| Follow-up periods |
Trials examining longer periods of adherence are needed. This may reflect that most studies were small sample pilot studies, but extending to 12 or more months would be necessary to gather compelling evidence. Across the studies included almost all used 9 months or less. |
Use longer follow-up periods (∼12 months). |
| Level of adherence at baseline |
Pre-intervention adherence levels continue to appear to show relevance in outcomes. |
Attend to pre-intervention levels of adherence as a potential moderator of effects. |
| Measurement of adherence |
Adherence was largely measured via self-report and while the combination of this with objective clinical outcomes is meaningful, patterns of dosing and persistence may be better captured by electronic dose monitoring or ecological assessment (eg., SMS) strategies. |
Use dose monitoring (electronic or SMS or other strategy) approaches in addition to recall-based self-report adherence data. |
| Utilization reporting |
Within main reports of study outcomes, utilization data should be standard. While several studies included percent interacting with the technology as intended, this should be a basic metric included in all technology approaches. |
Report utilization data in terms of calls placed, messages sent, reply rates, website use and software use and factors that may have influenced uptake. |
| Characterization of control condition |
Attending to active intervention components in the control arm was not uniformly incorporated but may have impact on outcomes.[27] |
Better characterize adherence strategies offered as standard of care. |
| Dissemination of findings |
Several studies had a 3-5 year lag-time from dates of study to publication date which is enough time for technology availability and use to change dramatically. |
Aggressively work to disseminate outcomes in short time-frames (<2 years); prior to shifts in technology and user preferences for certain kinds of technology. |
| Nomenclature |
There is inconsistent use of common terms such as “interactive”, “bidirectional”, “targeted messages”, “tailored messages”, and “personalized messaged”. |
Build a common nomenclature for describing important aspects of technology used in interventions, particularly for SMS messaging. |
| Key populations |
There was limited attention to key populations (eg., substance users, expecting mothers, sex workers). |
Focused work including key populations and emerging populations (e.g., those starting treatment immediately post diagnosis) is needed. |
