PHD-Department of Community Health

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Browsing PHD-Department of Community Health by Author "Mutua, Ernest Muthami"

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    Effectiveness of a Mobile Phone Based Intervention in Improving Medication Adherence among Hypertensive Patients in Nyeri County, Kenya
    (Kenyatta University, 2023-12) Mutua, Ernest Muthami
    Globally, non-adherence to prescribed medications is identified as a major barrier to blood pressure control among persons living with hypertension. Uncontrolled hyperten sion is a leading risk factor for heart disease, kidney disease, stroke and general poor health. In Kenya, over a quarter of the adult population is estimated to be living with hypertension, with only 12.5% of them having their blood pressure under control. This study sought to evaluate the effectiveness of a mobile phone based intervention in im proving medication adherence among hypertensive patients on follow-up in Nyeri County. The study adopted an interventional design conducted in two phases. In phase I, a total of 339 hypertensive patients attending two tertiary care hospitals (Consolata Mathari Mission Hospital and Nyeri County Referral Hospital) were enrolled in a base line cross sectional survey to assess the extent to which they were adhering to their pre scribed medicines, and also to explore the factors associated with their medication tak ing behavior. In phase II, a two arm parallel randomized controlled trial comprising of 120 patients who had been found to be non-adherent to their prescribed medicines in phase I was undertaken to evaluate the effectiveness of a mobile phone based interven tion in supporting medication adherence. Participants in the experimental arm received the study‘s mobile phone based intervention on top of the usual care offered in the out patient clinic, while those in the control group were continued on the regular care only. The mobile phone intervention comprised of text messages and voice calls to deliver hypertension related health education to patients allocated to the experimental arm. The primary outcome variable of the study was medication adherence, which was assessed using a validated medication adherence questionnaire and calculation of the proportion of days a patient was covered with medication (PDC) during the follow-up duration. Nearly half (46.6%) of the 339 patients who participated in the baseline survey were non-adherent to their prescribed medications. After fitting a multivariate logistic regres sion model, the factors that were significantly associated with antihypertensive medica tion non-adherence included: having poor hypertension knowledge (adjusted odds ratio (AOR), 5.6, 95% CI, 3.3, 9.4); being on multiple medications (AOR, 2.8, 95% CI, 1.7, 4.7) and receiving two or more daily doses of medications (AOR, 2.3, 95% CI 1.3, 4.0). In the randomized controlled trial, it was established that the study's mobile phone based intervention led to a statistically significant medication adherence improvement effect over a 6 month period of follow up; patients who had received the mobile phone based intervention were 6.1 times more likely to be adherent than those who had been on usual care only (95% CI 2.6, 14.3). The intervention also resulted to a significant improvement in blood pressure control; at the end of follow up, patients who were in the experimental arm were 4.6 times more likely to have achieved the target blood pres sure level compared to their counterparts in the usual care group (95% CI, 2.0, 10.3). The intervention also led to an improvement in patients‘ knowledge and perceptions about hypertension and the need for persistence with medication use. Overall, this study found that use of an educational mobile phone based intervention was effective in en hancing medication adherence among patients on hypertension treatment. Given the central role of medication adherence in hypertension management, the intervention may be considered as an additional component in the comprehensive care given to patients living with hypertension.