Development and piloting of a highly tailored digital intervention to support adherence to antihypertensive medications as an adjunct to primary care consultations

ObjectivesThis paper describes the systematic development and piloting of a highly tailored text and voice message intervention to increase adherence to medication in primary care.MethodsFollowing the Medical Research Council guidance, this paper describes (a) the systematic development of the theoretical framework, based on review of theories and meta-analyses of effectiveness; (b) the systematic development of the delivery mode, intervention content and implementation procedures, based on consultations, face-to-face interviews, think-aloud protocols, focus groups, systematic reviews, patient and public involvement/engagement input, intervention pre-test; and (c) the piloting of the intervention, based on a 1-month intervention; and follow-up assessment including interviews and questionnaires. The mixed-methods analysis combined findings from the parallel studies complementarily.Resultsintervention development suggested the target behaviour of the intervention should be the tablets taken at a regular time of the day. It recommended that patients could be more receptive to intervention content when they initiate medication taking or they change prescription plan; and more emphasis is needed to patients’ consent process. Intervention piloting suggested high intervention engagement with, and fidelity of, the intervention content; which included a combination of behaviour change techniques, and was highly tailored to patients’ beliefs and prescription plan. Patients reported that the intervention content increased awareness about the necessity to take and maintain adherent to medication, reinforced social support and habit formation, and reminded them to take medication as prescribed.ConclusionTailored automated text and voice message interventions are feasible ways to improve medication adherence as an adjunct to primary care.Trial registration numberISRCTN10668149.

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Development and piloting of a highly tailored text and voice messaging intervention to support adherence to antihypertensive medications within the primary care setting (Preprint)

10.2196/preprints.9724 ◽

2017 ◽

Author(s):

Aikaterini Kassavou ◽

Vikki Houghton ◽

Simon Edwards ◽

James Brimicombe ◽

Stephen Sutton

Keyword(s):

Primary Care ◽

Health Care ◽

Health Care Providers ◽

Service Providers ◽

Delivery Mode ◽

Care Providers ◽

Intervention Content ◽

Systematic Development ◽

Voice Message ◽

Meta Analyses

BACKGROUND Tailored automated text and voice message interventions are effective ways to increase adherence to medications. OBJECTIVE This paper describes the systematic development and piloting of a highly tailored text and voice message intervention to increase adherence to medications within primary care. METHODS Following the MRC guidance this paper describes: a) the systematic development of the theoretical framework and tailored intervention content, based on review of theories and meta-analyses of effectiveness (n=2 meta-analyses with meta-regression); b) the systematic development of the intervention delivery mode, intervention content and implementation procedures, based on consultations with telecommunication experts (n=6 experts, including industry, academics, and university service providers), face-to-face interviews using think aloud protocols (n=19 patients and n=5 health care providers), experiential focus groups (n=12 patients), stakeholders’ consultations (n=7 stakeholders, including commissioners, health care providers, and patients), systematic reviews (n=2 reviews), and PPI input (n=100 PPI members); and c) the piloting of the intervention, based on a one-month pre-post study (n=17 patients). The mixed methods analysis combined findings from the parallel studies complementarily. The target population that informed the intervention were adults above 40 years old, with a primary diagnosis of hypertension, taking multiple medications, presumed to be non-adherent to their medications, and attending primary care settings within different areas of deprivation in the East of England. RESULTS Intervention development suggested the target behaviour of the intervention to be the tablets taken at a regular time of the day. It also suggested the delivery of both INA and NINA messages and their interchange during a prescription-based month, but INA messages to be less frequent than NINA messages. It also suggested that participants could be more receptive to intervention content when they initiate medication taking or they change prescription plan. Intervention piloting suggested that the intervention is acceptable and feasible. It also suggested high intervention engagement with, and fidelity of, the intervention content, which included Behaviour Change Techniques (BCTs). The final version of the intervention aims to increase adherence to daily prescribed oral medications, is delivered using text and voice messages, and includes a combination of nine BCTs (e.g., implementation intentions, information about health consequences), is highly tailored to patients’ beliefs (e.g., beliefs about medications, self-efficacy, social norms, perceived regimens complexity), and prescription plan. During the intervention, patients can select between two BCTs to maintain medication taking (e.g., habit formation or self-monitoring). CONCLUSIONS This paper describes a theory and evidence based intervention that aims to support adherence to high blood pressure medications, as an adjunct to primary care consultations, and it is currently evaluated in a randomised controlled trial. CLINICALTRIAL ISRCTN10668149 DOI 10.1186/ISRCTN10668149.

