چکیده (انگلیسی):

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 analysisamongst 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
forchange,andprovidedpracticalandemotionalsupport 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.
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* Correspondence:Natalie.leon@mrc.ac.za
1
Health Systems Research Unit, South African Medical Research Council, P.O.
Box 19070 Fransie Van Zyl Drive, Tygerberg, Cape Town 7505, South Africa
Full list of author information is available at the end of the article
© 2015 Leon et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://
creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Leonet al. BMC Family Practice (2015) 16:80
DOI 10.1186/s12875-015-0289-7
(Continued from previous page)
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-resourceoperational setting, issuesthat future research should
explore in greater depth.