Three little words: Using text messages to support adherence

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By Amy Noise

In developed countries, only half of people with chronic illnesses take their medications as prescribed, and this number can be even lower for people with low health literacy skills, poor social supports or unstable housing.  But what if supporting adherence could be as simple as asking ‘How are you?’

In 2005, when Dr. Richard Lester and his team were starting an HIV treatment program in Kenya, the vast majority of his patients were starting treatment for the very first time. Not only that, they were spread out over a huge geographic area, with many in rural and remote parts of the country. The team knew adherence was going to be an issue, and needed to find a low-cost way to support patients to take their medicine, and take it correctly.

“We started by brainstorming with clinicians and patients and quickly found out that patients don’t want to be reminded to take their medication, they want to feel supported,” says Lester, an associate professor in UBC’s Division of Infectious Diseases. “Adherence is about more than just remembering to take your pills, it’s about the other priorities in your life – addictions, childcare, mental health – and how you balance all of these factors”.

The result was WelTel, a weekly automated text messaging service that makes use of widespread cell phone access in Kenya to simply ask ‘Mambo?’ (‘How are you?’ in Kiswahili).

According to Lester, a friendly ‘How are you?’ works because it isn’t intrusive but it opens the door to support if and when it is needed, without raising suspicion or sharing confidential information.

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Halfway around the world, at BC Women’s Hospital’s Oak Tree Clinic for women and children living with HIV/AIDS across BC, outreach nurses use similar weekly text messages to stay in touch with vulnerable patients.

“The texts help build a bond between patient and nurse. Even though the first message is automated, patients know that there is a person at the other end who is there to help them,” says Dr. Melanie Murray an infectious disease physician based at Oak Tree. “It gives users the opportunity to ask for the support they need, whether that is ‘I need to reschedule my appointment’ or ‘I have nothing to eat’.”

This ability to identify who needs support in real-time allows monitoring nurses to identify and address problems related to treatment, or societal barriers to adherence, before they escalate into crises.

If a patient develops a side effect, their nurse can provide advice by phone or text, or triage them as appropriate, helping the patient stay adherent and out of hospital in-between scheduled appointments.

“The great thing about text messaging is that with relatively simple technology we can offer support to a large patient population and make better use of in-person visits,” says Lester. “Initially, we focused on HIV and tuberculosis, but this approach can be applied globally for almost any condition.”

Read more about Dr. Lester’s work in Spark: Everyday tech for better care (www.msfhr.org/spark/06/). Spark is a digital magazine produced by the Michael Smith Foundation for Health Research (MSFHR), British Columbia’s health research funding agency.

In 2014 Lester received an MSFHR Scholar award to investigate how WelTel, originally developed in Kenya, could support those living with HIV and tuberculosis in British Columbia. MSFHR currently supports Dr. Richard Lester via a 2017 Innovation to Commercialization award for the development of smart-text-analytic-tools to analyse natural language text data.

Amy Noise is a Communications Specialist at the Michael Smith Foundation for Health Research.