Effectiveness of mHealth in improving medication adherence among hypertensive patients on follow-up in a tertiary hospital in central Kenya: a randomized controlled trial
Keywords:Medication, Adherence, Hypertension, Blood pressure control, mHealth, Intervention
Background: Non-adherence to medication is documented in the literature as a major barrier to blood pressure control among patients on treatment for hypertension. This study sought to evaluate the potential effectiveness of a mHealth intervention in supporting medication adherence among hypertensive patients on follow up.
Methods: We undertook a single blind parallel randomized controlled trial among hypertensive patients undergoing follow up care in Nyeri County Referral Hospital between January and December, 2020. The trial comprised of two arms, with a total of 120 patients randomized on a 1:1 ratio. Patients in the experimental group were put on an educational health intervention comprising of mobile phone delivered SMS messages and interactive voice calls. Patients in the control group were continued on the usual care offered in the hospital’s medical outpatient clinic. The primary endpoint was medication adherence. Data was analyzed through the intention to treat approach at 5% significance level.
Results: A total of 112 participants (93.3%) were retained in the study at the end of follow up. The proportion of patients who were adherent to their prescribed medications was higher by 38.3% among participants in the experimental arm compared to those in the control group (p<0.001). The odds of being adherent to medications was 6.1 times higher for patients who had received the study’s intervention compared to those in the control group (95% CI 2.6, 14.3).
Conclusions: The mHealth intervention applied in this study was effective in improving medication adherence among patients on treatment for hypertension.
Kyu HH, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392(10159):1859-922.
Stanaway JD, Afshin A, Gakidou E, Lim SS, Abate D, Abate KH, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392(10159):1923-94.
Zhou B, Carrillo-Larco RM, Danaei G, Riley LM, Paciorek CJ, Stevens GA, et al. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet. 2021;398(10304):957-80.
Pengpid S, Peltzer K. Prevalence, awareness, treatment and control of hypertension among adults in Kenya: cross-sectional national population-based survey. East Mediterr Health J. 2020;26(8):923-32.
Choudhry NK, Kronish IM, Vongpatanasin W, Ferdinand KC, Pavlik VN, Egan BM, et al. Medication Adherence and Blood Pressure Control: A Scientific Statement From the American Heart Association. Hypertension. 2022;79(1):e1-e14.
Burnier M, Egan BM. Adherence in Hypertension. Circ Res. 2019;124(7):1124-40.
Burnier M, Vrijens B. Taxonomy of Medication Adherence: Recent Developments. In: Burnier M, editor. Drug Adherence in Hypertension and Cardiovascular Protection. Cham: Springer International Publishing. 2018;1-8.
World Health Organization. Adherence to Long-Term Therapies: Evidence for action. Available at: http://apps.who.int/iris/bitstream/handle/10665/42682/9241545992.pdf;jsessionid=76E41C2EE570508498C218461A16020F?sequence=1. Accessed on 20 December 2022.
Moss JT, Kimani H, Mwanzo I. Compliance to antihypertensive therapy and associated factors among adults’ hypertensive patients attending medical clinics in Kilifi County Kenya. IJCMPH. 2021;8(10):11.
Achieng’ L, Joshi M, Ogola E, Karari E. Adequacy of blood pressure control and level of adherence with antihypertensive therapy. East Afr Med J. 2009;86(11).
Otenyo, Maranga A. Factors affecting adherence to Antihypertensive medication regimen among hemodialysis patients attending a private hospital in Mombasa. Int J Pharm Sci Res. 2018;12(9):755-60.
Xiong S, Peoples N, Østbye T, Olsen M, Zhong X, Wainaina C, et al. Family support and medication adherence among residents with hypertension in informal settlements of Nairobi, Kenya: a mixed-method study. J Hum Hypertens. 2022;19(10):022-00656.
Communication Authority of Kenya. Kenya National ICT Survey Report. Available at: https://ca.go.ke/wp-content/uploads/2018/02/National-ICT-Survey.pdf. Accessed on 21 December 2022.
Kenya Ministry of Health. Kenya National e-Health Strategy. Available at: http://publications.universal health2030.org/uploads/kenyanation_ehealth_strategy.pdf. Accessed on 21 December 2022.
Njoroge M, Zurovac D, Ogara EA, Chuma J, Kirigia D. Assessing the feasibility of eHealth and mHealth: a systematic review and analysis of initiatives implemented in Kenya. BMC Res Notes. 2017;10(1):017-2416.
