Targeting Medication Nonadherence Using Mobile Phone Based Tailored Messaging

The prevalence of diabetes is a growing public health issue, and rates are expected to continue to climb in the future. Adherence to prescribed medications is challenging, especially for diabetes patients, and contributes to excess costs and avoidable adverse health outcomes. While multiple approaches have attempted to improve this behavior, results of interventions have been mixed, and no single strategy has proven to be universally beneficial. Tailored health messages that can target multiple diabetes treatment barriers is an emerging intervention method. Independently, tailored messages and text messaging have each been shown to improve medication adherence, but their combined use as a method of behavior change has limited research.

The goal of this project is to test the effectiveness of individually tailored messages delivered by mobile phone text messaging to a sample of patients with diabetes. Specifically, the project aims to evaluate the impact of these messages on treatment and condition beliefs and attitudes, technology acceptance, and medication adherence. A randomized controlled study using a cohort of patients with uncontrolled diabetes was conducted over 3 months. The study developed original, theory-driven tailored messages derived from validated survey instruments and messages were delivered using automated systems.

The specific aims of the project were as follows:

• Construct a library of and successfully deliver condition and treatment-related tailored text messages that can be used to influence medication-taking behavior using theory-driven approaches among patients with diabetes. 
• Assess the effect of tailored text messages on health beliefs related to treatments, conditions, and technology acceptance in patients with diabetes. 
• Analyze changes in diabetes medication adherence between patients receiving tailored text messages and patients with only standard care. 

Study subjects were recruited from a western Michigan health system and were required to be 21-64 years of age, diagnosed with diabetes, taking at least one antidiabetic medication, and operating a mobile phone. Subjects were randomized to receive one text message per day or standard care only for 3 months. Survey responses measured changes in health beliefs, adherence was assessed using pharmacy claims, and interviews gathered intervention feedback.

Results found that the relaying of tailored materials by mobile phone is a feasible means by which behavioral interventions may be delivered, particularly when addressing the needs of patients with diabetes. Findings suggest that patients seem interested and willing to use mobile devices during their treatment process if their individual needs are met by these communication platforms. Health care systems and payers should be mindful of what they offer their patients and enrollees when developing and implementing mobile applications and communication channels. The study team believes that future studies should expand their tailoring to additional, known reasons for non-adherence and consider the use of active communication and information exchange between patients and providers.