Did not attend - (Increasing treatment attendance rates)
“Did not attend” (DNA) is the term used when someone unexpectedly fails to attend a health care appointment. DNAs are highly prevalent among clients of alcohol and other drug services and are associated with a greater risk of treatment non-completion and poorer outcomes, and result in an inefficient allocation of clinical resources. There is strong evidence that short message service (SMS) reminders improve general health care appointment attendance, particularly when they incorporate behaviour-change nudges to generate a small increase in a desired outcome (e.g. communicating that the social norm is to attend the appointment; communicating the specific cost of a missed appointment). We explored whether adding behaviour-change nudges to SMS appointment reminders can increase attendance rates in four alcohol and other drug treatment services using a mixed-methods approach, with three distinct phases.
In phase 1 we conducted focus groups were conducted with alcohol and other drug treatment consumers to explore the acceptability of a range of SMS appointment reminders (informed by the literature and BehaviourWorks Australia), which varied by nudge content. In phase 2, we undertook a multi-site interrupted time series study to test the impact of the preferred message (a positive-framed nudge SMS, “attending this appointment takes you one step closer to achieving your treatment goals”), on DNA rates among outpatients. This nudge SMS was implemented for six months, with DNA rates from this time period compared to a 3-month baseline (no-nudge SMS) period. In phase 3, we conducted semi-structured qualitative interviews with Managers and Program Leads participating to explore the barriers and facilitators to implementing nudge-SMS reminders.