Effectiveness of Text Messaging Intervention in Improving Medication Adherence among Hypertensive Adults of Pokhara Metropolitan City, Nepal.

The aim of the study is to evaluate the effectiveness of mobile phone-based text messaging intervention in improving medication adherence and controlling blood pressure among the adults of Pokhara Metropolitan City, Nepal. At first, hypertensive adults will be identified from the 5-year follow-up of a community-based intervention for blood pressure reduction in Nepal (COBIN trial), an open-label, cluster-randomized trial (trail registration ID: NCT02428075). From both the intervention and control groups of the cohort, eligible participants will be selected randomly to ensure comparability between the groups. Materials and Resources: SMS Messages: Daily messages will be sent to the individuals of the intervention group as a daily medication reminder. Also, weekly informational messages will be sent to them addressing common barriers to antihypertensive medication adherence reported by the participants in the pre-test. To ensure the appropriate reading level for the targeted population, the Flesch-Kincaid (FK) readability test will be used for testing each message (recommended grade level 5-8) to maximize understanding and effectiveness. Each message will be concise, with an average length of 160 characters, suitable for SMS delivery. Further, the text messages will also be translated into simple Nepali language. Content Review: The message will be developed by the principal investigator and reviewed by a team of healthcare professionals, including a general physician, pharmacist, and health assistant, for accuracy, clarity, and cultural appropriateness. Delivery Platform: Messages will be sent using a commercial SMS provider via local telecommunication networks (Nepal Telecom and Ncell). Procedures and Timeline: Pre-test (Week 1): A baseline assessment will be done using a structured questionnaire on socio-demographic characteristics, clinical factors, medication adherence, blood pressure, and reasons for non-adherence. Intervention (Week 2-5): After the completion of the baseline assessment, daily SMS reminders will be delivered according to each participant’s prescribed medication schedule and weekly informational messages automatically via mobile phone for a total duration of one month. Post-test (Week 7): The same questionnaire will be re-administered to measure the change in medication adherence and blood pressure one week after the intervention. To monitor the fidelity of the intervention, the message delivery report generated from the messaging platform will be reviewed, and 10 percent of the participants will be followed up through phone calls once a week to confirm receipt of the message. The full intervention package will be provided to the intervention groups for one month, and no modifications are planned during the study period.