A randomized controlled behavioral intervention trial to improve medication adherence in adult stroke patients with prescription tailored Short Messaging Service (SMS)-SMS4Stroke study
Open accessAbstract
BACKGROUND: The effectiveness of mobile technology to improve medication adherence via customized Short Messaging Service (SMS) reminders for stroke has not been tested in resource poor areas. We designed a randomized controlled trial to test the effectiveness of SMS on improving medication adherence in stroke survivors in Pakistan. METHODS: This was a parallel group, assessor-blinded, randomized, controlled, superiority trial. Participants were centrally randomized in fixed block sizes. Adult participants on multiple medications with access to a cell phone and stroke at least 4 weeks from onset (Onset as defined by last seen normal) were eligible. The intervention group, in addition to usual care, received reminder SMS for 2 months that contained a) Personalized, prescription tailored daily medication reminder(s) b) Twice weekly health information SMS. The Health Belief Model and Social Cognitive theory were used to design the language and content of messages. Frontline SMS software was used for SMS delivery. Medication adherence was self-reported and measured on the validated Urdu version of Morisky Medication Adherence Questionnaire. Multiple linear regression was used to model the outcome against intervention and other covariates. Analysis was conducted by intention-to-treat principle. RESULTS: Two hundred participants were enrolled. 38 participants were lost to follow-up. After 2 months, the mean medication score was 7.4 (95 % CI: 7.2-7.6) in the intervention group while 6.7 (95 % CI: 6.4-7.02) in the control group. The adjusted mean difference (Δ) was 0.54 (95 % CI: 0.22-0.85). The mean diastolic blood pressure in the intervention group was 2.6 mmHg (95 % CI; -5.5 to 0.15) lower compared to the usual care group. CONCLUSION: A short intervention of customized SMS can improve medication adherence and effect stroke risk factors like diastolic blood pressure in stroke survivors with complex medication regimens living in resource poor areas. TRIAL REGISTRATION: Clinicaltrials.gov NCT01986023 last accessed at https://clinicaltrials.gov/ct2/show/NCT01986023.
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In Kamal's study, having to respond to the health worker resulted in the quick 'Yes' or 'No' response message becoming routinised and not taking much of the patient's time.
“By having to respond to the health worker, this resulted in the quick ‘Yes’ or ‘No’ response message becoming routinised and did not take much of the patient’s time.”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [42]
In Kamal's study, reminders and motivating education/advice information were tailored to individual patients, making patients feel they had a relationship with their health worker, even without direct patient-health worker communication.
“In Kamal’s study the reminders and motivating education/advice information were tailored to the individual patients making the patient feel they had a relationship with their health worker, even though the intervention did not have any direct patient–health worker communication.”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [42]
In Kamal's study, the intervention led to a slight reduction in diastolic blood pressure.
“This led to improved adherence to medication and a slight reduction in diastolic blood pressure.”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [42]
In Kamal's study, the intervention led to improved adherence to medication.
“This led to improved adherence to medication and a slight reduction in diastolic blood pressure.”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [42]
Kamal's intervention was effective in increasing adherence to personalised stroke medication.
“Kamal’s intervention was effective in increasing adherence to personalised stroke medication.”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [42]
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- Authors
- Kamal, A. K., Shaikh, Q., Pasha, O., Azam, I., Islam, M., Memon, A. A., Rehman, H., Akram, M. A., Affan, M., Nazir, S., Aziz, S., Jan, M., Andani, A., Muqeet, A., Ahmed, B., & Khoja, S.
- Affiliations
- Aga Khan University (PK)
- Aga Khan Development Network (PK)
- United Nations Foundation (US)
- Corresponding author
- Kamal, Ayeesha Kamran
- ORCID
- Venue
- BMC Neurology
- Published
- 2015-10-21
- Volume
- 15
- Issue
- 1
- Pages
- 212-212
- ISSN
- 1471-2377 (ISSN-L)
- PMC
- PMC4618367
- OpenAlex
- W2119134819
- Cited by
- 159
- References
- 57
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 21 · 2023: 15 · 2022: 13 · 2021: 14 · 2020: 17 · 2019: 21 · 2018: 22 · 2017: 10 · 2016: 6
- FWCI
- 14.72
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Neurology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eCommons - AKU (Aga Khan University) (submittedVersion, cc-by)
- Funders
- Fogarty International Center (D43TW008660)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Health Professions › Health Information Management › Health, Technology, Consumer Behavior
- Keywords
- medication adherence, stroke survivors, SMS reminders, mobile health, Health Belief Model, social cognitive theory, diastolic blood pressure, complex medication regimens, resource-limited settings
- MeSH terms
- Antihypertensive Agents, Behavior Therapy, Blood Pressure, Female, Humans, Male, Middle Aged, Pakistan, Platelet Aggregation Inhibitors, Psychological Theory, Single-Blind Method, Reminder Systems, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Stroke, Cell Phone, Medication Adherence, Secondary Prevention, Text Messaging
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