Text Messaging to Improve Hypertension Medication Adherence in African Americans (Michigan)

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Summary:

Hypertension is the leading cause of cardiovascular disease worldwide, and particularly burdensome for African Americans who are more susceptible to the condition than other racial groups. Despite evidence that medication can reduce the risk of myocardial infarction and stroke, only about half of patients diagnosed in the United States adhere to the use of medication to control their hypertension.

Mobile phones and text messages have become widely integrated into daily life, and may offer a simple way to enhance medication adherence as compared to traditional methods. This project developed and assessed an automated text message system named BPMED to improve medication management by helping people self-monitor adherence through reminders. The system was assessed among African Americans with uncontrolled hypertension, and included their perceptions of intervention effectiveness and satisfaction. It was theorized that individuals who used BPMED would have improved medication adherence, medication self efficacy, and blood pressure control.

The specific aims of this project were as follows:

  • Utilize patient participant feedback in the development of a mobile phone text message system to improve adherence to antihypertensive medications. 
  • Understand the effect of the newly developed text message system on changes in medication adherence, medication self-efficacy, and blood pressure from baseline to 1-month followup in African Americans with uncontrolled hypertension. 
  • Assess participant perceptions of intervention effectiveness and satisfaction in order to guide further system refinement. 

Based on formative research, BPMED was developed to provide daily automated text message medication reminders at a time chosen by the participant over a 1-month intervention period. It also included eight educational messages based on hypertension management recommendations from the American Heart Association. Finally, a single-item weekly questionnaire asked participants to rate their satisfaction with BPMED.

A randomized controlled trial compared patients using BPMED to those receiving usual care. The results showed slight improvements in medication adherence and blood pressure after 1 month; however, the differences between the groups were not significant. Despite this, participants reported overwhelming satisfaction with BPMED, perceptions of greater adherence to antihypertensive medication regimens, and perceptions of overall health improvement. The research team hypothesized that the non-significant findings were largely attributed to the short trial and small sample size and recommended a longer-term and larger-scale randomized control trial of the BPMED be conducted.

Text Messaging to Improve Hypertension Medication Adherence in African Americans - 2012

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    PAR: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality Through Health Information Technology (IT) (R21)
  • Grant Number: 
    R21 HS 019092
  • Project Period: 
    September 2010 – September 2013
  • AHRQ Funding Amount: 
    $172,260
  • PDF Version: 
    (PDF, 275.39 KB)

Summary: Hypertension is the leading cause of cardiovascular disease worldwide. Chronic hypertension is particularly burdensome for African Americans because they are more susceptible to the condition than other racial groups. Despite evidence that hypertension medications can reduce the risk of myocardial infarction and stroke, only about half of patients who have been diagnosed with hypertension in the United States adhere to those regimens.

Mobile phones and text messages are becoming widely integrated into daily life and may offer a simple way to enhance medication adherence as compared to traditional methods. This project is developing and testing an automated text message system to improve medication management by helping people self-monitor adherence through reminders. It is theorized that individuals who use a mobile phone-based automated text message system will have improved medication adherence, medication self-efficacy, and blood pressure control. The system will assess African Americans who have uncontrolled hypertension on medication adherence, medication self-efficacy, and blood pressure measurements from baseline to 1-month followup, and will track participant perceptions of intervention effectiveness and satisfaction.

In 2011, the project team conducted three focus groups. Inclusion criteria for the focus groups were African American, hypertension as documented in the electronic medical record, cell phone ownership, and currently undergoing treatment for hypertension. Dr. Buis and her team used information from the focus groups to develop a text messaging system that provides patients with customizable adherence reminders and educational messages about high blood pressure, nutrition, and physical activity. The system underwent robust testing to ensure that all of its components functioned properly. An interface was developed to collect baseline and followup data, including demographic and clinical characteristics. The system will be evaluated in a randomized controlled trial (RCT).

