abstract: 'Background: Effective use of proven treatments for high blood pressure,

  a preventable health risk, is challenging for many patients. Prompts via

  mobile phone SMS-text messaging may improve adherence to clinic visits

  and treatment, though more research is needed on impact and patient

  perceptions of such support interventions, especially in low-resource

  settings.

  Method: An individually-randomised controlled trial in a primary care

  clinic in Cape Town (2012-14), tested the effect of an adherence support

  intervention delivered via SMS-texts, on blood pressure control and

  adherence to medication, for hypertensive patients. (Trial registration:

  ClinicalTrials.gov NCT02019823). We report on a qualitative evaluation

  that explored the trial participants'' experiences and responses to the

  SMS-text messages, and identified barriers and facilitators to

  delivering adherence support via patients'' own mobile phones. Two focus

  groups and fifteen individual interviews were conducted. We used

  comparative and thematic analysis approaches to identify themes and

  triangulated our analysis amongst three researchers.

  Results: Most participants were comfortable with the technology of using

  SMS-text messages. Messages were experienced as acceptable, relevant and

  useful to a broad range of participants. The SMS-content, the respectful

  tone and the delivery (timing of reminders and frequency) and the

  relational aspect of trial participation (feeling cared for) were all

  highly valued. A subgroup who benefitted the most, were those who had

  been struggling with adherence due to high levels of personal stress.

  The intervention appeared to coincide with their readiness for change,

  and provided practical and emotional support for improving adherence

  behaviour. Change may have been facilitated through increased

  acknowledgement of their health status and attitudinal change towards

  greater self-responsibility. Complex interaction of psycho-social

  stressors and health service problems were reported as broader

  challenges to adherence behaviours.

  Conclusion: Adherence support for treatment of raised blood pressure,

  delivered via SMS-text message on the patient''s own phone, was found to

  be acceptable, relevant and helpful, even for those who already had

  their own reminder systems in place. Our findings begin to identify for

  whom and what core elements of the SMS-text message intervention appear

  to work best in a low-resource operational setting, issues that future

  research should explore in greater depth.'
affiliation: 'Leon, N (Corresponding Author), South African Med Res Council, Hlth
  Syst Res Unit, POB 19070 Fransie Van Zyl Dr, ZA-7505 Cape Town, South Africa.

  Leon, Natalie; Muller, Jocelyn, South African Med Res Council, Hlth Syst Res Unit,
  ZA-7505 Cape Town, South Africa.

  Surender, Rebecca, Univ Oxford, Dept Social Policy \& Intervent, Oxford OX1 2ER,
  England.

  Bobrow, Kirsty, Univ Cape Town, Dept Med, Div Diabet \& Endocrinol, Chron Dis Initiat
  Africa,Observ, ZA-7925 Cape Town, South Africa.

  Bobrow, Kirsty, Groote Schuur Hosp, Observ, ZA-7925 Cape Town, South Africa.

  Bobrow, Kirsty, Univ Oxford, Nuffield Dept Primary Care Hlth Sci, Oxford OX2 6GG,
  England.'
article-number: '80'
author: Leon, Natalie and Surender, Rebecca and Bobrow, Kirsty and Muller, Jocelyn
  and Farmer, Andrew
author-email: Natalie.leon@mrc.ac.za
author_list:
- family: Leon
  given: Natalie
- family: Surender
  given: Rebecca
- family: Bobrow
  given: Kirsty
- family: Muller
  given: Jocelyn
- family: Farmer
  given: Andrew
da: '2023-09-28'
doi: 10.1186/s12875-015-0289-7
eissn: 1471-2296
files: []
journal: BMC FAMILY PRACTICE
keywords: 'Mobile phone-based SMS-messages; mHealth; Blood pressure treatment;

  Hypertension; Adherence; South Africa; low-and middle-income countries;

  primary-care; qualitative methodology; patient perspective'
keywords-plus: 'HEALTH SYSTEM; GLOBAL BURDEN; INTERVENTIONS; MHEALTH; HYPERTENSION;

  MEDICATION; DISEASE; ADULTS; CARE'
language: English
month: JUL 3
number-of-cited-references: '26'
papis_id: cc6304bc4e44d7fea2f1b626c0e86ed6
ref: Leon2015improvingtreatment
times-cited: '58'
title: 'Improving treatment adherence for blood pressure lowering via mobile phone
  SMS-messages in South Africa: a qualitative evaluation of the SMS-text Adherence
  SuppoRt (StAR) trial'
type: Article
unique-id: WOS:000357252400003
usage-count-last-180-days: '0'
usage-count-since-2013: '29'
volume: '16'
web-of-science-categories: Primary Health Care; Medicine, General \& Internal
year: '2015'