A Randomised Controlled Trial of an Sms-Based Mobile Epilepsy Education System
Abstract
We evaluated an epilepsy education programme based on text messaging (SMS). Epilepsy outpatients from three hospitals in Malaysia were randomised into two groups: intervention and control. Patients in the control group were supplied with printed epilepsy educational material while those in the intervention group also received text messages from the Mobile Epilepsy Educational System (MEES). A total of 136 patients completed the study (mean age 31 years; 91% Malay; 51% with an illness duration of more than 5 years). A between-group analysis showed that the awareness, knowledge and attitudes (AKA) about epilepsy did not significantly differ between the groups at baseline ( P > 0.05). The intervention patients reported better AKA levels during follow-up compared to the control patients ( P < 0.05). A within-group analysis showed that in intervention patients, there were significant improvements in all AKA domains with larger effect sizes ( P < 0.01) while control patients also exhibited significant improvement in most domains except for Awareness but with smaller effect sizes. After controlling for possible confounding variables (age, gender, educational qualification, monthly income and baseline mean for each domain), the intervention group still reported significantly higher AKA than the control group particularly in Awareness ( P < 0.001) and Total AKA ( P = 0.003). There was also significantly better medication adherence and clinic attendance in the intervention group ( P < 0.05). The results suggest that the addition of the MEES to conventional epilepsy education is effective in improving AKA.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Six studies (25%) included an immediate active control group.
“Six studies (25%) included an immediate active control group (paper-based education intervention, 39 supportive therapy, 34 yoga, 35 counseling as usual, 29 pharmacotherapy with a selective serotonin reuptake inhibitor, 30 social support 36 ).”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [39]
One study (4%) used an SMS-based approach.
“and 1 study (4%) used an Short Message Service (SMS)-based approach. 39”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [39]
Four studies (17%) managed to blind the participants in both the treatment group and the active control group by telling them that they would participate in an intervention to improve coping with epilepsy.
“Four studies (17%) 34 -36,39 managed to blind the participants in both the treatment group and the active control group by telling them that they would participate in an intervention to improve coping with epilepsy.”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [39]
Eight studies (33%) were rated as low risk for attrition bias as there was only a small number of missing data, which were balanced across the groups with justifiable reasons.
“Eight studies (33%) 27,29,36,38,39,44,48,49 were rated as low risk as there was only a small number of missing data, which were balanced across the groups with justifiable reasons.”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [39]
In the QOLIE-31 study Lua & Neni 39, the intervention group had a mean postintervention score of 69.2 (SD 17.4) versus control 58.4 (SD 13.7).
“Lua & Neni 39 | 69.2 | 17.4 | 58.4 | 13.7 |”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [39]
Of the 8 studies (47%) that were excluded from the meta-analysis, 4 studies (50%) reported significant improvements in the treatment group when comparing the postintervention outcomes of treatment and control groups in terms of QOLIE total score.
“Of the 8 studies (47%) that were excluded from the meta-analysis, 4 studies (50%) 37,39,47,48 reported significant improvements in the treatment group when comparing the postintervention outcomes of treatment and control groups in terms of QOLIE total score (Table 3A).”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [39]
Blinding of participants was performed in only 4 studies.
“Blinding of participants was performed in only 4 studies. 34 -36,39”
From Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life (2018) · cites this paper as [39]
Cites
Concurrent and Predictive Validity of a Self-reported Measure of Medication Adherence
Morisky, D. E., Green, L. W., & Levine, D. M. (1986) · Medical Care · doi:10.1097/00005650-198601000-00007 · Cited by 5,304 · see citing works
May, T. W., & Pfäfflin, M. (2002) · Epilepsia · doi:10.1046/j.1528-1157.2002.23801.x · Cited by 251 · see citing works
(2022) · doi:10.54615/2231-7805 · Cited by 194 · see citing works
May, H., & Hearn, G. (2005) · International Journal of Cultural Studies · doi:10.1177/1367877905052417 · Cited by 101 · see citing works
MOSES: An Educational Program for Patients with Epilepsy and Their Relatives
Ried, S., Specht, U., Thorbecke, R., Göcke, K., & Wohlfarth, R. (2001) · Epilepsia · doi:10.1046/j.1528-1157.2001.042suppl.3076.x · Cited by 88 · see citing works
Variation in Antiepileptic Drug Adherence Among Older Patients with New-Onset Epilepsy
Zeber, J., Copeland, L., & Pugh, M. (2010) · The Annals of Pharmacotherapy · doi:10.1345/aph.1p385 · Cited by 71 · see citing works
Selamat, N. W., Latif, A. Z. A., Wong, S. Y., & Lua, P. L. (2010) · Seizure · doi:10.1016/j.seizure.2010.04.006 · Cited by 69 · see citing works
Self-citationCongruence of Three Self-Report Measures of Medication Adherence among HIV Patients
Gao, X., & Nau, D. P. (2000) · Annals of Pharmacotherapy · doi:10.1345/aph.19339 · Cited by 69 · see citing works
Reducing Nonresponse by SMS Reminders in Mail Surveys
Virtanen, V., Sirkiä, T., & Jokiranta, V. (2007) · Social Science Computer Review · doi:10.1177/0894439307299588 · Cited by 36 · see citing works
Do the Elderly Benefit from Annual Physical Examination? An Example from Kaohsiung City, Taiwan
Chiou, C., & Chang, H. (2002) · Preventive Medicine · doi:10.1006/pmed.2002.1080 · Cited by 29 · see citing works
Lua, P. L., & Selamat, N. W. (2012) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2012.0047 · Cited by 24 · see citing works
Self-citationAn easily performed group education programme for patients with uncontrolled epilepsy—a pilot study
Helde, G., Brodtkorb, E., Bråthen, G., & Bovim, G. (2003) · Seizure · doi:10.1016/s1059-1311(03)00050-5 · Cited by 24 · see citing works
Behaviour Change Following a Workplace Health Check: How Much Change Occurs and Who Changes?
