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

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.