title: Improving medication adherence in stroke patients through Short Text Messages (SMS4Stroke)-study protocol for a randomized, controlled trial.
abstract: BACKGROUND
  Stroke is a major cause of morbidity and mortality, especially in low and middle income countries. Medical management is the mainstay of therapy to prevent recurrence of stroke. Current estimates are that only 1 in 6 patients have perfect adherence to medication schedules. Using SMS (Short Messaging Service) as reminders to take medicines have been used previously for diseases such as diabetes and HIV with moderate success. We aim to explore the effectiveness and acceptability of SMS in increasing adherence to medications in patients with stroke.
  
  
  METHODS
  This will be a randomized, controlled, assessor blinded single center superiority trial. Adult participants with access to a cell phone and a history of stroke longer than 1 month on multiple risk modifying medications will be selected from Neurology and Stroke Clinic. They will be randomized into two parallel groups in a 1:1 ratio via block technique with one group receiving the standard of care as per institutional guidelines while the parallel group receiving SMS reminders for each dose of medicine in addition to the standard of care. In addition intervention group will receive messages for lifestyle changes, medication information, risk factors and motivation for medication adherence. These will bemodeled on Social Cognitive Theory and Health Belief Model and will be categorized by Michies Taxonomy of Behavioral Change Communication. Patient compliance to medicines will be measured at baseline and then after 2 months in each group by using the Morisky Medication Adherence Scale. The change in compliance to medication regimen after the intervention and the difference between the two groups will be used to determine the effectiveness of SMS reminders as a tool to increase medication compliance. The acceptability of the SMS will be determined by a tool designed for this study whose attributes are based Rogers Diffusion of innovation theory. A sample size of 86 participants in each arm will be sufficient to detect a difference of 1 point on the MMAS with a power of 90 % and significance level of 5 % between the two groups; using an attrition rate of 15 %, 200 participants in all will be randomized.
  
  
  CONCLUSIONS
  The SMS for Stroke Study will provide evidence for feasibility and effectiveness of SMS in improving post stroke medication adherence in an LMIC setting.
  
  
  BACKGROUND
  https://clinicaltrials.gov/ct2/show/NCT01986023 11 /11/2013.
authors: Neurology, Stroke Service, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Department of Medicine, Aga Khan University, Karachi, Pakistan. ayeesha.kamal@aku.edu.
authors: Ayeesha Kamran
authors: AK
authors: Kamal
authors: The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan. drainee.nauman@gmail.com.
authors: Quratulain Nauman
authors: QN
authors: Shaikh
authors: Director Masters in Epidemiology and Biostatistics Program, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. omrana.pasha@aku.edu.
authors: Omrana
authors: O
authors: Pasha
authors: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. iqbal.azam@aku.edu.
authors: Iqbal
authors: I
authors: Azam
authors: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. muhammad.islam@aku.edu.
authors: Muhammad
authors: M
authors: Islam
authors: SMS4Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan. adeel.ali.memon@gmail.com.
authors: Adeel Ali
authors: AA
authors: Memon
authors: Department of Medicine, Aga Khan University, Karachi, Pakistan. hasanrehman89@gmail.com.
authors: Hasan
authors: H
authors: Rehman
authors: SMS4Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan. muhammad.affan87@gmail.com.
authors: Muhammad
authors: M
authors: Affan
authors: SMS4Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan. drsumairapk@yahoo.com.
authors: Sumaira
authors: S
authors: Nazir
authors: SMS4Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan. memon.salman@gmail.com.
authors: Salman
authors: S
authors: Aziz
authors: Stroke Service, Section of Neurology, Department of Medicine The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan. muhammad.jan@aku.edu.
authors: Muhammad
authors: M
authors: Jan
authors: Stroke Service, Section of Neurology, Department of Medicine The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan. anita.andani@aku.edu.
authors: Anita
authors: A
authors: Andani
authors: eHealth Innovation, Global, Aga Khan Development Network, Karachi, Pakistan. abdul.muqeet@akdn.org.
authors: Abdul
authors: A
authors: Muqeet
authors: Epidemiology and Biostatistics, Department of Medicine, Aga Khan University, Karachi, Pakistan. bilal.ahmed@aku.edu.
authors: Bilal
authors: B
authors: Ahmed
authors: Evidence, Capacity & Policy mHealth Alliance, United Nations Foundation Geneva Associate Professor COMSATS Institute of Information Technology, Islamabad Visiting faculty-University of Calgary, Calgary, AB, Canada. khojashariq@gmail.com.
authors: Shariq
authors: S
authors: Khoja
mesh_terms: D006801:Humans; D055118:Medication Adherence; D010154:Pakistan; D012008:Recurrence; D017010:Reminder Systems; D016037:Single-Blind Method; D020521:Stroke / Q000517:prevention & control*; D060145:Text Messaging