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Assessing the acceptability of a text messaging service and smartphone app to support patient adherence to medications prescribed for high blood pressure: a pilot study.

10.21203/rs.3.rs-24034/v4 ◽

2020 ◽

Author(s):

Aikaterini Kassavou ◽

Charlotte A Court ◽

Jagmohan Chauhan ◽

James Brimicombe ◽

Debbi Bhattacharya ◽

...

Keyword(s):

Primary Care ◽

Text Messaging ◽

Text Message ◽

Text Messages ◽

Controlled Study ◽

Future Research ◽

Smartphone App ◽

Delivery Mode ◽

Log Files ◽

Intervention Content

Abstract Aims and objectives. This paper describes a pilot non-randomised controlled study of a highly tailored 56-days text message and smartphone app prototype intervention to increase adherence to anti-hypertensive medication in primary care. The aim of this study was to evaluate the acceptability of the intervention and obtain patients views about the intervention content, delivery mode, and the mechanisms by which the intervention supported medication adherence. Methods. Patients diagnosed with hypertension were invited to the study via general practice text messages and were recruited face to face by the researcher team. Participants were asked to test the text message intervention for 28 consecutive days and switch to the smartphone app for 28 more days. Participants completed baseline and follow up questionnaires and took part in semi-structured telephone interviews. Digital log files captured patients’ usage of the intervention. Participant transcripts were analysed using thematic analysis. Descriptive statistics were used to summarize data from questionnaires and log files. A mixed methods analysis generated data to respond to the research questions. Results. 79 patients expressed interest to participate in this study, of whom 23 (64% male, 82% above 60 years old) were recruited to take part. With one drop-out, 22 participants tested the text message delivery mode (with 20 being interviewed) and four of them (17%) switched to the app (with 3 being interviewed). All participants engaged and interacted with the text message and app notifications, and most participants found the intervention content and delivery mode acceptable. They also self-reported that the interactive elements of the intervention motivated them to take their medications as prescribed. Conclusion. This study provides evidence that the digital intervention is acceptable by hypertensive patients recruited in primary care. Future research could usefully investigate its feasibility and effectiveness using rigorous research methods.

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Measuring adherence to antihypertensive medication using an objective test in older adults attending primary care: cross-sectional study

Journal of Human Hypertension ◽

10.1038/s41371-021-00646-w ◽

2021 ◽

Author(s):

James P. Sheppard ◽

Ali Albasri ◽

Pankaj Gupta ◽

Prashanth Patel ◽

Kamlesh Khunti ◽

...

Keyword(s):

Primary Care ◽

Medication Adherence ◽

Urine Sample ◽

Antihypertensive Medication ◽

Cross Sectional Study ◽

Urine Samples ◽

Sample Collection ◽

Antihypertensive Medications ◽

Cross Sectional ◽

Adherence To Medication

AbstractAnalysis of urine samples using liquid chromatography-tandem mass spectrometry (LC-MS/MS) has previously revealed high rates of non-adherence to antihypertensive medication. It is unclear whether these rates represent those in the general population. This study aimed to investigate whether it is feasible to collect urine samples in a primary care setting and analyse them using LC-MS/MS to detect non-adherence to antihypertensive medication. This study used a prospective, observational cohort design. Consecutive patients were recruited opportunistically from five general practices in UK primary care. They were aged ≥65 years with hypertension and had at least one antihypertensive prescription. Participants were asked to provide a urine sample for analysis of medication adherence. Samples were sent to a laboratory via post and analysed using LC-MS/MS. Predictors of adherence to medication were explored with multivariable logistic regression. Of 349 consecutive patients approached for the study, 214 (61.3%) gave informed consent and 191 (54.7%) provided a valid urine sample for analysis. Participants were aged 76.2 ± 6.6 years and taking a median of 2 antihypertensive medications (IQR 1–3). A total of 27/191 participants (14.2%) reported not taking all of their medications on the day of urine sample collection. However, LC-MS/MS analysis of samples revealed only 4/27 (9/191 in total; 4.7%) were non-adherent to some of their medications. Patients prescribed more antihypertensive medications were less likely to be adherent (OR 0.24, 95%CI 0.09–0.65). Biochemical testing for antihypertensive medication adherence is feasible in routine primary care, although non-adherence to medication is generally low, and therefore widespread testing is not indicated.

