Protocol for an automated, pragmatic, embedded, adaptive randomised controlled trial: behavioural economics-informed mobile phone-based reminder messages to improve clinic attendance in a Botswanan schools-based vision screening programme

Abstract Background Clinic non-attendance rates are high across the African continent. Emerging evidence suggests that phone-based reminder messages could make a small but important contributing to reducing non-attendance. We used behavioral economics principles to develop an SMS and voice reminder message to improve attendance rates in a school-based eye screening programme in Botswana. Methods We will test a new theory-informed SMS and voice reminder message in a national school-based eye screening programme in Botswana. The control will be the standard SMS message used to remind parents/guardians to bring their child for ophthalmic assessment. All messages will be sent three times. The primary outcome is attendance for ophthalmic assessment. We will use an automated adaptive approach, starting with a 1:1:1:1 allocation ratio. Patients will not be blinded, Discussion As far as we are aware, only one other study has used behavioral economics to inform the development of reminder messages to be deployed in an African healthcare setting. Our study will will use an adaptive trial design, embedded in a national screening programme. Our approach can be used to trial other forms of reminder message in the future. Trial registration ISRCTN:96528723. Registered 5 th January 2022, doi.org Administrative information Note: the numbers in curly brackets in this protocol refer to SPIRIT checklist item numbers. The order of the items has been modified to group similar items (see equator-network.org ).