Effect of a Telephone and Text Message Follow-Up Program on Medication Adherence among Patients with Diabetes Mellitus: A randomized controlled trial

Medication adherence is an essential factor in effective management of patient with diabetic disease, especially in developing countries. Recently, telenursing program have various applications in health care services all over the word.This study determined the effect of atelephoneand text message follow-up program on Medication Adherence among patients with diabetes mellitus.This was a controlled trial design onpatients with diabetes who were hospitalized in the University of Benin Teaching Hospital, Benin-City, Edo State.This study was conducted among 100 diabetic patients through census method and the participants were randomly assigned to the experimental and control groups. Morisky Medication Adherence Scale (MMAS) was used for data collection.Data collected were analyzed using descriptive statistics and independent t-test, chi-square, and repeated measures analysis of variance (ANOVA) at 0.05 significant levels. Findings of the study shows thatPrior to the intervention, there is no significant different in the medication adherence level of the two groups. However, it also show that there is significant different between the mean score of the experimental and control group after intervention(p˂ 0.001). Thus,the telephone and text message follow up program is effective in promoting the level of medication adherence among diabetic patients. Key: Diabetes mellitus, text messaging, patient, telephone, medication adherence. -------------------------------------------------------------------------------------------------------------------------------------Date of Submission: 25-10-2019 Date of acceptance: 09-11-2019 -------------------------------------------------------------------------------------------------------------------------------------¶ Introduction Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. [1] It is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys, and nerves. [2] According to the IDF statistics, presently every seven seconds someone is estimated to die from diabetes or its complications, with 50% of those deaths occurring under the age of 60 years. [3] This is against the background of a global diabetes prevalence of 8.8% (95% confidence interval 7.2-11.3%) of the world population in 2017, standardized for the age group 20-79 years. [4] The prevalence is expected to further increase to by the year 2045. [5] In total numbers, this reflects a population of 424.9 million people with diabetes worldwide in 2017 with an estimate of a 48% increase to 628.6 million people for the year 2045 . [6] Nigeria, with a population of 158 million people, is the most populous country in Africa and accounts for one sixth of Africa’s population [7,8] Incidence and prevalence of diabetes in Nigeria today is one of the most significant troubles [9] According to the International Diabetes Federation (IDF), in 2015 out of 415 million people living with diabetes in the world, 75% are in poor and middle income countries, with Sub-Sahara Africa accounting for 14.2 million. [10] Based on the available statistical report, the prevalence rate of diabetes in Nigeria is 1.9 percent for adults, and among the five million people that die from diabetes annually across the world, Nigeria accounts for more than 40,000. [10, 11] Relatively, Nigeria leads in the number of incidence and mortality rate of diabetes in Africa and this was found to be as a result of poor medication adherence among diabetic patients [12] Adherence to long-term therapies in chronic disease is poor, and traditional interventions to improve adherence are complex and not widely effective. [13] Mobile telephone and text messaging may be anaccessible means to improve medication adherence.The use of mobile communication method in nursing to follow up patient saves time, cost effective and increase coverage [14, 15]. Effect of a Telephone and Text Message Follow-Up Program on Medication Adherence . DOI: 10.9790/1959-0806011418 www.iosrjournals. org 15 | Page The efficacy of telenursing through text message and telephone follow-up in the management of chronic diseaseshas been studied in a number of previous studies, but none seems to look at diabetes mellitus. However, need to determine the effectiveness of text message on medication adherence among diabetic patients, and its influences on clinicaloutcomes.Due to the gap noticed in the results of previous studies and the limited number of studies performed in this respect in Nigeria, the present study was performed with the aim of determining the effect of a text message and telephone follow-up program on medication adherence among diabetic patients. II. Methodology The present study was a clinical trial. The study subjects consisted of patients with Diabetes who were hospitalized in the University of Benin