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Assessing the acceptability of a text messaging service and smartphone app to support patient adherence to medications prescribed for high blood pressure: a pilot study

Pilot and Feasibility Studies ◽

10.1186/s40814-020-00666-2 ◽

2020 ◽

Vol 6 (1) ◽

Cited By ~ 1

Author(s):

Aikaterini Kassavou ◽

Charlotte Emily A’Court ◽

Jagmohan Chauhan ◽

James David Brimicombe ◽

Debi Bhattacharya ◽

...

Keyword(s):

Primary Care ◽

Text Messaging ◽

Patient Adherence ◽

Text Messages ◽

Controlled Study ◽

Future Research ◽

Smartphone App ◽

Delivery Mode ◽

Log Files ◽

Intervention Content

Abstract Aims and objectives This paper describes a pilot non-randomised controlled study of a highly tailored 56-day text messaging and smartphone app prototype intervention to increase adherence to anti-hypertensive medication in primary care. The aim of this study was to evaluate the acceptability of the intervention and obtain patients’ views about the intervention content, the delivery mode, and the mechanisms by which the intervention supported medication adherence. Methods Patients diagnosed with hypertension were invited and recruited to the study via general practice text messages and attended a face to face meeting with a member of the researcher team. Participants were asked to test the text messaging intervention for 28 consecutive days and switch to the smartphone app for 28 more days. Participants completed baseline and follow-up questionnaires and took part in semi-structured telephone interviews. Digital log files captured patients’ engagement with the intervention. Participant transcripts were analysed using thematic analysis. Descriptive statistics were used to summarise data from questionnaires and log files. A mixed methods analysis generated data to respond to the research questions. Results Seventy-nine patients expressed interest to participate in this study, of whom 23 (64% male, 82% above 60 years old) were registered to take part. With one drop-out, 22 participants tested the text messaging delivery mode (with 20 being interviewed) and four of them (17%) switched to the app (with 3 being interviewed). All participants engaged and interacted with the text messages and app notifications, and all participants found the intervention content and delivery mode acceptable. They also self-reported that the interactive elements of the intervention motivated them to take their medications as prescribed. Conclusion This study provides evidence that the digital intervention is acceptable by hypertensive patients recruited in primary care. Future research could usefully investigate its feasibility and effectiveness using rigorous research methods. Trial registration ISRCTN12805654

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Assessing the acceptability of a text messaging service and smartphone app to support patient adherence to medications prescribed for high blood pressure: a pilot study.

10.21203/rs.3.rs-24034/v1 ◽

2020 ◽

Author(s):

Aikaterini Kassavou ◽

Charlotte A Court ◽

Jagmohan Chauhan ◽

James Brimicombe ◽

Debbi Bhattacharya ◽

...

Keyword(s):

Primary Care ◽

Pilot Study ◽

Text Messaging ◽

Patient Adherence ◽

Text Message ◽

Drop Out ◽

Smartphone App ◽

Delivery Mode ◽

Log Files ◽

Intervention Content

Abstract Aims and objectives. This paper describes the pilot study of a highly tailored text message and smartphone app intervention to increase adherence to anti-hypertensive medication in primary care. The aim of this study was to evaluate the acceptability of the intervention and obtain patients views about the intervention content, the delivery mode, and the mechanisms by which the intervention supported medication adherence. Methods. Patients diagnosed with hypertension were invited to the study via general practice text message invitation and recruited face to face by the researcher team. Participants tested the text message intervention for 28 or the text message followed by the app for 56 days. Participants completed baseline and follow up questionnaires and took part in a weekly or end of intervention telephone interviews. Digital log files captured patients’ usage of the intervention. Participant transcripts were analysed using thematic analysis. Descriptive statistics were used to summarize data from questionnaires and log files. A mixed methods analysis generated data to respond to the research questions. Results. 79 patients expressed their interest to participate in this study and 23 of these patients were recruited to take part. With one drop-out, 22 participants tested the text message delivery mode (with 20 being interviewed) and four requested to switch to the app (with 3 being interviewed). All participants used and engaged with the text message and app notifications, and most participants found the intervention content and delivery mode acceptable. They also self-reported that the intervention supported them to take their medications as prescribed. Conclusion. This study provides evidence that the digital intervention is acceptable by hypertensive patients recruited in primary care, thus it should be tested for its effectiveness using rigorous research methods. ISRCTN12805654 https://doi.org/10.1186/ISRCTN12805654

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Regularity, treatment adherence and outcome among diabetic patients in primary care: an overview

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20192349 ◽

2019 ◽

Vol 6 (6) ◽

pp. 2718

Author(s):

Sridhar D. ◽

Narayan K. A.