Specific Aims:

  • Utilize patient participant feedback in the development of a mobile phone text message system to improve adherence to antihypertensive medications. (Achieved)
  • Understand the effect of the newly developed text message system on changes in medication adherence, medication self-efficacy, and blood pressure from baseline to 1-month followup in African Americans with uncontrolled hypertension. (Ongoing)
  • Assess participant perceptions of intervention effectiveness and satisfaction in order to guide further system refinement. (Upcoming)

2012 Activities: Dr. Buis and her team began to recruit patients for the RCT through mailings that described the study and invited them to participate. By the end of the year, 46 eligible patients were identified and 34 enrolled in the study. While recruitment was slow, the retention rate has been high, with only one participant lost to followup. Dr. Buis has a target of 70 patients and is collaborating with other clinics that have large patient populations to facilitate the recruitment effort.

Due to challenges with patient recruitment, Dr. Buis is using a 1-year no-cost extension. As last self- reported in the AHRQ Research Reporting System, project progress and activities are mostly on track and project budget spending is on target.

Preliminary Impact and Findings: Analysis of the focus groups indicated that despite high self-reported adherence, participants do not always take their medications as prescribed. Additionally, the focus groups confirmed that the vast majority of participants had previously used text messaging. While all participants indicated that they were in favor of a text message approach to improving medication adherence, they overwhelmingly stated that they did not want to use texting to report adherence after each dose or on a daily basis. The majority of participants want to receive daily reminders to take their medications, with an option of customizing the time and frequency that texts are sent. In addition, many participants reported that they are interested in receiving occasional health promotion or educational messages related to high blood pressure, nutrition, and physical activity.

Target Population: Adults, Hypertension, Racial or Ethnic Minorities*: African American

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Implementation and Use

* This target population is one of AHRQ’s priority populations.

Text Messaging to Improve Hypertension Medication Adherence in African Americans - 2011

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    PAR: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality Through Health Information Technology (IT) (R21)
  • Grant Number: 
    R21 HS 019092
  • Project Period: 
    September 2010 - September 2012
  • AHRQ Funding Amount: 
    $172,260
  • PDF Version: 
    (PDF, 188.6 KB)

Summary: Hypertension is the leading cause of cardiovascular disease worldwide. Chronic hypertension is particularly burdensome for African Americans because they are more susceptible to the condition than other racial groups. Despite evidence that hypertension medications can reduce the risk of myocardial infarction and stroke, only about half of patients who have been diagnosed with hypertension in the United States adhere to those regimens.

Mobile phones and text messages are becoming widely integrated into daily life and may offer a simple and less labor-intensive way to enhance medication adherence. This project is developing and testing an automated text message system to improve medication management by helping individuals selfmonitor adherence through reminders. It is theorized that individuals who use a mobile phone-based automated text message system will have improved medication adherence, medication self-efficacy, and blood pressure control. The system will assess African Americans with uncontrolled hypertension on medication adherence, medication self-efficacy, and blood pressure measurements from baseline to 1-month followup, and will also track participant perceptions of intervention effectiveness and satisfaction.

Specific Aims:

  • Utilize patient participant feedback in the development of a mobile phone text message system to improve adherence to antihypertensive medications. (Achieved)
  • Understand the effect of the newly-developed text message system on changes in medication adherence, medication self-efficacy, and blood pressure from baseline to 1-month followup in African Americans with uncontrolled hypertension. (Ongoing)
  • Assess participant perceptions of intervention effectiveness and satisfaction in order to guide further system refinement. (Upcoming)

2011 Activities: At the start of the year, the project team conducted three focus groups. Inclusion criteria for the focus groups were African American, hypertension as documented in the electronic medical record, cell phone ownership, and under-active treatment. Based on the results of the focus groups, Dr. Buis and her team developed a text messaging system that provides patients with customizable adherence reminders as well as educational messages about high blood pressure, nutrition, and physical activity. The system underwent robust testing to ensure that all of its components functioned properly. System tests confirmed that text messages were properly sent and received. Automated processes were reviewed to ensure that the system was able to process different data structures and that the customizable features functioned as designed. An interface was developed to collect baseline and follow-up data, including demographic and clinical characteristics. The system will then be evaluated in a randomized controlled trial.

As last self-reported in the AHRQ Research Reporting System, project progress and activities are mostly on track and project budget spending is roughly on target.

