The Effectiveness of Short Term Mobile Phone Text Reminders in Improving Compliance among Hypertensive Patients

Jung Ah Lee; Woo Sang Kim; Moon Jung Bae; Young-Sik Kim; Han Jin Oh; Sang Yeoup Lee; Chul-Min Kim; Dong Hyeok Shin; Seong-Ho Han; Kyung-Hwan Cho

doi:10.15384/kjhp.2014.14.1.1

Korean J Health Promot > Volume 14(1); 2014 > Article

Lee, Kim, Bae, Kim, Oh, Lee, Kim, Shin, Han, and Cho: The Effectiveness of Short Term Mobile Phone Text Reminders in Improving Compliance among Hypertensive Patients

Original Article

Korean Journal of Health Promotion 2014;14(1):1-8.

Published online: January 20, 2014

DOI: https://doi.org/10.15384/kjhp.2014.14.1.1

The Effectiveness of Short Term Mobile Phone Text Reminders in Improving Compliance among Hypertensive Patients

¹Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

²Department of Family Medicine, Kwandong University College of Medicine, Gangneung, Korea

³Department of Family Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea

⁴Department of Family Medicine, The Catholic University of Korea Seoul St. Mary's Hospital, The Catholic University College of Medicine, Seoul, Korea

⁵Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea

⁶Department of Family Medicine, Dong-A University College of Medicine, Busan, Korea

⁷Department of Family Medicine, Korea University Anam Hospital, Seoul, Korea

Jung Ah Lee¹, Woo Sang Kim¹, Moon Jung Bae¹, Young-Sik Kim^1,, Han Jin Oh², Sang Yeoup Lee³, Chul-Min Kim⁴, Dong Hyeok Shin⁵, Seong-Ho Han⁶, Kyung-Hwan Cho⁷

￭ Corresponding author：Young-Sik Kim, MD Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea
Tel: +82-2-3010-3810, Fax: +82-2-3010-3815 E-mail: youngkim@amc.seoul.kr

Received March 18, 2014 Accepted March 28, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

For the effective management of hypertension, drug adherence and life style modification are important. We investigated the effects of mobile phone text‐message reminders on compliance and life style modification in patients with hypertension.

Methods

The study was performed at family medicine outpatient clinics at 15 hospitals in South Korea from July 2008 to June 2010. Study subjects included 1,449 patients who were all prescribed candesartan cilexetil. Patients were randomly divided into two groups‐ mobile phone text‐message reminder group and control group. In the reminder group, contents of text messages were recommendations for antihypertensive adherence, exercise, low salt diet, and reduction of weight and alcohol. In the control group, the date of next visit was sent at 10 week. Mobile phone text-messages were sent at 2, 4, 6, 8 and 10 weeks by the coordinating center. Thereafter, they were followed up for 12 weeks. Chi-square test was performed to compare compliance and performance indexes of the two groups.

Results

The reminder group had 719 (49.6%) patients vs. 730 (50.4%) patients in the control group. Attendance rate were 92.8% for the reminder group and 94.7% for the control group (P=0.14). 94.7% of the reminder group and 94.0% of the control group took their medication regularly (P=0.59). The target blood pressure was attained in 75.8% of the reminder group and 75.4% of the control group (P=0.87). Similarly, rates of weight loss, decreased alcohol use, increased physical activity and a low salt diet showed no significant differences between the two groups.

Conclusions

In our study, mobile phone text reminders did not show to have any significant positive effect on the management of hypertension.

Keywords: Hypertension, Compliance, Mobile phone text message

Figure 1.

General scheme of the study.

Table 1–1.

