***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Undernutrition is a major concern for Myanmar children with low exclusive breastfeeding rate ( 24 % ) . A formative study was conducted to explore the perceptions and practice s relating to exclusive breastfeeding , and barriers and facilitators to using mobile communications for exclusive breastfeeding counselling . The results inform the design of a r and omized control trial to promote exclusive breastfeeding practice s among Myanmar mothers . Methods We conducted twenty in-depth interviews with pregnant women and accompanying family members attending an antenatal clinic at the Central Women ’s Hospital , Yangon , seven key-informant interviews and one focus group discussion with fifteen service providers such as nurses , doctors , managers and staff from the National Nutrition Centre , Department of Health , United Nations Children ’s Fund International and National Non-Government Organizations and Ooredoo , a private mobile company . Results Widespread practice s of feeding water , honey , infant formula and semi-solid food were reported to be existed in the community before the child reaches four months , mostly influenced by gr and mothers from both sides . All couples knew breast milk was good for baby and intended to breastfeed , though limited underst and ing of the term exclusive breastfeeding was reported . Perception that breast milk alone was not sufficient to provide all nutrients needed for the first six months of baby ’s life , mother had insufficient milk supply or breast problems , mother ’s back to work and gr and mothers ’ influence emerged as barriers to breastfeed exclusively for six months . All women knew how to make basic phone calls , majority could read mobile text message in Burmese and possess mobile phones while a few of them shared phones with their husb and s. All couples preferred to receive text messages 2–3 times per week in the evening . Institutional staff suggested messages to be simple , easily underst and able and culturally appropriate . Perceived barriers included limited mobile network coverage , affordability of mobile h and set and phone bills , literacy and community familiarity with text messages . All respondents welcomed the idea of planned intervention . Conclusion We incorporated findings to develop messages and determine the modality , inclusion criteria and tailored with gestation and child age , to be delivered in the r and omized controlled trial intervention This r and omized behavioral trial examined whether youth living with HIV ( YLH ) receiving cell-phone support with study funded phone plans , demonstrated improved adherence and viral control during the 24 week intervention and 24 weeks post-intervention compared to controls . Monday through Friday phone calls confirmed medications were taken , provided problem-solving support , and referred to services to address adherence barriers . Of 37 participants ( ages 15–24 ) , 62 % were male and 70 % were African American .  Self-reported adherence was significantly higher in the intervention group compared to the control at 24 and 48 weeks for the past month ( P = 0.007 ) and log 10 HIV VL was significantly lower at both 24 weeks ( 2.82 versus 4.52 P = 0.002 ) and 48 weeks ( 3.23 versus 4.23 P = 0.043 ) . Adherence and viral load showed medium to large effect sizes across the 48 week study . This is the first study to demonstrate sustained clinical ly significant reductions in HIV VL using youth friendly technology . ResumenEste ensayo de comportamiento aleatorio examinó si los jóvenes que viven con el VIH ( YLH ) reciben apoyo por celular con el estudio financiado de teléfono , se demostró un mejor cumplimiento y control viral durante la intervención de 24 semanas y 24 semanas después de la intervención en comparación con los controles . De Lunes a Viernes las llamadas telefónicas confirmaron los medicamentos , apoyaron la resolución de problemas , y se refirió a los servicios para hacer frente a las barreras de adherencia . De los 37 participantes ( siglos 15–24 ) , el 62 % eran hombres y el 70 % eran afroamericanos . Adherencia auto-reportada fue significativamente mayor en el grupo de intervención en comparación con el control a las 24 y 48 semanas del mes pasado ( P = 0.007 ) y el log 10 VL VIH fue significativamente menor en ambos 24 semanas ( 2.82 versus 4.52 P = 0.002 ) y 48 semanas ( 3.23 versus 4.23 P = 0.043 ) . La adhesión y la carga viral mostraron medianas y gr and es tamaños del efecto en todo el estudio de 48 semanas . Este es el primer estudio que demuestra descensos importantes de la VL VIH utiliz and o tecnología amigable para la juventud HIV-positive adolescents and young adults often experience suboptimal medication adherence , yet few interventions to improve adherence in this group have shown evidence of efficacy . We conducted a r and omized trial of a two-way , personalized daily text messaging intervention to improve adherence to antiretroviral therapy ( ART ) among N = 105 poorly adherent HIV-positive adolescents and young adults , ages 16–29 . Adherence to ART was assessed via self-reported