Development and piloting of a highly tailored text and voice messaging intervention to support adherence to antihypertensive medications within the primary care setting (Preprint)
Authors: Kassavou Aikaterini , Houghton Vikki , Edwards Simon , Brimicombe James , Sutton Stephen 
Published: December 2017

BACKGROUND

Tailored automated text and voice message interventions are effective ways to increase adherence to medications.

OBJECTIVE

This paper describes the systematic development and piloting of a highly tailored text and voice message intervention to increase adherence to medications within primary care.

METHODS

Following the MRC guidance this paper describes: a) the systematic development of the theoretical framework and tailored intervention content, based on review of theories and meta-analyses of effectiveness (n=2 meta-analyses with meta-regression); b) the systematic development of the intervention delivery mode, intervention content and implementation procedures, based on consultations with telecommunication experts (n=6 experts, including industry, academics, and university service providers), face-to-face interviews using think aloud protocols (n=19 patients and n=5 health care providers), experiential focus groups (n=12 patients), stakeholders’ consultations (n=7 stakeholders, including commissioners, health care providers, and patients), systematic reviews (n=2 reviews), and PPI input (n=100 PPI members); and c) the piloting of the intervention, based on a one-month pre-post study (n=17 patients). The mixed methods analysis combined findings from the parallel studies complementarily. The target population that informed the intervention were adults above 40 years old, with a primary diagnosis of hypertension, taking multiple medications, presumed to be non-adherent to their medications, and attending primary care settings within different areas of deprivation in the East of England.

RESULTS

Intervention development suggested the target behaviour of the intervention to be the tablets taken at a regular time of the day. It also suggested the delivery of both INA and NINA messages and their interchange during a prescription-based month, but INA messages to be less frequent than NINA messages. It also suggested that participants could be more receptive to intervention content when they initiate medication taking or they change prescription plan. Intervention piloting suggested that the intervention is acceptable and feasible. It also suggested high intervention engagement with, and fidelity of, the intervention content, which included Behaviour Change Techniques (BCTs). The final version of the intervention aims to increase adherence to daily prescribed oral medications, is delivered using text and voice messages, and includes a combination of nine BCTs (e.g., implementation intentions, information about health consequences), is highly tailored to patients’ beliefs (e.g., beliefs about medications, self-efficacy, social norms, perceived regimens complexity), and prescription plan. During the intervention, patients can select between two BCTs to maintain medication taking (e.g., habit formation or self-monitoring).

CONCLUSIONS

This paper describes a theory and evidence based intervention that aims to support adherence to high blood pressure medications, as an adjunct to primary care consultations, and it is currently evaluated in a randomised controlled trial.

CLINICALTRIAL

ISRCTN10668149 DOI 10.1186/ISRCTN10668149.