A randomized controlled behavioural intervention trial to improve medication adherence in adult stroke patients with prescription tailored short messaging services (SMS)

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


Stroke is the third leading cause of disability worldwide. Secondary prevention via medications reduces the risk of recurrence by 80%. However, adherence to complex medication regimens is low. Behavioural interventions to promote adherence are challenging to implement in resource limited health systems like Pakistan. Short Messaging Service (SMS) has high sociocultural acceptability and penetration. We designed a randomized controlled trial to test the effectiveness of personalized, prescription based SMS to improve medication adherence in stroke survivors. Methods: This was a parallel group, assessor-blinded, randomized, controlled, superiority trial conducted at the Aga Khan University, Karachi. Centralized randomization with fixed block size was performed at the University's Clinical Trials Unit. Adult stroke survivors with minimal disability and possessing a mobile phone were eligible for participation. Intervention arm received SMS for two months in addition to usual care, which were composed of a) Personalized, prescription tailored daily medication reminder/s b) Twice weekly health information SMS. The Health Belief Model and Social Cognitive theory were used to design the language and content of messages. Open source Frontline SMS software was used for SMS delivery. Medication adherence was self-reported and measured on the validated Urdu version of Morisky Medication Adherence Questionnaire. Multiple linear regression was used to model the outcome against intervention and other covariates. Analysis was conducted by intention-to-treat principle. Results: 200 participants were enrolled while 38 were lost to follow-up. After 2 months the mean medication score was 7.4 (95% CI: 7.2-7.6) in the intervention arm while 6.7 (95% CI: 6.4-7.02) in the usual care arm. The adjusted mean difference (A) was 0.54 (95% CI: 0.22-0.85).

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