An mHealth Intervention to Improve Medication Adherence: A Randomized Controlled Trial (Preprint)

Abstract

The treatment of many chronic illnesses involves long-term pharmaceutical therapy. Nevertheless, it is an ongoing challenge to find effective ways to change medication adherence to promote good health outcomes. Particularly for patients with coronary heart disease, taking cardio-protective medications can prevent the enlargement of harmful clots, cardiovascular symptoms, and poor therapeutic outcomes such as uncontrolled high blood pressure and hyperlipidemia. Poor adherence to cardio-protective medications, however, has been reported as a global health concern among patients with coronary heart disease and is particularly so in China.

To evaluate the efficacy of an mHealth intervention of using two mobile apps on medication adherence score and health outcomes.

A randomized, placebo controlled, two-arm parallel study was conducted in a major university-affiliated medical center located in Chengdu, China. Participants were recruited by using flyers and healthcare provider referral. For each participant, the study lasted for 90 days, including a 60-day period of mHealth intervention, and a 30-day period of none-intervention follow-up. Participants in the experimental group received medication-taking reminders and educational materials from the two mobile apps, Message Express and WeChat, respectively. Participants in the control group only received educational materials.

The mean of the decrease of medication non-adherence score was not statistically significant at either 60 days (t=2.04, df=179, P=.04) or 90 days (t=3.48, df=155, P<.01). Systolic blood pressure and diastolic blood pressure decreased in the experimental group, but increased in the control group. The mean of the decrease in diastolic blood pressure was statistically significant at both 60 days (t=2.07, df=160, P=.04) and 90 days (t=2.21, df=164, P=.03). The mean of the decrease in systolic blood pressure was statistically significant at 90 days (t=3.12, df=165, P<.01), but not significant at 60 days (t=1.92, df=161, P=.06).

The efficacy of improving medication adherence and health outcomes including systolic blood pressure and diastolic blood pressure by the proposed mHealth intervention is high.

This study received ethical approval from the Duke Health Institutional Review Board (Pro00073395) on 05/05/2018. The first recruitment was on 05/20/2018. Its pilot study was registered in ClinicalTrials.gov (NCT02793830) on 06/08/2016 and was updated on 01/30/2017.