Baseline characteristics of the subjects^a

Variables	Text message reminder (n=719)	Control (n=730)	P^b
Sex
Man	309 (43.0)	296 (40.4)	0.350
Woman	410 (57.0)	434 (59.4)
Age, y	59.7±10.7	58.7±10.3	0.100
<50	135 (18.8)	127 (17.4)	0.100
50–59	213 (29.6)	256 (35.1)
60–69	241 (33.5)	240 (32.9)
≥70	130 (18.1)	107 (14.6)
Monthly income, million Korean Won
<200	170 (25.8)	141 (21.4)	0.170
200–399	204 (30.9)	219 (33.2)
≥400	286 (43.3)	299 (45.4)
Education, y
<12 12	188 (27.5) 263 (38.4)	183 (26.2) 276 (39.5)	0.850
>12	233 (34.1)	239 (34.3)
Marital status
Married	585 (84.1)	612 (86.2)	0.260
Not married	111 (15.9)	98 (13.8)
Smoking
None-smoker	473 (66.4)	463 (64.3)	0.310
Ex-smoker	145 (20.4)	170 (23.6)
Smoker	94 (13.2)	87 (12.1)
Alcohol use
None-drinker	438 (62.5)	454 (63.9)	0.570
Drinker	263 (37.5)	256 (36.1)
Degree of physical activity
Inactive	280 (40.1)	312 (43.8)	0.240
Minimally active	269 (38.5)	270 (37.9)
Health enhancing (vigorous)	149 (21.4)	130 (18.3)
Body mass index, kg/m²	25.5±3.4	25.3±5.5	0.420
Blood pressure, mmHg
<140 and <90	294 (42.9)	305 (43.9)	0.720
≥140 or ≥90	391 (57.1)	390 (56.1)
Habit of salt intake
Normal intake	398 (55.7)	405 (56.3)	0.850
High intake	316 (44.3)	315 (43.7)

^aValues are presented as N (%) or mean±SD.

^bCalculated by chi-squared test or Student's t-test.

Table 1–2.

Baseline characteristics of the subjects^a

Variables	Text message reminder (n=719)	Control (n=730)	P^b
Family history of disease
Hypertension	330 (47.7)	326 (46.4)	0.620
Diabetes mellitus	150 (21.7)	149 (21.2)	0.840
Stroke	128 (18.5)	139 (19.8)	0.540
Heart disease	79 (11.4)	90 (12.8)	0.430
Comorbidity	398 (58.2)	385 (55.6)	0.320
Diabetes mellitus	155 (22.7)	138 (20.0)	0.220
Hyperlipidemia	335 (49.2)	323 (47.0)	0.410
Heart disease	14 (2.1)	11 (1.6)	0.530
Cerebrovascular disease	13 (1.9)	12 (1.7)	0.820
History of having taken antihypertensive agents
Yes	480 (68.0)	474 (65.5)	0.300
No	226 (32.0)	250 (34.5)
Concurrently prescribed medication	496 (72.3)	499 (72.2)	0.970
Antihypertensive agents taking with candesartan cilexetil	264 (38.5)	253 (36.7)	0.470
Antidiabetic agents	143 (20.9)	127 (18.4)	0.250
Serum lipid lowering agents	338 (49.3)	310 (44.9)	0.100
Antiplatelet agents	161 (23.5)	177 (25.7)	0.360
Other cardiovascular medications	10 (1.5)	5 (0.7)	0.190

^aValues are presented as N (%).

^bCalculated by chi-squared test.

Table 2.

Comparison of compliance and performance index between mobile phone text-message reminder group and control group^a

Variables	Text message reminder (n=719)	Control (n=730)	P^b
Attendance
Yes	605 (92.8)	631 (94.7)	0.140
No	47 (7.2)	35 (5.3)
Drug adherence
≥80%	612 (94.7)	616 (94.0)	0.590
<80%	34 (5.3)	39 (6.0)
Controlled blood pressure^c
Yes	500 (75.8)	508 (75.4)	0.870
No	160 (24.2)	166 (24.6)
Weight loss^d
Yes	40 (6.6)	43 (6.9)	0.800
No	568 (93.4)	576 (93.1)
Reduced alcohol use^e
Yes	68 (11.1)	68 (11.0)	0.940
No	542 (88.9)	550 (89.0)
Increased regular exercise^e
Yes	123 (18.8)	117 (17.5)	0.550
No	531 (81.2)	550 (82.5)
Reduced dietary sodium intake^e
Yes	219 (33.4)	205 (30.8)	0.300
No	430 (65.7)	459 (68.9)

^aValues are presented as N (%).

^bCalculated by chi-squared test.

^cControlled blood pressure was defined as blood pressure being controlled as systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg.

^dA significant weight loss was defined as weight loss more than 3% compared to initial weight.

^eReduced alcohol use, increased regular exercise and reduced dietary sodium intake were evaluated by a questionnaire.

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