Effectiveness of a Mobile Phone Based Intervention in Improving Medication Adherence among Hypertensive Patients in Nyeri County, Kenya
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Date
2023-12
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Publisher
Kenyatta University
Abstract
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.
Description
A Thesis Submitted in Partial Fulfillment of the Requirements for the Award of the Degree of Doctor of Philosophy (Epidemiology) in the School of Health Sciences of Kenyatta University, December 2023.
Supervisors
1. B.M. Okello Abina
2. Isaac Mwanzo