Bartlett Yvonne Kiera, Farmer Andrew, Newhouse Nikki, Miles Lisa, Kenning Cassandra, French David P
Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
JMIR Form Res. 2022 Apr 29;6(4):e30058. doi: 10.2196/30058.
Poor adherence to oral medications is common in people with type 2 diabetes and can lead to an increased chance of health complications. Text messages may provide an effective delivery method for an intervention; however, thus far, the majority of these interventions do not specify either a theoretical basis or propose specific mechanisms of action. This makes it hard to determine how and whether an intervention is having an effect. The text messages included in the current intervention have been developed to deliver specific behavior change techniques. These techniques are the "active ingredients" of the intervention and were selected to target psychological constructs identified as predictors of medication adherence.
There are 2 aims of this study: (1) to assess whether a text message intervention with specified behavior change techniques can change the constructs that predict medication adherence behaviors in people with type 2 diabetes and (2) to assess whether changes to psychological constructs are associated with changes in self-reported medication adherence.
We conducted a randomized controlled, 6-month feasibility trial. Adults prescribed oral medication for type 2 diabetes (N=209) were recruited from general practice and randomized to either receive a text message-based intervention or care as usual. Data were analyzed with repeated measures analysis of covariance and Spearman rho correlation coefficients.
For 8 of the 14 constructs that were measured, a significant time-by-condition interaction was found: necessity beliefs, intention, maintenance self-efficacy, recovery self-efficacy, action control, prompts and cues, social support, and satisfaction with experienced consequences all increased in the intervention group compared to the control group. Changes in action self-efficacy, intention, automaticity, maintenance self-efficacy, and satisfaction with experienced consequences were positively associated with changes in self-reported medication adherence.
A relatively low-cost, scalable, text message-only intervention targeting medication adherence using behavior change techniques can influence psychological constructs that predict adherence. Not only do these constructs predict self-reported medication adherence, but changes in these constructs are correlated with changes in self-reported medication adherence. These findings support the promise of text message-based interventions for medication adherence in this population and suggest likely mechanisms of action.
ISRCTN Registry ISRCTN13404264; https://www.isrctn.com/ISRCTN13404264.
2型糖尿病患者口服药物依从性差的情况很常见，这可能会增加健康并发症的发生几率。短信可能是一种有效的干预措施传递方式；然而，到目前为止，这些干预措施大多没有明确理论基础或提出具体作用机制。这使得难以确定干预措施如何以及是否产生效果。当前干预措施中包含的短信旨在传递特定的行为改变技巧。这些技巧是干预措施的“有效成分”，被选出来针对那些被确定为药物依从性预测因素的心理结构。
本研究有两个目的：（1）评估采用特定行为改变技巧的短信干预是否能改变2型糖尿病患者中预测药物依从行为的心理结构；（2）评估心理结构的变化是否与自我报告的药物依从性变化相关。
我们进行了一项为期6个月的随机对照可行性试验。从全科医疗中招募了209名开具2型糖尿病口服药物处方的成年人，并将他们随机分为接受基于短信的干预组或常规护理组。采用重复测量协方差分析和Spearman等级相关系数对数据进行分析。
在测量的14个心理结构中的8个中，发现了显著的时间与分组交互作用：与对照组相比，干预组的必要性信念、意图、维持自我效能感、恢复自我效能感、行动控制、提示与线索、社会支持以及对经历结果的满意度均有所增加。行动自我效能感、意图、自动性、维持自我效能感以及对经历结果的满意度的变化与自我报告的药物依从性变化呈正相关。
一种相对低成本、可扩展的、仅使用短信且采用行为改变技巧针对药物依从性的干预措施能够影响预测依从性的心理结构。这些心理结构不仅能预测自我报告的药物依从性，而且这些结构的变化与自我报告的药物依从性变化相关。这些发现支持了基于短信的干预措施在该人群中改善药物依从性的前景，并提示了可能的作用机制。
国际标准随机对照试验编号ISRCTN13404264；https://www.isrctn.com/ISRCTN13404264
