InterTxt2Heart pilot: A trial to evaluate efficacy of text message to improve adherence to cardiovascular medications in secondary prevention.

在欠发达国家，心血管疾病(心脏病和中风)在个人和社会层面具有巨大的有害影响。心血管疾病患者可以从负担得起的有效药物中受益，但只有一小部分患者服用这些药物，过去测试的改善这些药物服用的策略都失败了。移动电话正在成为生活在欠发达国家的人们日常生活中必不可少的工具，因此已成为提供干预措施以改变行为的理想“工具”，例如服药。以前使用手机短信改善对艾滋病毒药物依从性的研究的成功提供了一个强有力的先例，即这种成功可以转化为心血管疾病。然而，要做到这一点，就需要仔细了解人们停止服药的原因，同时也要考虑到当地的情况。到目前为止，还没有关于心血管疾病的研究完全满足这些标准。我们的长期目标是进行最大规模的研究，以评估手机短信是否有助于提高对救命心血管药物的依从性。作为第一步(目前的提议)，我们将使用一些共同申请者共同开发的“最新”心理策略来研究心血管药物依从性差的原因。然后，我们将把这些关于依从性较差的原因的知识转换为针对患者的特定需求而量身定做的短信，以提高心血管药物的依从性。在第二步(不包括在这项提案中)，我们将在受控实验条件下(称为随机试验)测试手机短信是否有助于增加对心血管药物的依从性，这些药物可以降低血压和坏胆固醇，并使血液变稀，以避免心脏、大脑和四肢的动脉阻塞。这项研究将在哥伦比亚、加纳和印度进行，这些国家代表着不同经济发展阶段和医疗保健系统的主要地理区域。我们预计，我们对欠发达国家的广泛覆盖将促进我们的干预(如果成功)迅速适用于其他欠发达国家。我们的研究将向世界卫生组织倡议使用移动文本电话干预来改善对心血管疾病等慢性病的管理

In less developed countries cardiovascular diseases (heart diseases and stroke) have a vast deleterious impact at individual and society level. Patients with cardiovascular diseases can benefit from affordable and effective medications, but only a minority of patients takes the medications, and strategies tested in the past to improve taking of these medications have failed. Mobile phones are becoming an essential instrument in daily life of people living in less developed countries and therefore have become an ideal "instrument" to deliver interventions to change behaviours, such as taking medications. Previous successes of studies using mobile text messages to improve adherence to HIV-medications provides a strong precedent that this success could be translated to cardiovascular diseases. However, to achieve this, it requires a carefully work on understanding the reasons why people stop taking medications that also considers the local-context. To date, there are no studies in cardiovascular disease that full fill these criteria. Our long-term aim is to conduct the largest study to evaluate if mobile text messages can be helpful to increase adherence to life-saving cardiovascular medications. As a first step (current proposal), we will be studying reasons for poor adherence to cardiovascular medications using "state of art" psychological strategies co-developed by some of the co-applicants. Then, we will convert this knowledge, on reasons for poor adherence, into short-text messages tailor to the specific needs of patients in order to increase adherence of cardiovascular medications. In a second step (not included in this proposal) we will test under controlled experimental conditions (known as randomized trial) if mobile text messages are useful to increase adherence to cardiovascular medications that decrease blood pressure and the bad-cholesterol as well as making the blood thinner to avoid occlusion of arteries in the heart, brain and extremities. The study will take place in Colombia, Ghana, and India, representing major geographical areas with different stage of economic development and health care systems. We expect that our wide-coverage of less-developed countries will facilitate a rapid adoption of our intervention (if successful) to other less-developed countries. Our study will inform the World Health Organization initiative on uses of mobile text phone interventions to improve management of chronic conditions such as cardiovascular diseases