Text messaging helps people to remember their medication. So why don’t we do it?

I’ve written about individual trials involving text messaging before. A meta-analysis was just published, though. “Mobile Telephone Text Messaging for Medication Adherence in Chronic Disease“:

Importance: Adherence to long-term therapies in chronic disease is poor. Traditional interventions to improve adherence are complex and not widely effective. Mobile telephone text messaging may be a scalable means to support medication adherence.

Objectives: To conduct a meta-analysis of randomized clinical trials to assess the effect of mobile telephone text messaging on medication adherence in chronic disease.

Data Sources: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL (from database inception to January 15, 2015), as well as reference lists of the articles identified. The data were analyzed in March 2015.

Study Selection: Randomized clinical trials evaluating a mobile telephone text message intervention to promote medication adherence in adults with chronic disease.

Data Extraction: Two authors independently extracted information on study characteristics, text message characteristics, and outcome measures as per the predefined protocol.

Main Outcomes and Measures: Odds ratios and pooled data were calculated using random-effects models. Risk of bias and study quality were assessed as per Cochrane guidelines. Disagreement was resolved by consensus.

Researchers looked at all RCTs examining a mobile text messaging system to improve medication adherence in adults with chronic disorders. The main outcomes of interest were odds ratios of adherence.

They identified 16 RCTs. Five of them involved personalized messages. Half of them used two-way communication, and half sent a text message every day. Half of the interventions were 12 weeks of more.

The pooled analysis found that text messaging significantly improved medication adherence (aOR 2.1). The effect wasn’t different based on study characteristics or text messaging characteristics. Even after an adjustment for potential publication bias, the results were still statistically significant (aOR 1.7).

These are relative improvements, of course. But the authors cite literature that finds that baseline adherence rates in developing countries of people with chronic disease are about 50%. Using the odds ratio found in this study means that text messaging could be expected to increase this adherence rate to about 67.8%, or an absolute rate increase of 17.8%. That’s stunning.

There are still “short term” results. Many of them rely on self-reported adherence measures. But still… this is pretty impressive.

In the 11 studies that reported on text message acceptability, most showed moderate to high levels of satisfaction with programs. The study that used twice-daily text messaging found that only 6% of participants said the messages were intrusive and inconvenient.

This stuff works. It’s not expensive. People like it. Why aren’t we trying this more often in systems-level studies?


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