Purpose:
An important treatment modality for coronary heart disease (CHD) is taking cardio-protective medications (American Heart Association, 2017). However, poor adherence to cardio-protective medications is a global public health issue (Kolandaivelu, Leiden, O’Gara, & Bhatt, 2014), and is particularly so in China (Jiang, Hong, Yu, Zhang, Liu, & Huo, 2012). One proposed solution is to use mobile technology as tools to increase access to care and care delivery for patients (Shaw, Bonnet, Modarai, George, & Shahsahebi, 2015). Mobile technology, also known as “mHealth”, is defined as the provision of health-related services via mobile devices (Park, 2016). China has 1.28 billion mobile phone users (China Daily, 2017), and 81% of the total Internet users in China access the Internet by using a mobile phone (China Internet Network Information Center, 2014). However, using mHealth to improve medication adherence among Chinese patients with CHD is in its infancy. The development of a mobile-technology-based medication-reminder program for individuals with cardiovascular disease may serve as a critically important way to improve medication adherence in China. From May 17, 2017 to July 18, 2018, a study was conducted to evaluate the feasibility of using mHealth to remind patients to take their medications. In this study, two mobile applications were used, “WeChat” and “BB Reminder”. WeChat is used to send participants educational materials; BB Reminder is used to send participants medication-taking reminders.
Methods:
This study included an exploratory randomized controlled trial (RCT, N=50) and phone-call interviews (n=10). The RCT was conducted from May 17, 2017 to July 18, 2017 in West China Hospital, located in Chengdu, China. All participants were diagnosed with coronary heart disease (CHD). They received the same educational materials via WeChat. The educational materials were sent every five days. Participants in the experimental group (n=25) received daily medication-taking reminders. These reminders were sent through BB Reminder every day. The duration of the study was 30 days for each participant. The research team compared the effects of the mHealth intervention (n=25) and control condition (n=25) on the medication adherence scores, which were collected at baseline enrollment and days 15 and 30 post-baseline.
Results:
(1) This study demonstrated that using mHealth to provide health services and manage patient information is feasible in China among patients with coronary heart disease. Study results showed that 80% of participants were using WeChat daily and had used WeChat for more than a year before participating in the study. In addition, 72% of participants completed the study and were responsive over the 30-day study period.
(2) Medication adherence increased at 30-day follow-up in both groups compared to the baseline. At the 30-day follow-up, medication adherence improved better in the experimental group than the control group. However, this difference was not statistically significant (p=.33).
(3) This study found that participants in the experimental group were more likely to have a lower level of diastolic blood pressure during the study period. Whereas, participants in the experimental group were more likely to have higher levels of systolic blood pressure and heart rate.
Conclusion:
The feasibility of using mHealth in China to remind CHD patients to take their medications is high. A larger scale study should be done to evaluate the efficacy of using mHealth to improve health outcomes, including blood pressure and heart rate.
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