Addressing Medication Nonadherence Using Mobile Phone-Based Tailored Messaging.

Mobile Health;Medication Adherence;Tailoring;Pharmacy and Pharmacology;Health Sciences;Social and Administrative Sciences

Gatwood, Justin D.Erickson, Steven R. ;

University of Michigan

关键词: Mobile Health;    Medication Adherence;    Tailoring;    Pharmacy and Pharmacology;    Health Sciences;    Social and Administrative Sciences;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/108852/gatwood_1.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

While numerous treatments exist to manage diabetes, adherence to guideline-recommended medications remains suboptimal. Both tailoring health messages and text messaging have been observed to improve medication adherence, but analysis of their combined effect is limited. This study aimed to (1) construct a library of and deliver condition and treatment-related tailored text messages to influence medication-taking among adults with diabetes and (2) assess the effect of tailored text messages on diabetes-related health beliefs, technology acceptance, and medication adherence between patients receiving tailored text messages or standard care.Adults with uncontrolled diabetes were recruited from a western Michigan health system and randomized into two study arms where subjects received either a daily tailored text message or standard care for 90 days. Self-Determination Theory and the Health Belief Model guided message development; a library of 168 theory-driven and 128 medication-specific tailored messages were developed for automated delivery to mobile phones. A set algorithm determined the order and timing of messages with the aim of progressively influencing diabetes-related beliefs affecting medication adherence. Baseline responses to a survey were used to establish the series of tailored messages for each participant. Changes from baseline in mean responses to seven theory-based items and adherence were evaluated using endpoint surveys and pharmacy claims data, respectively. Four survey items captured technology acceptance and personal interviews were conducted after the intervention.A total of 48 subjects were randomized into two cohorts. The receipt of a daily tailored text message was well accepted by intervention subjects and most were interested in continuing to receive similar messages. Adjusted analysis indicated there were no statistically significant differences between groups in the seven theoretical concepts resulting from the intervention; however, changes for most constructs were in the desired direction for intervention subjects. Similarly, no statistically significant changes in adherence to diabetes medications were observed between or among cohorts after the three-month intervention, and mean adherence values declined over nine months. The tailoring of diabetes-specific text messages remains an area of opportunity to improve medication adherence and provide motivation to adults with diabetes but larger studies are needed to fully understand their effectiveness.