminder initiatives.Over 70% of participating Member States in the high-income group reported established appointmentreminder initiatives with a preference for using SMS to send appointment reminders, complemented byvoice and e-mail reminders and online scheduling options. Most implementations reported were offeredby health service providers and hospitals. These findings are in contrast to the other groups, where lessthan 40% of Member States reported appointment reminder initiatives. Zimbabwe was one exception,reporting established mHealth follow-up programmes for HIV/AIDS, TB, cholera, and influenza homecarepatients in rural areas. In the Eastern Mediterranean Region, Egypt, Lebanon, and the Syrian ArabRepublic reported established appointment reminder programmes.3.4.2 Relevant literatureStudies show that missed appointments have a financial and operational cost, especially in health systemswith strained capacity (26). However, results on the effectiveness of appointment reminders from studies inChina, Brazil, and the United Kingdom were mixed (27–30). Fairhurst and Sheikh’s randomized controlledtrial in Scotland yielded insignificant results on the evaluation of using SMS reminders to improve nonattendance
rates (31). In contrast, a study in Sao Paulo, Brazil that sent 7890 SMS reminder messages
through the clinic manager and clinic web software system to patients at four medical clinics found that nonattendance
rates were lower among patients who received SMS messages (28). For appointment reminder
systems to be effectively implemented, mobile phone penetration with SMS capability must be widespread.
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