Psychosocial factors and medication adherence among patients with coronary heart disease: A text messaging intervention.
OBJECTIVE
Medication adherence is a complex behavior that is influenced by numerous factors. Applying self-efficacy theory, the primary aim of this randomized controlled trial was to compare medication self-efficacy among patients with coronary heart disease who received: (a) text messages (TMs) for medication reminders and education, (b) TMs for education, or (c) no TMs. The second aim was to identify the personal (sociodemographic and clinical characteristics) and psychosocial factors that were associated with and predicted medication adherence.


METHODS
Customized TMs were delivered over 30 days. Repeated measures analysis of variance was used to analyze medication self-efficacy. A multiple regression analysis was performed at baseline and follow-up to determine variables that were associated with and predicted self-reported medication adherence.


RESULTS
Among 90 subjects with mean age 59.2 years (standard deviation (SD) 9.4, range 35-83), total scores for medication self-efficacy improved over 30 days; however, there was no significant difference in this improvement as a function of the different treatment groups (p=0.64). Controlling for other variables in the model (age, education, depression, and social support), less depression (p=0.004) and higher social support (p=0.02) positively predicted higher medication adherence in the final model.


CONCLUSIONS
TM medication reminders and/or health education did not improve medication self-efficacy. Further theory testing of current and future models and interventions are required to understand variables related to self-efficacy and medication adherence. Addressing psychosocial factors such as depression and social support should be a priority to improve medication adherence among patients with coronary heart disease.
Veterans Affairs Medical Center, University of California, San Francisco, USA linda.park@ucsf.edu.
Linda G
LG
Park
Department of Physiological Nursing, University of California, San Francisco, USA.
Jill
J
Howie-Esquivel
Veterans Affairs Medical Center, University of California, San Francisco, USA Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, USA.
Mary A
MA
Whooley
Department of Physiological Nursing, University of California, San Francisco, USA.
Kathleen
K
Dracup
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000008:administration & dosage; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011237:Predictive Value of Tests; D011379:Prognosis; D011584:Psychology; D017010:Reminder Systems; D018570:Risk Assessment; D020377:Self Efficacy; D012720:Severity of Illness Index; D015996:Survival Rate; D017216:Telemedicine; D060145:Text Messaging; D013997:Time Factors; D016896:Treatment Outcome; D016903:Drug Monitoring
D002316:Cardiotonic Agents; D010975:Platelet Aggregation Inhibitors
Medication adherence; coronary heart disease; depression; mobile health; self-efficacy; social support; text messaging