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:

Uninsured subjects aged 2:40 years who live in the catchment area of the participating primary care clinics with a mobile for personal use and a 10-year CVD risk of;:;: 10%, as classified by a community health worker.

Exclusion Criteria:

Pregnant women, bed-bound illiterate and persons who cannot give informed consent, or are planning to move away from the vicinity of the clinic in the following year will be excluded.
B: Inclusion Criteria:

1. OEF/OIF/OND Veteran
2. Can identify a VA Medical Center and VA Health Care Provider responsible for his/her care in the system
3. Interested in starting a physical activity program in the next 30 days
4. Access to a computer with an internet connection and a working USB port.
5. A smartphone running a compatible iOS or Android operating system.
6. Younger than Age 65

Exclusion Criteria:

1. Veteran self-reports that a health care provider has told the patient that it is currently unsafe to exercise in an unsupervised or unmonitored setting. (Can become eligible with written medical clearance).
2. History of eating disorders or a BMI \< 20
3. Not competent to consent to a research study by self-reporting a legal guardian who makes medical decisions for the Veteran.
C: Inclusion Criteria:

* Age ≥ 55 years (from the day of the 55. birthday inclusive)
* Diagnosis of primary (essential) hypertension (I10 according to International Classification of Diseases (ICD-10))
* Filling of blood pressure-lowering prescription(s) at trial recruitment (Visit 1)
* Duration of antihypertensive drug treatment for at least 1 year without any discontinuation
* Ownership of a mobile phone for personal use with the ability to open and read SMS
* Understanding of Slovak language on native-speaker level
* Informed consent for participation in the clinical trial and personally signed Informed Consent Form

Exclusion Criteria:

Exclusion criteria assessed prior to patient enrolment (by trial pharmacists):

* Planned hospitalisation during the trial period (3 months)
* Biological impairment affecting the ability to read the SMS (e.g. loss of vision, visual field cuts, aphasia)
* Living in the same household with another trial participant
* Participation in another clinical trial

Exclusion criteria assessed after patient enrolment (by trial pharmacists and project leader):

* Hospitalisation during the trial period
* Patient informs he/she won't be able to participate in the trial
* Withdrawal of Informed Consent
D: 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.

Answer: D