Condition category
Mental and Behavioural Disorders
Date applied
06/02/2018
Date assigned
15/02/2018
Last edited
13/02/2018
Prospective/Retrospective
Prospectively registered
Overall trial status
Ongoing
Recruitment status
Recruiting

Plain English Summary

Background and study aims
The NHS Improving Access to Psychological Therapies (IAPT) services currently experience a relatively high rate of missed appointments (roughly 11%). This imposes a cost on the services and increases waiting times for others. The aim of this study is to test whether changes to the content of SMS (text message) reminders sent to IAPT patients before their appointments can reduce the rate of missed appointments. More specifically two different messages are tested against the existing business as usual message; one based on implementation intentions and the other on reciprocity. In addition to this, the study tests whether the behavioural messages can increase completion of treatment and ultimately improve mental health outcomes.

Who can participate?
Patients of one of the three participating IAPT services who have an appointment during the study period

What does the study involve?
Participants are randomly allocated to receive either the business as usual SMS reminder message or one of the two new messages. One of the new reminders asks the patient to take a moment to ensure that they are able to make their appointment. These messages are based on the psychological insight that asking people to consider the when, where and how of their behaviour can help translate intentions into action. The other new reminder lets the patient know that an appointment has been booked for them by their therapist. These messages are based on the concept of reciprocity whereby when someone does something on our behalf we reciprocate by going along with their request. All SMS messages are sent to patients 1-2 days before their appointment. The message also contains a prompt to rearrange the appointment if necessary. The messages purposely contain no message content that is clinical in nature. Appointment attendance and completion of treatment are recorded by the IAPT services at the end of the study period.

What are the possible benefits and risks of participating?
The new messages aim to increase the likelihood that patients attend their appointments. Attending an appointment should increase the likelihood that the patient recovers and also help them recover sooner. Given that this study is being conducted with participants referred to or undergoing mental health treatment the main risk is that the new messages backfire and increase missed appointments or dropout. The messages have been carefully worded to guard against this happening.

Where is the study run from?
The study will be run at three participating NHS IAPT providers:
1. West London Mental Health Trust (UK)
2. Camden and Islington NHS Foundation Trust (UK)
3. Norfolk and Suffolk Foundation Trust (UK)

When is study starting and how long is it expected to run for?
January 2017 to September 2018

Who is the main contact?
Edward Flahavan
Edward.Flahavan@bi.team

Trial website

Contact information

Type

Public

Primary contact

Mr Edward Flahavan

ORCID ID

Contact details

Behavioural Insights Team
4 Matthew Parker Street
London
SW1H 9NP
United Kingdom
+44 (0)7521035452
edward.flahavan@bi.team

Additional identifiers

EudraCT number

ClinicalTrials.gov number

Protocol/serial number

2017175

Study information

Scientific title

A randomised controlled trial to measure the impact of behavioural SMS reminders messages on missed appointments among IAPT patients

Acronym

Study hypothesis

The hypothesis is that changes to the wording of SMS appointment reminders informed by behavioural science can reduce the missed appointment rate among IAPT patients.

Ethics approval

Not provided at time of registration

Study design

Randomised controlled trial

Primary study design

Interventional

Secondary study design

Randomised controlled trial

Trial setting

Other

Trial type

Other

Patient information sheet

Not available in web format, please use the contact details to request a patient information sheet

Condition

Mild to moderate anxiety or depression

Intervention

The intervention in this trial is a change to the wording of the SMS appointment reminders sent to patients 1-2 days prior to their IAPT appointment. Method of randomisation is a random allocation mechanism with SQL. This will be carried out by our partner on the trial Mayden (the company who send the SMS messages). Patients of participating IAPT services will be allocated 1:1:1 to receive either the business as usual SMS reminder messages or one of the two behavioural SMS treatment arms. Once allocated to a trial arm, the patient will receive messages from that arm for the duration of the trial period.

