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

Article information

Korean J Health Promot. 2014;14(1):1-8

Publication date (electronic) : 2014 January 20

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

Jung Ah Lee ¹, Woo Sang Kim ¹, Moon Jung Bae ¹, Young-Sik Kim ¹^,, Han Jin Oh ², Sang Yeoup Lee ³, Chul-Min Kim ⁴, Dong Hyeok Shin ⁵, Seong-Ho Han ⁶, Kyung-Hwan Cho ⁷

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

￭ 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 2014 March 18; Accepted 2014 March 28.

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

Table 1–2.

Baseline characteristics of the subjects^a

Table 2.

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

References

1. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a metaanalysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360(9349):1903–13.

2. WHO. Prevention of cardiovascular disease: guidelines for assessment and management of cardiovascular risk. World Health Organization(WHO) 2007. http://whqlibdoc.who.int/pub-lications/2007/9789241547178_eng.pdf?ua=1.

3. Korea Centers for Disease Control and Prevention. Korea Health Statistics 2010: Korea National Health and Nutrition Examination Survey (KNHANES V-1) Available from: https://knhanes.cdc.go.kr/knhanes/index.do.

4. Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA 2010;303(20):2043–50.

5. WHO. Adherence to longterm therapies: evidence to action. World Health Organization (WHO) 2003. http://whqlibdoc.-who.int/publications/2003/9241545992.pdf.

6. Grant RW, Singer DE, Meigs JB. Medication adherence before an increase in antihypertensive therapy: a cohort study using pharmacy claims data. Clin Ther 2005;27(6):773–81.

7. Cramer JA, Benedict Á, Muszbek N, Keskinaslan A, Khan ZM. The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review. Int J Clin Pract 2008;62(1):76–87.

8. Park JH. Antihypertensive drug medication adherence of national health insurance beneficiaries and its affecting factors in Korea [dissertation] Seoul: Seoul National University; 2006. Korean.

9. Choi NH, Kim HK, Lee HR, Kim KS. A Study of the Factors influencing the Compliance of Hypertensive Patients to Therapy -Centered on the Registered Patients of Hypertension in a Rural Clinic–. Family physician 1991;12(10):1–12.

10. DiMatteo MR, Giordani PJ, Lepper HS, Croghan TW. Patient adherence and Medical treatment outcomes: a metaanalysis. Med Care 2002;40(9):794–811.

11. Touchette DR, Burns AL, Bough MA, Blackburn JC. Survey of medication therapy management programs under Medicare Part D. J Am Pharm Assoc 2006;46(6):683–91.

12. Ministry of Health and Welfare National Health Plan 2020. http://www.mindbank.info/item/4070.

13. Chen Z, Fang L, Chen L, Dai H. Comparison of an SMS text messaging and phone reminder to improve attendance at a health promotion center: a randomized controlled trial. Journal of Zhejiang University SCIENCE B 2008;9(1):34–8.

14. Korean Statistical Information Center. The number of mobile phone subscriptions http://kosis.kr/statisticsList/statisticsL-ist_03List.jsp?vwcd=MT_RTITLE&parmTabId=M_03_01#Su. bCont.

15. Viswanathan H, Lambert BL. An inquiry into medication meanings, illness, medication use, and the transformative potential of chronic illness among African Americans with hypertension. Research in Social and Administrative Pharmacy 2005;1(1):21–39.

16. Gohar F, Greenfield SM, Beevers DG, Lip GY, Jolly K. Self-care and adherence to medication: a survey in the hypertension outpatient clinic. BMC Complementary and Alternative Medicine 2008;8:4.

17. Egan BM, Lackland DT, Cutler NE. Awareness, knowledge, and attitudes of older Americans about high blood pressure: implications for health care policy, education, and research. Arch Intern Med 2003;163(6):681–7.

18. Lenfant C, Chobanian AV, Jones DW, Roccella EJ. Seventh report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7): resetting the hypertension sails. Circulation 2003;107:2993–4.

19. The Korean Society of Hypertension. 2004 Korean Hypertension Treatment Guidelines The Korean Society of Hypertension;2005.

20. Oh JY, Yang YJ, Kim BS, Kang JH. Validity and Reliability of Korean Version of International Physical Activity Questionnaire (IPAQ) Short Form. Korean J Fam Med 2007;28(7):532–41.

21. Kim HJ, Paik HY, Lee SY, Shim JE, Kim YS. Salt usage behaviors are related to urinary sodium excretion in normotensive Korean adults. Asia Pacific Journal of Clinical Nutrition 2007;16(1):122–7.

22. Pop-Eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, de Walque D, et al. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS 2011;25(6):825–34.

23. Dick JJ, Nundy S, Solomon MC, Bishop KN, Chin MH, Peek ME. Feasibility and usability of a text message-based program for diabetes self-management in an urban African-American population. Journal of Diabetes Science and Technology 2011;5(5):1246–54.

24. Hussein WI, Hasan K, Jaradat AA. Effectiveness of mobile phone short message service on diabetes mellitus management; the SMS-DM study. Diabetes Res Clin Pract 2011;94(1):e24–6.

25. Márquez Contreras E, de la Figuera von Wichmann M, Gil Guillén V, Ylla-Catalá A, Figueras M, Balaña M, at al. Effectiveness of an intervention to provide information to patients with hypertension as short text messages and reminders sent to theirmobile phone (HTA-Alert). Aten Primaria 2004;34(8):399–405.

26. Park KA. The related factors on medication adherence in elderly patients with hypertension or diabetes mellitus [dissertation] Daegu: Kyungpook National University; 2010. Korean.

27. Kim HW, Lee YJ, Youn BB. A follow up study for drop-out of hypertensive patients registered in a community hospital. Family Physician 1986;7(1):1–11.

Article information Continued

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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)

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

Calculated 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

Values are presented as N (%).

Calculated 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)

Values are presented as N (%).

Calculated by chi-squared test.

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

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

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