BACKGROUND
Mobile health technologies offer potential to improve reach and delivery of interventions to promote long-term secondary prevention of coronary heart disease (CHD).
OBJECTIVE
To determine the effectiveness of a text-messaging intervention (Text4HeartII) to improve adherence to medication and lifestyle change over and above usual care in people with CHD.
METHODS
A two-arm, parallel, randomized controlled trial conducted in New Zealand. Participants with a recent acute coronary syndrome were randomised to receive usual cardiac services alone (control n=153) or a 24-week text message programme to support self-management plus usual cardiac services (n=153). The primary outcome was adherence with medication at 24-weeks, defined as medication possession ratio (MPR) of 80% or more for aspirin, statin and anti-hypertensive therapy. Secondary outcomes included MPR at 52-weeks, self-reported medication adherence, and adherence with healthy lifestyle behaviours at 24- and 52-weeks.
RESULTS
National hospitalization and pharmacy dispensing records were available for all participants; 282 (92%) completed 24-weeks questionnaire and 291 (95%) completed 52-weeks questionnaire. Adherence with 3 medication classes was greater in the control compared to the intervention group, respectively both at 24-weeks (105(69%) versus 87(57%) OR 0.60, 95%CI 0.38 to 0.96, p=0.03), and 52 weeks (104(68%) vs 83(53%) OR 0.56, 95%CI 0.35 to 0.89, p=0.01). Self-reported medication adherence score showed the same trend at 52 weeks (mean difference 0.3, 95%CI 0.01 to 0.59, p=0.04). Self-reported adherence with health related behaviours were similar between groups.
CONCLUSIONS
Text4HeartII did not improve dispensed medication, or adherence to a favorable lifestyle over and above usual care. This finding contrasts with previous studies, and highlights that the benefits of text interventions may depend on the context in which they are used.
CLINICALTRIAL
Australian New Zealand Clinical Trials Registry, ID: ACTRN12616000422426
Improving Medication Adherence through Graphically Enhanced Interventions in Coronary Heart Disease (IMAGE-CHD): A Randomized Controlled Trial