Preliminary Impact and Findings: Analysis of the focus groups indicated that despite high self-reported adherence to medications, participants do not always take their medications as prescribed. Additionally, the focus groups confirmed that the vast majority of participants had previously used text messaging. While all participants indicated that they were in favor of a text message approach to improving medication adherence, they overwhelmingly stated that they did not want to use texting to report adherence after each dose or on a daily basis. The majority of participants wanted to receive daily reminders to take their medications with the option of customizing the time that texts are sent as well as the number of reminders. In addition, many participants reported that they are interested in receiving occasional health promotion or educational messages related to high blood pressure, nutrition, and physical activity. These findings contributed to the design of the automated text message intervention, which is now being evaluated in a small randomized controlled trial.

Target Population: Adults, Hypertension, Racial or Ethnic Minorities*: African American

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Implementation and Use

* This target population is one of AHRQ's priority populations.

Text Messaging to Improve Hypertension Medication Adherence in African Americans - 2010

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    PAR: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality Through Health Information Technology (IT) (R21)
  • Grant Number: 
    R21 HS 019092
  • Project Period: 
    September 2010 – September 2012
  • AHRQ Funding Amount: 
    $172,260
  • PDF Version: 
    (PDF, 334.42 KB)


Target Population: Adults, Hypertension, Racial or Ethnic Minorities*: African American

Summary: Hypertension is a major public health concern and is the leading cause of cardiovascular disease worldwide. Chronic hypertension is particularly onerous for African Americans as they are more susceptible to the condition. Poor adherence to prescribed medication regimens is a major problem because, in spite of evidence that hypertension medications can reduce the risk of stroke and myocardial infarction, only about half of patients who have been diagnosed with hypertension adhere to those regimens.

Mobile phones and text messages are becoming widely integrated into daily life and may offer a simple and less labor-intensive way to enhance medication adherence. This project will develop and test an automated text message system to improve medication management by helping individuals self-monitor adherence through medication logging, adherence reminders, and feedback on adherence goals. The text messaging system will be assessed by blood pressure measurements, from baseline to 1 month followup, among African Americans with uncontrolled hypertension, and by participant perceptions of intervention effectiveness and satisfaction. It is theorized that individuals who use a mobile phone-based automated text message system will have improved medication adherence, medication self-efficacy, and blood pressure control.

This research is one of the first theoretically driven text message interventions for improving medication adherence among African Americans. The intervention is a highly-innovative, scalable, and adaptable technological infrastructure that can be applied to other public health concerns.

Specific Aims:
  • Utilize patient participant feedback in the development of a mobile phone text message system to improve adherence to antihypertensive medications. (Ongoing)
  • Understand the effect of the newly developed text message system on changes in medication adherence, medication self-efficacy, and blood pressure from baseline to 1 month follow up in African Americans with uncontrolled hypertension. (Upcoming)
  • Assess participant perceptions of intervention effectiveness and satisfaction in order to guide further system refinement (Upcoming)

2010 Activities: Two recruitment sites were identified in the original grant application. After receiving funds for the project, the grantee contacted the sites to prepare for the focus groups. The grantee learned that the first site had recently relocated and that the research assistant who worked at this site resigned, both of which delayed recruitment. The grantee found that the second site was difficult to contact and engage in study participation, and is considering replacing the second recruitment site. These recruitment issues delayed the initiation of focus groups. Additional project activities have focused on preparation for the focus groups, including hiring staff, developing and refining the focus group script, and revising recruitment materials for the internal review board.

Grantee's Most Recent Self-Reported Quarterly Status (as of December 2010): The project is slightly delayed due to the issues with the recruitment sites. The grantee anticipates getting back on track in the first quarter of 2011. The project is somewhat underspent due to the delays described in the 2010 Activities section.

Preliminary Impact and Findings: This project has no findings to date.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Implementation and Use

*AHRQ Priority Population.

Text Messaging to Improve Hypertension Medication Adherence in African Americans - Final Report

Citation:
Artinian N. Text Messaging to Improve Hypertension Medication Adherence in African Americans - Final Report. (Prepared by Wayne State University under Grant No. R21 HS019092). Rockville, MD: Agency for Healthcare Research and Quality, 2014. (PDF, 460.87 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
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