A randomized controlled behavioral intervention trial to improve medication adherence in adult stroke patients with prescription tailored Short Messaging Service (SMS)-SMS4Stroke study

Ayeesha Kamran Kamal, Quratulain Shaikh, Omrana Pasha, Iqbal Azam, Muhammad Islam, Adeel Ali Memon, Hasan Rehman, Masood Ahmed Akram, Muhammad Affan, Sumaira Nazir, Salman Aziz, Muhammad Jan, Anita Andani, Abdul Muqeet, Bilal Ahmed, Shariq Khoja

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Article number212
JournalBMC Neurology
Volume15
Issue number1
DOIs
StatePublished - Oct 21 2015
Externally publishedYes

Fingerprint

Medication Adherence
Prescriptions
Stroke
Blood Pressure
Survivors
Randomized Controlled Trials
Cell Phones
Lost to Follow-Up
Pakistan
Health
Linear Models
Language
Software
Technology
Control Groups

Keywords

  • Cost effectiveness
  • IT technology
  • Lower and middle income countries
  • Medication adherence
  • MHealth
  • Non communicable disease
  • Prevention
  • SMS
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

A randomized controlled behavioral intervention trial to improve medication adherence in adult stroke patients with prescription tailored Short Messaging Service (SMS)-SMS4Stroke study. / Kamal, Ayeesha Kamran; Shaikh, Quratulain; Pasha, Omrana; Azam, Iqbal; Islam, Muhammad; Memon, Adeel Ali; Rehman, Hasan; Akram, Masood Ahmed; Affan, Muhammad; Nazir, Sumaira; Aziz, Salman; Jan, Muhammad; Andani, Anita; Muqeet, Abdul; Ahmed, Bilal; Khoja, Shariq.

In: BMC Neurology, Vol. 15, No. 1, 212, 21.10.2015.

Research output: Contribution to journalArticle

Kamal, AK, Shaikh, Q, Pasha, O, Azam, I, Islam, M, Memon, AA, Rehman, H, Akram, MA, Affan, M, Nazir, S, Aziz, S, Jan, M, Andani, A, Muqeet, A, Ahmed, B & Khoja, S 2015, 'A randomized controlled behavioral intervention trial to improve medication adherence in adult stroke patients with prescription tailored Short Messaging Service (SMS)-SMS4Stroke study', BMC Neurology, vol. 15, no. 1, 212. https://doi.org/10.1186/s12883-015-0471-5
Kamal, Ayeesha Kamran ; Shaikh, Quratulain ; Pasha, Omrana ; Azam, Iqbal ; Islam, Muhammad ; Memon, Adeel Ali ; Rehman, Hasan ; Akram, Masood Ahmed ; Affan, Muhammad ; Nazir, Sumaira ; Aziz, Salman ; Jan, Muhammad ; Andani, Anita ; Muqeet, Abdul ; Ahmed, Bilal ; Khoja, Shariq. / A randomized controlled behavioral intervention trial to improve medication adherence in adult stroke patients with prescription tailored Short Messaging Service (SMS)-SMS4Stroke study. In: BMC Neurology. 2015 ; Vol. 15, No. 1.
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AU - Kamal, Ayeesha Kamran

AU - Shaikh, Quratulain

AU - Pasha, Omrana

AU - Azam, Iqbal

AU - Islam, Muhammad

AU - Memon, Adeel Ali

AU - Rehman, Hasan

AU - Akram, Masood Ahmed

AU - Affan, Muhammad

AU - Nazir, Sumaira

AU - Aziz, Salman

AU - Jan, Muhammad

AU - Andani, Anita

AU - Muqeet, Abdul

AU - Ahmed, Bilal

AU - Khoja, Shariq

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N2 - 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.

AB - 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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KW - Prevention

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KW - Stroke

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