Keyword(s):

Primary Care ◽

Treatment Adherence ◽

Diabetic Patients ◽

Process Of Care ◽

Improve Medication Adherence ◽

Cross Sectional ◽

Adherence To Medication ◽

Life Threatening ◽

Developed Nations ◽

Diabetic Care

Early detection and compliance to prescribed treatment is the cornerstone to avert life threatening complications among those with non-communicable diseases (NCD). Assessing regularity of visits, adherence to medication and its correlates can help in devising effective strategies to improve medication adherence. The objective of the study was to review about regularity, treatment adherence and outcome among diabetic patients in primary care. In this literature review, electronic data sources viz. Pub Med, Proquest, Google Scholar, Research gate with the use of the keywords or Mesh words like “Diabetes,” “Primary Health care” “Treatment adherence” “Regularity of treatment” “process of care indicators” and “outcome indicators” were searched. The searches were limited to studies reported in English and were available as free full text from January 2009 to June 2018. Related articles including descriptive cross-sectional, cohort, randomized controlled trials, qualitative studies and systematic reviews were also extracted and refined further. From our review it’s clearly evident that the level of Diabetic care in terms of regularity and follow-up is suboptimal compared to standards established in developed nations. There is a wide scope for improvement in diabetic care as demonstrated successfully in many nations using regular clinical audit, which needs future introspection.

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A serious puzzle game to enhance adherence to anti-rheumatic drugs in rheumatoid arthritis patients: systematic development using Intervention Mapping (Preprint)

10.2196/preprints.31570 ◽

2021 ◽

Author(s):

Bart Pouls ◽

Charlotte L Bekker ◽

Johanna E Vriezekolk ◽

Sandra van Dulmen ◽

Bart J F van den Bemt

Keyword(s):

Rheumatoid Arthritis ◽

Medication Adherence ◽

Intrinsic Motivation ◽

Implicit Attitudes ◽

Intervention Mapping ◽

Randomised Clinical Trial ◽

Serious Game ◽

Behaviour Change Techniques ◽

Improve Medication Adherence ◽

Systematic Development

BACKGROUND Patients’ implicit attitudes towards medication need and concerns may influence their adherence. Targeting these implicit attitudes by combining game-entertainment with medication-related triggers might improve medication adherence in rheumatoid arthritis (RA) patients. OBJECTIVE To describe the systematic development of a serious game to enhance adherence to anti-rheumatic drugs using Intervention Mapping. METHODS A serious game was developed using the Intervention Mapping framework guided by a multidisciplinary expert group which proceeded along six steps: (1) exploring the problem by assessing the relationship between medication adherence and implicit attitudes, (2) defining change objectives, (3) selecting evidence-based behaviour change techniques that focussed on adjusting implicit attitudes, (4) designing the intervention, (5) guaranteeing implementation by focussing on intrinsic motivation and (6) planning a scientific evaluation. RESULTS Based on the problem assessment and guided by the Dual-Attitude Model, implicit negative and illness related attitudes of RA patients were defined as the main target for the intervention. Consequently the change objective was: ‘After the intervention, participants have a more positive attitude towards anti-rheumatic drugs’. Attention bias modification, evaluative conditioning and goal priming were the techniques chosen to implicitly target medication needs. These techniques were redesigned into medication-related triggers and built in the serious puzzle game. Thirty-seven RA patients tested the game at several stages. Intrinsic motivation was led by the self-determination theory and addressed the three needs competence, autonomy and relatedness. The intervention will be evaluated in a randomised clinical trial that assessed the effect of playing the serious game on anti-rheumatic drug adherence. CONCLUSIONS We systematically developed a serious game application to enhance adherence to anti-rheumatic drugs among RA patients using the Intervention Mapping framework. This protocol could serve as a guideline for other healthcare providers when developing similar interventions.

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Assessing the acceptability of a text messaging service and smartphone app to support patient adherence to medications prescribed for high blood pressure: a pilot study.

10.21203/rs.3.rs-24034/v2 ◽

2020 ◽

Author(s):

Aikaterini Kassavou ◽

Charlotte A Court ◽

Jagmohan Chauhan ◽

James Brimicombe ◽

Debbi Bhattacharya ◽

...

