Psychosocial factors and medication adherence among patients with coronary heart disease: A text messaging intervention

Objective Medication non-adherence is linked to adverse clinical outcomes (i.e. rehospitalization, mortality) among patients with coronary heart disease. Given its global adoption and growing popularity among older adults, mobile technology may be an effective strategy to improve medication adherence. The aim of this article is to present the perceptions, attitudes, and beliefs of individuals with coronary heart disease about using text messaging and mobile phone applications for medication adherence. Methods We recruited 28 participants (veterans and non-veterans) with a history of coronary heart disease and antiplatelet medication use in Northern California. We formed six focus groups of individuals who participated in three sessions (total 18 sessions). We analyzed our data using grounded theory. Results The median age was 69.5 ± 10.8 years for non-veterans (50% male) and 70 ± 8.6 years for veterans (100% male). In the first session, we found that participants perceived text message reminders as a convenient, easy, and flexible tool to establish a routine for taking medications. In the second session, participants were eager to use applications for their greater interactivity, individualized health monitoring, and personalized medication information. The third session, participants shared preferred features (i.e. drug interactions, tracking symptoms) after using two applications at home for 2 weeks. Conclusions Older adults are engaged and can be proficient mobile technology users. Text messaging and mobile phone applications are perceived as helpful tools for medication adherence. Future research should include rigorous clinical trials to test the efficacy of mobile health technology to promote medication adherence in populations that require strict medication adherence.

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Faculty Opinions recommendation of Effect of Lifestyle-Focused Text Messaging on Risk Factor Modification in Patients With Coronary Heart Disease: A Randomized Clinical Trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725803813.793515966 ◽

2016 ◽

Author(s):

Juan-Carlos Kaski ◽

Amelia Carro

Keyword(s):

Clinical Trial ◽

Coronary Heart Disease ◽

Risk Factor ◽

Heart Disease ◽

Randomized Clinical Trial ◽

Text Messaging ◽

Risk Factor Modification ◽

Factor Modification

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Improving Medication Adherence in Coronary Heart Disease

Current Cardiology Reports ◽

10.1007/s11886-017-0918-y ◽

2017 ◽

Vol 19 (11) ◽

Cited By ~ 15

Author(s):

Leah L. Zullig ◽

Katherine Ramos ◽

Hayden B. Bosworth

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Medication Adherence

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Effects of a tailored text messaging intervention among diverse adults with type 2 diabetes: Evidence from the 15-month REACH RCT

10.2337/figshare.13052981.v1 ◽

2020 ◽

Author(s):

Lyndsay A. Nelson ◽

Robert A. Greevy ◽

Andrew Spieker ◽

Kenneth A. Wallston ◽

Tom A. Elasy ◽

...

Keyword(s):

Type 2 Diabetes ◽

Medication Adherence ◽

Self Efficacy ◽

Text Messaging ◽

Self Care ◽

Baseline Hba1c ◽

Median Response ◽

Text Messaging Intervention

Objective: Text messaging interventions have high potential for scalability and to reduce health disparities; however, more rigorous, long-term trials are needed. We examined the long-term efficacy and mechanisms of a tailored text messaging intervention. Research Design and Methods: Adults with type 2 diabetes participated in a parallel-groups, 15-month randomized trial, assigned to receive REACH (Rapid Education/Encouragement and Communications for Health) for 12 months or control. REACH included interactive texts and tailored texts addressing medication adherence, and non-tailored texts supporting other self-care behaviors. Outcomes included HbA1c, diabetes medication adherence, self-care, and self-efficacy. Results: Participants (N=506) were approximately half racial/ethnic minority and half were underinsured, had annual household incomes <$35,000 USD and ≤ high school education; 11% were homeless. <a>Average baseline HbA1c was 8.6%±1.8%; 70.0±19.7 mmol/mol) with n=219 having HbA1c≥8.5% (69 mmol/mol)</a> and half were prescribed insulin. Retention was over 90%. Median response rate to interactive texts was 91% (interquartile range 75%, 97%). The treatment effect on HbA1c at 6 months (-0.31%; 95% CI [-0.61%, -0.02%]) was greater among those with baseline HbA1c≥8.5% (-0.74%; 95% CI [-1.26%, -0.23%]), and there was not evidence of effect modification by race/ethnicity or socioeconomic disadvantage. REACH improved medication adherence and diet through 12 months, and self-efficacy through 6 months. Treatment effects were not significant for any outcome at 15 months. REACH reduced barriers to adherence, but barrier reduction did not mediate outcome improvements. Conclusions: REACH engaged at-risk patients in diabetes self-management and improved short-term HbA1c. More than texts alone may be needed to sustain effects.

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