Please select the eligibility criteria that correspond to the clinical trial below.
Title: SMS-text Adherence Support (StAR*) Study, a Randomized Three-arm Open Parallel Group Trial to Evaluate the Effects of a Structured Programme of Hypertension Treatment Adherence Support Delivered Remotely Through SMS-text Messages on Blood Pressure at 12 Months as Compared With Usual Care.
Brief Summary: General synopsis for SMS-text Adherence Support (\*StAR) Study and associated preparatory and pilot work

Background: High blood pressure is an important risk factor for heart disease, stroke and chronic kidney disease. Clear evidence exists that for individuals with high blood pressure (hypertension) lowering blood pressure really reduces this risk. One of the critical factors in the long term control of blood pressure is the regular use of effective antihypertensive medications. In South Africa, poor treatment adherence (attending clinic, re-filling prescriptions, and regularly taking hypertension tablets) is known to be an important and alterable risk factor for uncontrolled high blood pressure and its complications (heart disease, stroke and chronic kidney disease). SMS-text messages have been shown to improve clinic attendance and medication adherence for some diseases (like HIV and TB) in other low-resource settings. It is not clear whether SMS-text messages to support treatment adherence have an effect on long-term blood pressure control. The acceptability, sustainability and scalability such technology also remains to be determined.

Aim: To investigate if a system of SMS-text messages to support treatment adherence is more effective than usual care for controlling high blood-pressure.

Objectives: The main objective is to test whether advice and support given by SMS-text, either by providing information (informational) or by allowing a two-way communication (interactive) improves control of blood pressure at one year compared to usual care.

Additional objectives include assessing whether the interventions have an effect on,

* Clinic attendance
* Prescription refill adherence
* Self-reported medication adherence
* Hypertension related illness or death
* Patient empowerment

Study design: Single centre randomized three-arm parallel group trial As it is not clear how best to support treatment adherence for people with hypertension we need to compare the different ways this might be done. Eligible patients who provide written consent will be put into one of three groups and then compared. The groups are selected by a computer which has no information about the individual (i.e. by chance). Participants in each group will get different types of SMS-text messages and these are compared.

Study interventions:

* Enhanced usual care In addition to their usual clinical care participants will receive the pre-randomisation "Welcome to the \*StAR Study" SMS-text, a "Happy Birthday" SMS-text on their date of birth and up to six additional SMS-text messages containing study specific information and thanking the participant for taking part in the study.
* Informational SMS-text messages In addition to enhanced usual care, participants allocated to the informational SMS-text support group will receive semi-tailored structured adherence-support (including clinic appointment and medication pick-up reminders, medication adherence support and hypertension-related education.)
* Interactive SMS-text messages In addition to enhanced usual care and informational SMS-text messages, SMS-text messages sent to participants in the interactive SMS-text group will contain a "prompt to respond" which will guide participants to additional SMS-text based resources.

Outcome measures: The main outcome measure is mean blood pressure measured at one year. Additional outcomes include the proportion of participants with "controlled blood pressure" as well as measures of clinic attendance, prescription refill adherence, self-reported medication adherence, hypertension related illness or death, and patient empowerment.


Options:
A: Inclusion Criteria:

* Clinical diagnosis of hypertension and are either currently receiving or are about to start blood pressure lowering medication
* Mean blood pressure at enrolment is \< 175/105
* Aged 21 years or older
* Must have access to a cell-phone (shared access is allowed if access is daily and the phone owner agrees to participate)
* Must be able to use SMS-text (help by a partner is allowed for illiterate subjects, subjects with poor vision, or subjects who are learning disabled)
* Must be resident in the study area and must be expected to be resident for the duration of the study

Exclusion Criteria:

* Another member of the household has already been recruited into the trial
* If female, they are not pregnant or within three months post-partum by self-report
* They are not willing to give informed consent and take part in the study.
B: Inclusion Criteria:

* Adults \> 18 years
* Diagnosed with stroke at least one month ago on neuroimaging (CT or MRI)
* Taking more than one drug for risk factor control
* Possessing a personal mobile phone
* Modified Rankin scores \<3 (to exclude severely disabled persons)
* Able to operate sms
* Do not intend to travel outside the country in the next 2 months (because the followup period is 2 months and during this period mobile communication through sms is required)
* Give informed consent

Exclusion Criteria:

* Chronic Renal Failure (because such patients keep getting admitted often and also have several contraindications for therapy)

  * Any known malignancy
  * Enrolled in another study
C: Inclusion Criteria:

* Age \> 18 years
* Capability of filling in questionnaires in Finnish language.
* Be able to use Remote Patient Monitoring System
* Be able to use the devices provided
* Has adequate cognitive capacities to participate
* In their medical records, one or both of the following diagnoses:

  a) Type 2 Diabetes, for enrolment
* diagnosed over 3 months prior to the enrolment and
* HbA1c \> 6,5 % b) Heart Disease, for enrolment
* Ischemic heart disease or
* Heart Failure or
* Atrial fibrillation or
* Other arrhythmia
* Be able to walk

Exclusion Criteria:

* Not willing to participate (e.g., not willing to sign the consent)
D: Inclusion Criteria:

Veterans with heart failure (HF) treated at the VA Louis Stokes (Cleveland) facilities will be eligible if they have New York Heart Association (NYHA) Class II-III diastolic or systolic HF noted by inpatient or outpatient ICD-9 codes.

Exclusion Criteria:

Veterans treated at the VA Louis Stokes (Cleveland) facilities will be ineligible if they:

* have a serious mental illness or cognitive dysfunction, e.g., psychosis, dementia, or active substance abuse (alcohol and/or other drugs);
* do not speak English fluently;
* are receiving palliative care due to advanced HF or other health problems;
* receive the majority of their HF care from providers outside of the VA;
* are unable to use a telephone to respond to weekly automated self-management support calls; or
* are unable to nominate an eligible informal caregiver.

Answer: A