Validation of phone messages to promote health in people with HIV

Methodological development study to validate 10 phone messages, with participation of 11 experts that assessed their clarity and relevance. The content validity index of each phone message was calculated and a minimum concordance of 75% was established.

Results

The messages were considered clear (79.1%) and very relevant (98.2%). The general content validity index was 0.98. Main suggested alterations: inclusion of a series of short questions about the subject at the beginning of every message; adjustment to a simpler and more interactive language; replacement of specific terms and exclusion of words or expressions related to HIV.

Conclusion

The experts considered the messages clear and relevant to promote health in people with HIV.

HIV; Text messaging; Communication; Health promotion; Validation studies

Subject	Clarity evaluation
	Yes	No
	n(%)	n(%)
Presentation of the monitoring	10(90.9)	1(9.1)
Adhesion to antiretroviral therapy	8(72.7)	3(27.3)
Physical activity	8(72.7)	3(27.3)
Social support	10(90.9)	1(9.1)
Self-esteem	9(81.8)	2(18.2)
Anxiety and depression	7(63.6)	4(36.4)
Dietary habits	10(90.9)	1(9.1)
Preventive behavior	9(81.8)	2(18.2)
Sexuality	8(72.7)	3(27.3)
Ending of the monitoring	8(72.7)	3(27.3)

Subject	Relevance evaluation			I-CVI
	Irrelevant	Slightly relevant	Very relevant
	n(%)	n(%)	n(%)
Presentation of the monitoring	0	0	11(100)	1.00
Adhesion to antiretroviral therapy	0	1(9.1)	10(90.9)	0.90
Physical activity	0	0	11(100)	1.00
Social support	0	1(9.1)	10(90.9)	0.90
Self-esteem	0	0	11(100)	1.00
Anxiety and depression	0	0	11(100)	1.00
Dietary habits	0	0	11(100)	1.00
Preventive behavior	0	0	11(100)	1.00
Sexuality	0	0	11(100)	1.00
Ending of the monitoring	0	0	11(100)	1.00
			S-CVI/Ave	0.98

Subject	Message
Presentation of the phone monitoring	My name is (professional’s name); I am the nurse responsible for sending you messages about health instructions every 15 days. I would like you to confirm that you received my messages by replying with a smiley emoticon. If you have questions about the subject, you can contact me by WhatsApp every day, at any time.
Adhesion to antiretroviral therapy	Did you know that taking your medicines every day, at the same time, according to your doctor’s instructions, helps improve your health and your quality of life? Not missing appointments and having your medical examinations are important. Talk to your doctor about any difficulty with the medicine. Do not give up on your treatment!
Physical activity	Have you exercised today? Practicing exercises every day or at least three times a week for 30 minutes makes your body’s defenses stronger, helps you to lose weight, and decreases the content of fat in your blood. You will feel well and your mind will get calm. You can choose a physical activity that you like, always under the supervision of your doctor.
Social support	Did you know that it is important to take some time to be with your family and friends? Talking to someone you trust about the difficulties helps in your treatment. You can ask questions and look for help from the healthcare team at your clinic whenever you need. Keep in mind that there are people and professionals that can help you overcome the challenges.
Self-esteem	Be aware that liking yourself helps in daily activities and improves your health. Think of today and value your achievements. Do something that makes you happy every day. It can be something simple, such as dancing, reading, taking some time off, listening to music, walking, or whatever you like. Keep in mind that you are unique, special, and valuable.
Anxiety and depression	Anxiety and depression may occur sometimes in our lives. Exercising, sleeping well, having a healthy diet, and keeping good relationships with family and friends help to prevent anxiety and depression. In some situations, medicines are necessary. Seek help from the healthcare team at your clinic.
Dietary habits	How is your diet? Did you know that a healthy diet gives you energy for daily activities and helps avoiding undesirable effects from the drugs? Also, an appropriate diet prevents diabetes, heart diseases, increases in bad cholesterol levels in your blood, and lipodystrophy (change in the distribution of body fat). You can make an appointment with a nutritionist to improve your dietary habits. Do not forget to drink at least two liters of water a day!
Preventive behavior	Use of alcohol, cigarettes, and illicit drugs may impair the action of the medicines and intensify their undesirable effects. It is important to avoid or decrease the consumption of these substances so as not to hinder your treatment. Anyway, be sure to take your medicine.
Sexuality	Sex is important in people’s lives and helps them to feel well. During intercourse, it is important to use condoms to protect yourself and your partner from sexually transmitted diseases. Kisses, hugs, and caresses are ways to give and receive sexual pleasure without the risk of contracting these diseases.
Ending of the phone monitoring	Thank you for answering the messages. We are finished with the phone monitoring by WhatsApp now. However, you will continue to be assisted in the health service and may ask for help from the healthcare team if you need it. Our last meeting will be on the day of your follow-up (date of the appointment). I would like to count on your presence to perform the last evaluation of your health. We will ask your opinion about this experience and finish the survey.

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author. Ivana Cristina Vieira de Lima. Alexandre Baraúna street, 1115, 60430-160, Fortaleza, CE, Brazil. doutorandaivana@gmail.com