Hanlon, P., Carey, L., Tannahill, C., Kelly, M. P., Gilmour, H., Tannahill, A., & McEwen, J. (1998) · Health Promotion International · doi:10.1093/heapro/13.2.131 · Cited by 22 · see citing works
Relationships Between Awareness, Knowledge, Attitudes And Coping Mechanisms In Epilepsy
Neni, S. W., & Lua, P. L. (2011) · ASEAN Journal of Psychiatry · Cited by 5 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Mobile Telephone Text Messaging for Medication Adherence in Chronic Disease: A Meta-analysis
Thakkar, J., Kurup, R., Laba, T.-L., Santo, K., Thiagalingam, A., Rodgers, A., Woodward, M., Redfern, J., & Chow, C. K. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.7667 · Cited by 685 · see citing works
Michaelis, R., Tang, V., Goldstein, L. H., Reuber, M., LaFrance, W. C., Lundgren, T., Modi, A. C., & Wagner, J. L. (2018) · Epilepsia · doi:10.1111/epi.14444 · Cited by 167 · see citing works
Peiris, D., Praveen, D., Johnson, C., & Mogulluru, K. (2014) · Journal of Cardiovascular Translational Research · doi:10.1007/s12265-014-9581-5 · Cited by 150 · see citing works
Abaza, H., & Marschollek, M. (2017) · Methods of Information in Medicine · doi:10.3414/me17-05-0003 · Cited by 138 · see citing works
Michaelis, R., Tang, V., Wagner, J. L., Modi, A. C., LaFrance, W. C., Goldstein, L. H., Lundgren, T., & Reuber, M. (2018) · Epilepsia · doi:10.1111/epi.13989 · Cited by 122 · see citing works
Psychological treatments for people with epilepsy
Michaelis, R., Tang, V. Y. H., Wagner, J. L., Modi, A. C., LaFrance, W. C., Jr., Goldstein, L. H., Lundgren, T., & Reuber, M. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012081.pub2 · Cited by 101 · see citing works
mHealth SMS text messaging interventions and to promote medication adherence: an integrative review
DeKoekkoek, T., Given, B. A., Given, C. W., Ridenour, K., Schueller, M., & Spoelstra, S. (2015) · Journal of Clinical Nursing · doi:10.1111/jocn.12918 · Cited by 89 · see citing works
Haas, K., Martin, A., & Park, K. T. (2017) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2017.02.062 · Cited by 70 · see citing works
mHealth for Integrated People-Centred Health Services in the Western Pacific: A Systematic Review
Godinho, M. A., Jonnagaddala, J., Gudi, N., Islam, R., Narasimhan, P., & Liaw, S. (2020) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2020.104259 · Cited by 51 · see citing works
Psychological treatments for people with epilepsy
Michaelis, R., Tang, V., Nevitt, S. J., Wagner, J. L., Modi, A. C., LaFrance Jr, W. C., Goldstein, L. H., Gandy, M., Bresnahan, R., Valente, K., et al. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012081.pub3 · Cited by 37 · see citing works
Managing Epilepsy by Telemedicine in Resource-Poor Settings
Patterson, V. (2019) · Frontiers in Public Health · doi:10.3389/fpubh.2019.00321 · Cited by 36 · see citing works
Telemedicine for epilepsy support in resource-poor settings
Patterson, V. (2014) · Frontiers in Public Health · doi:10.3389/fpubh.2014.00120 · Cited by 33 · see citing works
Lua, P. L., & Selamat, N. W. (2013) · Quality of Life Research · doi:10.1007/s11136-013-0352-6 · Cited by 28 · see citing works
Self-citationImplementation of psychological clinical trials in epilepsy: Review and guide
Modi, A. C., Wagner, J. L., Smith, A. W., Kellermann, T. S., & Michaelis, R. (2017) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2017.06.016 · Cited by 20 · see citing works
Michaelis, R., Tang, V. Y. H., Nevitt, S. J., Wagner, J. L., Modi, A. C., LaFrance, W. C., Jr., Goldstein, L. H., Gandy, M., Bresnahan, R., Valente, K. D. R., et al. (2021) · Epileptic Disorders · doi:10.1684/epd.2021.1357 · Cited by 16 · see citing works
Short message services interventions for chronic disease management: A systematic review
Ebuenyi, M. C., Schnoor, K., Versluis, A., Meijer, E., & Chavannes, N. (2021) · Clinical eHealth · doi:10.1016/j.ceh.2020.11.004 · Cited by 17 · see citing works
Epilepsy: behavioural, psychological, and ketogenic diet treatments.