Lam WY, Fresco P. Medication Adherence Measures: An Overview. Biomed Res Int. 2015;217047(10):11.
Abughosh SM, Wang X, Serna O, Henges C, Masilamani S, Essien EJ, et al. A Pharmacist Telephone Intervention to Identify Adherence Barriers and Improve Adherence Among Nonadherent Patients with Comorbid Hypertension and Diabetes in a Medicare Advantage Plan. J Manag Care Spec Pharm. 2016;22(1):63-73.
Sullivan KM, Dean A, Soe MM. OpenEpi: a web-based epidemiologic and statistical calculator for public health. Public Health Rep. 2009;124(3):471-4.
Lim CY, In J. Randomization in clinical studies. Korean J Anesthesiol. 2019;72(3):221-32.
Kim J, Shin W. How to do random allocation (randomization). Clin Orthop Surg. 2014;6(1):103-9.
Saghaei M. Random allocation software for parallel group randomized trials. BMC Med Res Methodol. 2004;4(26):1471-2288.
Abu H, Aboumatar H, Carson KA, Goldberg R, Cooper LA. Hypertension knowledge, heart healthy lifestyle practices and medication adherence among adults with hypertension. Eur J Pers Cent Healthc. 2018;6(1):108-14.
Olowe OA, Ross AJ. Knowledge, adherence and control among patients with hypertension attending a peri-urban primary health care clinic, KwaZulu-Natal. Afr J Prim Health Care Fam Med. 2017;9(1):e1-e7.
Lynch HM, Green AS, Clarke Nanyonga R, Gadikota-Klumpers DD, Squires A, Schwartz JI, et al. Exploring patient experiences with and attitudes towards hypertension at a private hospital in Uganda: a qualitative study. Int J Equity Health. 2019;18(1):206.
Celerity Systems Ltd. Ltd CS. bulsms.com. Available at: https://www.bulksms.com/company/. Accessed on 20 December 2022.
Baumgartner PC, Haynes RB, Hersberger KE, Arnet I. A Systematic Review of Medication Adherence Thresholds Dependent of Clinical Outcomes. Front Pharmacol. 2018;9(1290).
Algabbani FM, Algabbani AM. Treatment adherence among patients with hypertension: findings from a cross-sectional study. Clin Hypertens. 2020;26(18):020-00151.
Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, et al. CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c869.
McCoy CE. Understanding the Intention-to-treat Principle in Randomized Controlled Trials. West J Emerg Med. 2017;18(6):1075-8.
Rombach I, Knight R, Peckham N, Stokes JR, Cook JA. Current practice in analysing and reporting binary outcome data—a review of randomised controlled trial reports. BMC Med. 2020;18(1):147.
Kozik M, Isakadze N, Martin SS. Mobile health in preventive cardiology: current status and future perspective. Curr Opin Cardiol. 2021;36(5):580-8.
Xiong S, Berkhouse H, Schooler M, Pu W, Sun A, Gong E, et al. Effectiveness of mHealth Interventions in Improving Medication Adherence Among People with Hypertension: a Systematic Review. Curr Hypertens Rep. 2018;20(10):86.
Bobrow K, Farmer AJ, Springer D, Shanyinde M, Yu L-M, Brennan T, et al. obile Phone Text Messages to Support Treatment Adherence in Adults With High Blood Pressure (StAR): A Single-Blind, Randomized Trial. Circulation. 2016;133(6):592-600.
Chandler J, Sox L, Kellam K, Feder L, Nemeth L, Treiber F. Impact of a Culturally Tailored mHealth Medication Regimen Self-Management Program upon Blood Pressure among Hypertensive Hispanic Adults. Int J Environ Res Public Health. 2019;16(7).
Gonzalez C, Early J, Gordon-Dseagu V, Mata T, Nieto C. Promoting Culturally Tailored mHealth: A Scoping Review of Mobile Health Interventions in Latinx Communities. J Immigr Minor Health. 2021;23(5):1065-77.
Zhang F, Or PPL, Chung JWY. How different health literacy dimensions influences health and well-being among men and women: The mediating role of health behaviours. Health Expectations. 2021;24(2):617-27.
Walters R, Leslie SJ, Polson R, Cusack T, Gorely T. Establishing the efficacy of interventions to improve health literacy and health behaviours: a systematic review. BMC Public Health. 2020;20(1):1040.