Efficacy of a text messaging (SMS) based intervention for adults with hypertension: protocol for the StAR (SMS Text-message Adherence suppoRt trial) randomised controlled trial
Open accessAbstract
BACKGROUND: Interventions to support people with hypertension in attending clinics and taking their medication have potential to improve outcomes, but delivery on a wide scale and at low cost is challenging. Some trials evaluating clinical interventions using short message service (SMS) text-messaging systems have shown important outcomes, although evidence is limited. We have developed a novel SMS system integrated with clinical care for use by people with hypertension in a low-resource setting. We aim to test the efficacy of the system in improving blood pressure control and treatment adherence compared to usual care. METHODS/DESIGN: The SMS Text-message Adherence suppoRt trial (StAR) is a pragmatic individually randomised three-arm parallel group trial in adults treated for hypertension at a single primary care centre in Cape Town, South Africa. The intervention is a structured programme of clinic appointment, medication pick-up reminders, medication adherence support and hypertension-related education delivered remotely using an automated system with either informational or interactive SMS text-messages. Usual care is supplemented by infrequent non-hypertension related SMS text-messages. Participants are 1:1:1 individually randomised, to usual care or to one of the two active interventions using minimisation to dynamically adjust for gender, age, baseline systolic blood pressure, years with hypertension, and previous clinic attendance. The primary outcome is the change in mean systolic blood pressure at 12-month follow-up from baseline measured with research staff blinded to trial allocation. Secondary outcomes include the proportion of patients with 80% or more of days medication available, proportion of participants achieving a systolic blood pressure less than 140 mmHg and a diastolic blood pressure less than 90 mmHg, hospital admissions, health status, retention in clinical care, satisfaction with treatment and care, and patient related quality of life. Anonymised demographic data are collected on non-participants. DISCUSSION: The StAR trial uses a novel, low cost system based on widely available mobile phone technology to deliver the SMS-based intervention, manage communication with patients, and measure clinically relevant outcomes. The results will inform implementation and wider use of mobile phone based interventions for health care delivery in a low-resource setting. TRIAL REGISTRATION: NCT02019823.
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Despite general interest in mobile phone-based interventions related to disease management and behavior change, the allied evidence remains limited.
“Despite the general interest in mobile phone–based interventions related to disease management and behavior change, the allied evidence remains limited [20].”
SMS text messaging is available on all mobile phone service providers that support 1- or 2-way communication.
“Moreover, SMS text messaging is available on all mobile phone service providers that support 1- or 2-way communication [20].”
Although trials suggested potential for small to moderate effect sizes in improving compliance and blood pressure control, the effects were not statistically significant.
“Although the results of trials suggested the potential for small to moderate effect sizes in improving compliance and BP control, the effects were not statistically significant [20].”
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Text Messages to Incentivise Response in a Web-First Sequential Mixed-Mode Survey
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バングラデシュ農村地域における高血圧患者の意識向上とモバイルヘルステクノロジーの使用 : 無作為化比較試験
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- Authors
- Bobrow, K., Brennan, T., Springer, D., Levitt, N. S., Rayner, B., Namane, M., Yu, L.-M., Tarassenko, L., & Farmer, A.
- Affiliations
- University of Cape Town (ZA)
- University of Oxford (GB)
- Corresponding author
- Bobrow, Kirsty
- ORCID
- Venue
- BMC Public Health
- Published
- 2014-01-11
- Volume
- 14
- Issue
- 1
- Pages
- 28-28
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC3909351
- OpenAlex
- W1976523718
- Cited by
- 83
- References
- 32
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 5 · 2023: 5 · 2022: 5 · 2021: 8 · 2020: 4 · 2019: 7 · 2018: 12 · 2017: 10 · 2016: 12 · 2015: 6 · 2014: 2
- FWCI
- 18.11
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Public Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Open University of Cape Town (University of Cape Town) (submittedVersion, cc-by)
- Funders
- Wellcome Trust
- National Institute for Health and Care Research (NF-SI-0512-10077)
- Engineering and Physical Sciences Research Council
- NIHR Oxford Biomedical Research Centre
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- hypertension, text messaging, text messaging intervention, medication adherence, blood pressure control, appointment reminders, mobile health, resource-limited settings, primary care, automated messaging, patient retention, health education
- MeSH terms
- Adult, Appointments and Schedules, Blood Pressure, Health Status, Humans, Hypertension, Patient Education as Topic, Quality of Life, Research Design, South Africa, Outcome Assessment, Health Care, Cell Phone, Medication Adherence, Text Messaging
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