Keyword(s):

Primary Care ◽

Text Messaging ◽

Text Message ◽

Text Messages ◽

Controlled Study ◽

Future Research ◽

Smartphone App ◽

Delivery Mode ◽

Log Files ◽

Intervention Content

Abstract Aims and objectives. This paper describes the a pilot non-randomised controlled study of a highly tailored 56-days text message and smartphone app prototype intervention to increase adherence to anti-hypertensive medication in primary care. The aim of this study was to evaluate the acceptability of the intervention and obtain patients views about the intervention content, the delivery mode, and the mechanisms by which the intervention supported medication adherence. Methods. Patients diagnosed with hypertension were invited to the study via general practice text messages invitation and were recruited face to face by the researcher team. Participants were asked to tested the text message intervention for 28 consecutive days and switch to or the text message followed by the smartphone app for 56 28 more days. Participants completed baseline and follow up questionnaires and took part in a semi-structured weekly or end of intervention telephone interviews. Digital log files captured patients’ usage of the intervention. Participant transcripts were analysed using thematic analysis. Descriptive statistics were used to summarize data from questionnaires and log files. A mixed methods analysis generated data to respond to the research questions. Results. 79 patients expressed their interest to participate in this study, of whom and 23 (64% male, 82% above 60 years old) of these patients were recruited to take part. With one drop-out, 22 participants tested the text message delivery mode (with 20 being interviewed) and four of them (17%) requested to switched to the app (with 3 being interviewed). All participants used and engaged and interacted with the text message and app notifications, and most participants found the intervention content and delivery mode acceptable. They also self-reported that the interactive elements of the intervention supported motivated them to take their medications as prescribed. Conclusion. This study provides evidence that the digital intervention is acceptable by hypertensive patients recruited in primary care. Future research could usefully, thus it should investigatebe its tested for its feasibility and effectiveness using rigorous research methods.

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Measuring adherence to therapy in apparent treatment-resistant hypertension: a feasibility study in Irish primary care

British Journal of General Practice ◽

10.3399/bjgp19x705077 ◽

2019 ◽

Vol 69 (686) ◽

pp. e621-e628 ◽

Cited By ~ 2

Author(s):

Peter Hayes ◽

Monica Casey ◽

Liam G Glynn ◽

Gerard J Molloy ◽

Hannah Durand ◽

...

Keyword(s):

Mass Spectrometry ◽

Primary Care ◽

Resistant Hypertension ◽

Urine Analysis ◽

Clinical Importance ◽

Secondary Hypertension ◽

White Coat Hypertension ◽

Treatment Resistant ◽

Antihypertensive Medications ◽

Adherence To Medication

BackgroundApparent treatment-resistant hypertension (aTRH) is defined as uncontrolled blood pressure (BP) in patients taking three or more antihypertensive medications. Some patients will have true treatment-resistant hypertension, some undiagnosed secondary hypertension, while others have pseudo-resistance. Pseudo-resistance occurs when non-adherence to medication, white-coat hypertension (WCH), lifestyle, and inadequate drug dosing are responsible for the poorly controlled BP.AimTo examine the feasibility of establishing non-adherence to medication, for the first time in primary care, using mass spectrometry urine analysis. Operationalisation would be established by at least 50% of patients participating and 95% of samples being suitable for analysis. Clinical importance would be confirmed by >10% of patients being non-adherent.Design and settingEligible patients with aTRH (n = 453) in 15 university research-affiliated Irish general practices were invited to participate.MethodParticipants underwent mass spectrometry urine analysis to test adherence and ambulatory BP monitoring (ABPM) to examine WCH.ResultsOf the eligible patients invited, 52% (n = 235) participated. All 235 urine samples (100%) were suitable for analysis: 174 (74%) patients were fully adherent, 56 (24%) partially adherent, and five (2%) fully non-adherent to therapy. A total of 206 patients also had ABPM, and in total 92 (45%) were categorised as pseudo-resistant. No significant associations were found between adherence status and patient characteristics or drug class.ConclusionIn patients with aTRH, the authors have established that it is feasible to examine non-adherence to medications using mass spectrometry urine analysis. One in four patients were found to be partially or fully non-adherent. Further research on how to incorporate this approach into individual patient consultations and its associated cost-effectiveness is now appropriate.

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