1. Control - this is the business as usual SMS reminder message.
2. Implementation plans - these reminders ask the patient to take a moment to ensure that they will be able to make their appointment. These messages are based on the psychological insight that asking people to consider the when, where and how of their behaviour can help translate intentions into action. The concept was developed by psychologist Paul Gollwitzer.
3. Reciprocity - these reminders let the patient know that an appointment has been booked for them by their therapist. These messages are based on the concept of reciprocity whereby when someone does something on our behalf we reciprocate by going along with their request. The Behavioural Insights Team found this to be effective in encouraging job seekers to attend careers fairs.

These SMS messages will be sent to patients 1-2 days before their appointment. The message will also contain a prompt to rearrange the appointment if necessary. The messages purposely contain no message content that is clinical in nature.

The trial will run for 4 months, data collected during this period will be collected for analysis. After that point no new data will be collected for the trial.

Intervention type

Behavioural

Phase

Drug names

Primary outcome measures

Recorded by the IAPT services at the end of the trial period:
1. Appointment attendance - whether or not a patient misses their appointment
2. Completion of treatment - whether or not a patient completes their treatment

Secondary outcome measures

Reliable recovery, assessed using the PHQ-9 and/or the GAD-7 at initial assessment and at the end of treatment (or last available appointment where an assessment was taken)

Overall trial start date

01/01/2017

Overall trial end date

01/09/2018

Reason abandoned

Eligibility

Participant inclusion criteria

1. Patients of all conditions, age and gender will be eligible
2. Patients has an appointment with one of the participating IAPT services during the trial period
3. Patient has consented to receive SMS communication from the service
4. Patient has supplied a valid mobile phone number to the service

Participant type

Patient

Age group

Adult

Gender

Both

Target number of participants

It is expected that roughly 10,000 participants will be recruited into the trial during the period

Participant exclusion criteria

Does not meet inclusion criteria

Recruitment start date

01/03/2018

Recruitment end date

01/07/2018

Locations

Countries of recruitment

United Kingdom

Trial participating centre

Camden and Islington NHS Foundation Trust
Room 208 3rd Floor South Wing St Pancras Hospital 4 St Pancras Way
London
NW1 0PE
United Kingdom

Trial participating centre

Norfolk and Suffolk NHS Foundation Trust
Drayton High Road
Norwich
NR6 5BE

Trial participating centre

West London Mental Health Trust (Ealing)
3rd Floor 84 Uxbridge Road West Ealing
London
W13 8RA

Trial participating centre

West London Mental Health Trust (Hammersmith and Fulham)
1 Hammersmith Broadway
London
W6 9DL

Sponsor information

Organisation

Behavioural Insights Team

Sponsor details

4 Matthew Parker Street
London
SW1H 9NP
United Kingdom
+44 (0)7521035452
info@bi.team

Sponsor type

Other

Website

Organisation

Mayden House Limited

Sponsor details

1 Widcombe Crescent
Bath
BA2 6AH
United Kingdom

Sponsor type

Industry

Website

mayden.co.uk

Funders

Funder type

Industry

Funder name

Behavioural Insights Team

Alternative name(s)

Funding Body Type

Funding Body Subtype

Location

Funder name

Mayden House Limited

Alternative name(s)

Funding Body Type

Funding Body Subtype

Location

Results and Publications

Publication and dissemination plan

The protocol is not currently available online and there are no immediate plans to publish this. Results will be published on the company website and in policy publications. The trialists also plan to publish the results in a high-impact peer-reviewed journal.

IPD sharing statement
The participant level data is being shared with BIT for the trial in accordance with a data sharing agreement agreed with the participating IAPT providers. In this it is agreed that the raw data will not be made public. Though the data is anonymous the services are understandably very conscious of data protection issues.

Intention to publish date

01/09/2019

Participant level data

Not expected to be available

Results - basic reporting

Publication summary

Publication citations

Additional files

Editorial Notes