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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 1

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 State anxiety scores, before clinic appointment, Outcome 1 Cheng 2008 [combined].
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Analysis 1.1

Comparison 1 State anxiety scores, before clinic appointment, Outcome 1 Cheng 2008 [combined].

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Summary of findings for the main comparison. Mobile phone messaging for communicating results of medical investigations

Early communication of result from prenatal serum screening for Down syndrome by mobile phone messaging compared to standard care

Patient or population: Pregnant women undergoing prenatal serum screening for Down syndrome
Settings: One district general hospital in Taiwan
Intervention: The test result from prenatal screening is communicated early, i.e. before the scheduled clinic appointment, by mobile phone messaging
Comparison: The test result from prenatal screening is communicated directly only at the time of the scheduled clinic appointment

Outcomes

Illustrative comparative risks* (95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Standard care

Mobile phone messaging

State anxiety score before scheduled clinic appointment (that is, when the intervention group had already received the test result by SMS)

Overall effect (i.e. irrespective of screening result)

The mean anxiety score for the control group was 39.2 (SD 10.2).

The overall mean state anxiety score in the intervention group was 2.48 lower (8.79 lower to 3.84 higher).

2782
(1 study)

⊕⊕⊝⊝
low1

Serum‐negative group

The mean anxiety score for the control group was 39.1 (SD 10.1).

The mean state anxiety score for the serum‐negative group in the intervention group was 5.30 lower (5.99 to 4.61 lower).

2673
(1 study)

⊕⊕⊝⊝
low1

Serum‐positive group

The mean anxiety score for the control group was 42.9 (SD 11.5).

The mean state anxiety score for the serum‐positive group in the intervention group was 1.20 higher (3.48 lower to 5.88 higher).

109
(1 study)

⊕⊕⊝⊝
low1

Other outcomes

Health‐seeking behaviour

Not measured

Patient's evaluation of the intervention (including perceptions of safety)

Not measured

Harms & adverse effects

Not measured

Costs

Not measured

*The basis for the assumed risk (the mean control group risk across studies) is provided above. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 High or unclear risk in three of the six risk of bias domains (serious limitations in study design)

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Summary of findings for the main comparison. Mobile phone messaging for communicating results of medical investigations
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Table 1. Characteristics of communication modes

Face‐to‐face

Postal Letter

Call to Landline

Call to Mobile

Web Based (EHR)

E‐mail

SMS / MMS

Immediacy

Slow: Requires a visit to provider

Slow: 2 days

Immediate:
If person at home. Return call may be necessary

Immediate:
If person answers (more likely than landline)
Return call may be necessary

Immediate:

Immediate
Or stored

Immediate
Or stored

Privacy and Confidentiality

High:
Personal communication

High:
Personally addressed

Low: Confidentiality prevents message being left as others may answer or retrieve it

High:
Personal device enables possibility of message being left

Moderate:
Personal / public device?

Moderate:
Personal / public device?

High if
Personal device.

Likelihood of misinterpretation

Low

Moderate

Low:
Patient can request immediate clarification

Low:
Patient can request immediate clarification

Moderate

Moderate

Moderate

Delivery confirmation

N/A

Yes:
at significant expense

Unnecessary if call answered. No if message left

Unnecessary if call answered. No if message left

N/A

Yes

Yes

Cost

High

Moderate

Low

Moderate

Low

Low

Low
Figuras y tablas -
Table 1. Characteristics of communication modes
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Comparison 1. State anxiety scores, before clinic appointment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Cheng 2008 [combined] Show forest plot

1

2782

Mean Difference (IV, Random, 95% CI)

‐2.48 [‐8.79, 3.84]

1.1 Cheng 2008 [Serum‐negative]

1

2673

Mean Difference (IV, Random, 95% CI)

‐5.30 [‐5.99, ‐4.61]

1.2 Cheng 2008 [Serum‐positive]

1

109

Mean Difference (IV, Random, 95% CI)

1.20 [‐3.48, 5.88]
Figuras y tablas -
Comparison 1. State anxiety scores, before clinic appointment
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