visual analogue scale ( VAS ; 0–100 % ) at 3 and 6-months for mean adherence level and proportion ≥90 % adherent . The average effect estimate over the 6-month intervention period was significant for ≥90 % adherence ( OR = 2.12 , 95 % CI 1.01–4.45 , p < .05 ) and maintained at 12-months ( 6 months post-intervention ) . Satisfaction scores for the intervention were very high . These results suggest both feasibility and initial efficacy of this approach . Given study limitations , additional testing of this intervention as part of a larger clinical trial with objective and /or clinical outcome measures of adherence is warranted Social media technologies have become increasingly useful tools for research -based interventions . However , participants and social media users have expressed ethical concerns with these studies , such as risks and benefits of participation , as well as privacy , confidentiality , and informed consent issues . This study was design ed to follow up with and assess experiences and perceptions of ethics-related issues among a sample of 211 men who have sex with men who participated in the Harnessing Online Peer Education ( HOPE ) Peru study , a r and omized controlled HIV prevention intervention conducted in Peru . We found that after adjusting for age , highest educational attainment , race , sexual orientation , and prior HIV research experience , participants in the intervention group were more likely than those in the control group to have safe sex ( p = 0.0051 ) and get tested for HIV regularly ( p = 0.0051 ) . As a result of their participation , those in the intervention group benefited more positively than participants in the control group in improving HIV care ( p = 0.0077 ) and learning where to receive sexual health services ( p = 0.0021 ) . Participants in the intervention group expressed higher levels of comfort than those in the control group in joining and seeing other people in the Facebook group ( p = 0.039 ) , seeing other people ’s posts ( p = 0.038 ) and having other group members talk to them online ( p = 0.040 ) . We discuss the implication s of these results as they relate to social media-based HIV research Background Poor adherence to antiretroviral treatment has been a public health challenge associated with the treatment of HIV . Although different adherence-supporting interventions have been reported , their long term feasibility in low income setting s remains uncertain . Thus , there is a need to explore sustainable context ual adherence aids in such setting s , and to test these using rigorous scientific design s. The current ubiquity of mobile phones in many re source -constrained setting s , make it a context ually appropriate and relatively low cost means of supporting adherence . In India , mobile phones have wide usage and acceptability and are potentially feasible tools for enhancing adherence to medications . This paper presents the study protocol for a trial , to evaluate the influence of mobile phone reminders on adherence to first-line antiretroviral treatment in South India . Methods / Design 600 treatment naïve patients eligible for first-line treatment as per the national antiretroviral treatment guidelines will be recruited into the trial at two clinics in South India . Patients will be r and omized into control and intervention arms . The control arm will receive the st and ard of care ; the intervention arm will receive the st and ard of care plus mobile phone reminders . Each reminder will take the form of an automated call and a picture message . Reminders will be delivered once a week , at a time chosen by the patient . Patients will be followed up for 24 months or till the primary outcome i.e. virological failure , is reached , whichever is earlier . Self-reported adherence is a secondary outcome . Analysis is by intention-to-treat . A cost-effectiveness study of the intervention will also be carried out . Discussion Stepping up telecommunications technology in re source -limited healthcare setting s is a priority of the World Health Organization . The trial will evaluate if the use of mobile phone reminders can influence adherence to first-line antiretrovirals in an Indian context .Trial Registration Trial registration : IS RCT N79261738 Background Despite the increasing breast cancer incidence and mortality rates , Korean American immigrant women have one of the lowest rates of breast cancer screening across racial groups in the United States . Mobile health ( mHealth ) , defined as the delivery of health care information or services through mobile communication devices , has been utilized to successfully improve a variety of health outcomes . Objective This study adapted the principles of mHealth to advance breast cancer prevention efforts among Korean American immigrant women , an underserved community . Methods Using a r and omized controlled trial design , 120 Korean American women aged 40 to 77 years were recruited and r and omly assigned to either the mMammogram intervention group ( n=60 ) to receive culturally and personally tailored multilevel and multimedia messages through a mobile phone app