Teaching Hospital, Benin-city, Nigeria betweenJanuary to August 2019 and met the inclusion criteria. This study was conducted among 100 diabetic patients through census method and the participants were randomly assigned to the experimental and control groups. (through the random selection of cards with the numbers 1 and 2 by the patients) divided into two groups of intervention (n = 50) and control (n = 50). The inclusion criteria consisted of diagnosis of Diabetes and registered with University of Benin Teaching Hospital, able to read and write, having stable physical condition, lack of any visual, speech, and hearing difficulties, having access to a telephone at home and in the his/her office. The exclusion criteria consisted of patients withCo-morbidities such as depression or other mental diseases that can affect their ability to understand and respond to questionnaire. Data collection was performed in the two groups of patients before, 3 months after, and 4 months after the beginning of the intervention. The data collection tool comprised two parts. The first part consisted of questions on demographic characteristics and information on the disease (age, gender, education level, and marital status, history of risk factors such as, hypertension, family history of diabetes, smoking, and history of hospitalization). The second part consisted of the Morisky Medication adherence scale (MMAS-8) which is made up of eight questions formulated to assess medication adherence among diabetic patients. The first seven questions are closed ended question with Yes or No answer. NO were scored as 1 while yes were scored as 0, except question 5 where reverse is the case in the scoring. The remaining one question is structured in a 5 point – scale, which is as follows: all the time, usually, and never,were scored from 1 to 5 respectively. The Morisky Medication adherence scale (MMAS-8) were rated as follows: patients with MMAS-8 score of zero (0) were rated as higher adherence, score ranges from 1-2 were rated as medium adherence and score range of 3-8 MMAS-8 score were rated as low adherence [1]The MMAS-8 Scale is a standard questionnaire, the reliability and validity of which have been approved by researches performed in Nigeria and other countries. [1] The Cronbach’s alpha was used to test the reliability of the instrument, andthe reliability coefficient in this study is 0.85. The patients were informed of the goals of the study and informed consents were obtained from them. After primary data collection, the home telephone number and mobile number of the patients were obtained. To ensure that messages were sent, the researcher activated the delivery option in her mobile phone. During the 3 months of text message follow-up, six messages were sent to the subjects each week. In total, during the intervention period, 72 text messages were sent to each study subject. Each text message consisted of a maximum of 150 words. The context of the text messages sent to the intervention group comprised of a reminder on when, how, benefits of their drug and adverse effect of not taken the drug as prescribed. Text message follow-up of the control group patients was achieved through messages with contents other than medication adherence messages, such as political messages.In the course of the 3 months of telephone follow-up, telephone calls were made two times per week during the first month and once a week during the second and third months. On average, the duration of each call was 15 min, and in total, 16 calls were made to each subject. Statistical analysis of data was conducted using Student’s independent t-test, Chi-square, and repeated measures analysis of variance (ANOVA) using the Statistical Package for Social Science(SPSS) version 21.00 statistical software (IBM corp. released 2012. IBM SPSS statistics for widows, version 21.0 Armonk, NY: IBM Corp. Thus, data obtained from 50 patients in the intervention group and 50 patients in the control group were analyzed. Ethical Considerations The ethical approval was obtained from the university of Benin teaching hospital research and ethical committee, with approval reference Number: ADM/E22/A/VOL.V11/14738 on February 15 th , 2019, the hospital where the study was conducted. Principle of voluntary participation was applied, and proper explanation of the purpose of the research was ensured. Consent form was given to the participants to seek verbal and written consent before data collection. Effect of a Telephone and Text Message Follow-Up Program on Medication Adherence . DOI: 10.9790/1959-0806011418 www.iosrjournals.org 16 | Page III. Results TABLE 1: Demographic characteristics of Diabetic patients admitted to surgical and Medical Surgical Units at the University of Benin Teaching Hospital, Nigeria. Intervention Group Control Group Statistical Test VARIABLES RESPONSES N % N % Chi-square (X) p-value Gender Female 21 42 20 40 0.07 0.79