Targeting medication nonadherence using mobile phone based tailored messaging

Gatwood, Justin

Abstract

Adherence to prescribed medications remains suboptimal, particularly in patients with diabetes, and contributes to excess costs and avoidable health outcomes. Interventions to improve medication use have proven insufficient, in terms of effect size, duration of behavior change, and the extent of adherence-related factors addressed;improved means to address this issue are needed. Emerging methods have included the tailoring of health messages - individualized approaches that can target multiple barriers - and the application of innovative channels, such as mobile phone text messaging. Independently, tailored messages and text messaging have shown to improve medication adherence, but the extent of their effects is still yet not fully understood and their combined use as a method of behavior change has only limited data. The objective of this study is to evaluate the effect that tailored text messages may have on the treatment process in patients with diabetes. Specifically, the project aims to evaluate the impact of these messages on treatment and condition beliefs and attitudes, technology acceptance, and medication adherence in patients with diabetes. This will be accomplished using patients from the Lakeshore Health Network in Muskegon, Michigan and by crafting original, theory-driven tailored messages derived from validated survey instruments applied in previous adherence studies. Further, messages will be delivered using automated systems in collaboration with researchers from the University of Michigan Center for Health Communications Research. This will be a randomized, controlled study over three months using a cohort of patients with uncontrolled diabetes and will compare the effects of tailored text messages to standard care. This pilot project anticipates seeing an improvement in treatment and condition beliefs and attitudes as well as positive acceptance of technology in subjects receiving tailored text messages. Further, it is expected that adherence to diabetes medications will be significantly improved as a result of receiving tailored text messages when compared to standard care. Such a project will demonstrate proof of a communication concept that can be further applied to improving both medication use behavior and, ultimately, health outcomes in patients with diabetes.

Public Health Relevance

Patients with diabetes struggle to adhere to their medication regimens, leading to potentially avoidable costs and detrimental health outcomes. This study will evaluate the effect that tailored text messages may have on the treatment process in patients with diabetes with the aim of improving treatment beliefs, condition-related attitudes, and medication use behavior.