along with health navigator services or the usual care control group ( n=60 ) to receive a printed brochure . Outcome measures included knowledge , attitudes , and beliefs about breast cancer screening , readiness for mammography , and mammogram receipt . The feasibility and acceptability of the mMammogram intervention was also assessed . Results The intervention group showed significantly greater change on scores of knowledge of breast cancer and screening guidelines ( P=.01 ) . The intervention group also showed significantly greater readiness for mammography use after the intervention compared with the control group . A significantly higher proportion of women who received the mMammogram intervention ( 75 % , 45/60 ) completed mammograms by the 6-month follow-up compared with the control group ( 30 % , 18/60 ; P<.001 ) . In addition , the intervention group rated satisfaction with the intervention ( P=.003 ) , effectiveness of the intervention ( P<.001 ) , and increase of knowledge on breast cancer and screenings ( P=.001 ) significantly higher than the control group . Conclusions A mobile phone app – based intervention combined with health navigator service was a feasible , acceptable , and effective intervention mechanism to promote breast cancer screening in Korean American immigrant women . A flexible , easily tailored approach that relies on recent technological advancements can reach underserved and hard-to-recruit population s that bear disproportionate cancer burdens . Trial Registration Clinical trials.gov NCT01972048 ; https:// clinical trials.gov/show/NCT01972048 ( Archived by WebCite at https:// clinical trials.gov/archive/NCT01972048/2013_10_29 & NA ; Patient engagement in care and adherence to medication are critical to achieving the full benefits of antiretroviral therapy ( ART ) among people with HIV infection . A r and omized controlled trial in Kenya , WelTelKenya1 , showed that an interactive mobile phone text‐messaging intervention can improve adherence and viral load suppression . We conducted a pilot study to adapt the WelTel intervention for HIV‐infected clients ( n = 25 ) at an HIV clinic in Vancouver , British Columbia . Between April and June 2012 , we recruited five participants from five groups : youth ( 14–24 years ) , mature ( ≥50 years ) , English as a second language , remote ( ≥3 hours travel time to clinic ) , and nonsuppressed ( CD4 + T cell count < 200 cells/mm3 and viral load ≥250 copies/mL on two consecutive occasions ) . Participants described the intervention as a useful way to communicate with health care providers , thus increasing the ability to access services , report side effects , and attend appointments BACKGROUND Oral contraceptive ( OC ) knowledge deficits may contribute to OC discontinuation . We examined the effect of an innovative educational intervention on young women 's OC knowledge . STUDY DESIGN As part of a r and omized trial evaluating the impact of text message reminders on OC continuation , we assessed  OC knowledge in 659 women ages 13 - 25 years . Women received routine care or routine care plus 6 months of daily educational text messages . We administered a comprehensive 41-item OC knowledge survey at baseline and 6 months . RESULTS Mean OC knowledge scores improved over time for all women ( baseline 22.8 , 56 % correct versus 24.7 , 60 % at 6 months ) , including knowledge of OC 's mechanisms of action ( p=.004 ) , effectiveness ( p<.001 ) , side effects ( p=.03 ) and benefits ( p<.001 ) . Mean 6-month scores were greater in the intervention ( 25.5 ) than the control group (23.7)(p<.001 ) . In multivariable linear regression models , the text message intervention most strongly predicted OC knowledge ( β=1 
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Our synthesis showed that clients ' experiences of these types of programmes were mixed .
However , clients also pointed to problems when using these programmes .
The cost of messages could also be a problem , and many thought that messages should be free of charge ( high confidence ) .
Language issues as well as skills in reading , writing , and using mobile phones could also be a problem ( moderate confidence ) .
Clients dealing with stigmatised or personal health conditions such as HIV , family planning , or abortion care were also concerned about privacy and confidentiality ( high confidence ) .
Some clients suggested strategies to deal with these issues , such as using neutral language and tailoring the content , timing , and frequency of messages ( high confidence ) .
Clients wanted messages at a time and frequency that was convenient for them ( moderate confidence ) .
Clients ' views about who sent the digital health communication could influence their views of the programme ( moderate confidence ) .
Our matrix shows that many of the trials assessing these types of programmes did not try to address the problems we identified , although this may have been a reporting issue .
Authors ' conclusions Our synthesis identified several factors that can influence the successful implementation of targeted client communication programmes using mobile devices .