Cross, J. H. (2015) · Europe PMC (PubMed Central) · Cited by 15 · see citing works
Braga, P., Mifsud, J., D’Souza, C., Clarke, M., Honein, A., Avirmed, T., & Pfäfflin, M. (2019) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2019.106653 · Cited by 11 · see citing works
Beyene, D. A., Demsie, D. G., Tafere, C., Yazie, T. S., Endeshaw, D., Tadesse, T. A., & Addisu, Z. D. (2025) · Frontiers in Neurology · doi:10.3389/fneur.2025.1546911 · Cited by 6 · see citing works
Caring electronically for young outpatients who have epilepsy
Oppenheimer, J. E., Leviton, A., Chiujdea, M., Antonetty, A., Ojo, O. W., Garcia, S. M., Weas, S., Fleegler, E. W., Chan, E., & Loddenkemper, T. (2018) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2018.06.018 · Cited by 6 · see citing works
Digital Technology, Including Telemedicine, in the Management of Mental Illness
Naslund, J. A., Bartels, S. M., & Marsch, L. A. (2019) · Wiley eBooks · doi:10.1002/9781119282686.ch29 · Cited by 6 · see citing works
Nonadherence to antiseizure medications: what have we learned and what can be done next?
Al-Aqeel, S. (2024) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1080/14737167.2024.2349191 · Cited by 4 · see citing works
Service delivery, behavioural, and self-management interventions for adults with epilepsy.
Huang, Y., Nevitt, S., Mayer, J., Fleeman, N., Hill, R. A., Doherty, A., Wilson, N., Boland, P., Clegg, A. J., Bilsborough, H., et al. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd015284.pub2 · Cited by 2 · see citing works
Malm, C. S., Klecki, J., Lisovska, K., & Zelano, J. (2023) · Epilepsia Open · doi:10.1002/epi4.12893 · Cited by 1 · see citing works
Intervenções para adesão terapêutica medicamentosa de pacientes com epilepsia
Settervall, C. H. C. (2014) · doi:10.11606/t.7.2014.tde-05012015-151045
The Influence of Mobile Health Adoption on Medication Adherence on Population Health
Folami, F. F. (2019) · Advances in educational technologies and instructional design book series · doi:10.4018/978-1-5225-9746-9.ch013
Sarudianky, M. (2019) · Redalyc (Universidad Autónoma del Estado de México)
Goode, K., Pirbaglou, M., Grace, S. L., Katz, J. D., Henriques, D., & Ritvo, P. (2024) · doi:10.2196/preprints.60208
What Are the Prospects of Forecasting the Far Future?
Bernard, D. R., & Vivalt, E. (2025) · Oxford University Press eBooks · doi:10.1093/9780191979972.003.0012
- Authors
- Lua, P. L., & Neni, W. S.
- Affiliations
- Sultan Zainal Abidin University (MY)
- Centre for Clinical and Quality of Life Studies, Faculty of Medicine and Health Sciences, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
- ORCID
- Lua, Pei Lin
- Venue
- Journal of Telemedicine and Telecare
- Publisher
- SAGE Publications
- Published
- 2013-01
- Volume
- 19
- Issue
- 1
- Pages
- 23-28
- ISSN
- 1357-633X (ISSN-L)
- 1758-1109
- OpenAlex
- W2319995346
- Cited by
- 29
- References
- 14
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 1 · 2021: 2 · 2020: 2 · 2019: 5 · 2018: 3 · 2017: 4 · 2016: 1 · 2015: 2 · 2014: 3 · 2013: 1
- FWCI
- 4.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Telemedicine and Telecare (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Physical Sciences › Computer Science › Information Systems › Mobile Learning in Education
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Keywords
- epilepsy, patient education, text messaging, mobile health, medication adherence, clinic attendance, printed educational materials
- MeSH terms
- Adult, Analysis of Variance, Awareness, Epilepsy, Female, Humans, Health Knowledge, Attitudes, Practice, Malaysia, Male, Patient Education as Topic, Program Evaluation, Health Behavior, Telemedicine, Medication Adherence, Text Messaging
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
