Efficacy of short message service (SMS) intervention on medication adherence and knowledge of stroke prevention among clinic attendees at risk of stroke: a randomized controlled trial

BackgroundStroke remains a leading cause of long-term disability and mortality worldwide, particularly in low- and middle-income countries where suboptimal management of modifiable risk factors such as hypertension and diabetes mellitus are prevalent. Poor medication adherence, a critical barrier to effective risk management, is widespread in Nigeria, with adherence rates below 50% in patients with chronic illnesses. This study evaluates the efficacy of a 12-week short message service (SMS)-based intervention in improving medication adherence, knowledge, and prevention practices among hypertensive and diabetic patients attending the Medical Outpatient Clinic at the University College Hospital, Ibadan, Nigeria.MethodologyA single-center randomized controlled trial was conducted with 150 participants aged 18 years and above and had a documented clinical diagnosis of hypertension and/or diabetes mellitus and currently being treated with a prescribed medication. The intervention group received bi-daily SMS reminders on medication adherence, lifestyle modifications, and stroke prevention, alongside standard care. The control group received standard care only. Outcomes assessed included change in medication adherence, knowledge, stroke prevention practices, and quality of life. A p value of 0.05 was used.ResultThe prevalence of hypertension and diabetes were 90.0% and 20.7% respectively; 16 individuals (10.7%) had comorbidity of hypertension and diabetes. There was a 14.7% increase in the proportion of participants with a high medication adherence in the intervention arm whereas the control arm had a 2.7% increase. This 5 times relative increase in proportion was however not statistically significant. The study showed a significant effect of the intervention on participants knowledge of stroke prevention (t = 3.339, p = 0.001). There was no significant impact of the intervention on self-rated health scores (t = 0.132; p = 0.896).ConclusionThe SMS intervention significantly improved stroke prevention knowledge and showed a non-significant trend towards better medication adherence. Baseline motivational and cultural factors likely influenced outcomes, underscoring the need to address behavioral, cultural and economic barriers. This scalable telehealth model warrants further exploration to optimize adherence in resource-limited settings.Clinical trial registrationThis study was registered on the 25th July and approved on 25th of August 2023 by the Pan African Clinical Trials Registry (PACTR) with unique identification number: PACTR202308767234235. The findings from this study are presented in accordance with the Consolidated Standards of Reporting Trials (CONSORT) statement.