Please select the eligibility criteria that correspond to the clinical trial below.
Title: Using a Tailored Health Information Technology Driven Intervention to Improve Health Literacy and Medication Adherence in a Pakistani Population With Vascular Disease
Brief Summary: Although most patients admitted with acute coronary syndrome or acute ischemic stroke in South Asian countries receive these evidence-based treatments, their overall continuation in the outpatient phase of care remains low. Patient from Pakistan are uniquely challenged in this respect because the overall literacy rates remain one of the lowest in Pakistan among South Asian Countries. In addition, a great majority of Pakistani patients often do not understand or follow health prescriptions (which are still written in English). Additionally, due to an unregulated health industry, they frequently take multiple opinions and prescriptions from different physicians. The investigators propose to develop a "talking prescription" for patients with stroke or myocardial infarction for secondary prevention. This will enable them to understand their medications better, improve health literacy and adherence. This is an IT enabled health literacy intervention. Physicians will prescribe statin and/or antiplatelet to the selected patients and enter the necessary details on an Optical Mark Recognition (OMR) sheet.Patients will be assigned to either of the 2 arms--either regular care or talking prescriptions. Follow-up will be done at 3 months post recruitment for behavioral knowledge assessment and adherence assessment.


Options:
A: 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.
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:

* self-identify as African American/Black
* be \>18 years
* have a diagnosis of HBP based on ICD-9 codes
* have uncontrolled hypertension on two successive clinic visits prior to screening (clinic SBP \> 140 mm Hg, DBP \> 90 mm Hg or SBP \> 130, DBP \> 80 for those with diabetes or kidney disease) as documented in the medical record
* be taking at least one antihypertensive medication
* own a cell phone capable of receiving and sending text messages
* be able to pay for and obtain hypertension medication
* English speaking
* willing to attend two data collection visits in Detroit, MI

Exclusion Criteria:

* receiving hemodialysis
* admits to planning to terminate cell phone contract during the next one month
* compliance risk (i.e., self-reported illicit drug use and/or alcohol abuse as measured by a score of \>2 for CAGE questions
* health literacy less than third grade reading level
* other major health problems (e.g., terminal stage of cancer, advanced liver disease)
D: Inclusion Criteria:

* Adult Men and Women ,18 years old
* Use of anti-platelets and statins both.
* Ischemic Stroke or CAD which is stable and outpatient based
* Own Cell Phone
* Can read local language,hear Cell phone,See a short text message
* Willing to Give Written Informed Consent
* Consent to follow up
* Stroke and CAD are stable specifically, not requiring medical procedures that would necessitate frequent interruptions in medications.
* Modified Rankin Score (MRS) Disability score should be less than 3.

Exclusion Criteria:

* No Ischemic Stroke or CAD
* Ischemic Stroke and CAD are unstable e.g. Unstable Angina, Acute MI, Need for CABG, Need for CEA, Need to rapidly adjust medication and inpatient care
* Biological impairment in reading or responding to short text messages such as (but not limited to) loss of vision, visual field cuts, aphasia.
* Diagnosed organ dysfunction or malignancy requiring stopping or adjustment of medications
* Plans to travel outside the country inside the two months following enrollment
* Known allergy or adverse reaction.
* Absolute or relative contraindication to antiplatelet or statin e.g chronic liver disease, myopathy, Thrombotic Thrombocytopenic Purpura, GI bleed , Active Gastritis

Answer: D