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）对个人和社会都有巨大的有害影响。患有心血管疾病的患者可以从负担得起的有效药物中受益，但只有少数患者服用这些药物，过去测试的改善这些药物服用的策略失败了。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”，例如服用药物。以往利用手机短信提高艾滋病毒药物依从性的研究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，需要仔细研究人们停止服用药物的原因，并考虑到当地的情况。到目前为止，还没有心血管疾病的研究完全符合这些标准。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的心血管药物的依从性。作为第一步（目前的建议），我们将使用一些共同申请者共同开发的“最先进的”心理策略来研究心血管药物依从性差的原因。然后，我们将根据依从性差的原因将这些知识转化为适合患者特定需求的短信，以增加心血管药物的依从性。在第二步（不包括在本提案中），我们将在受控的实验条件下（称为随机试验）测试手机短信是否有助于增加心血管药物的依从性，这些药物可以降低血压和坏胆固醇，并使血液更稀释，以避免心脏、大脑和四肢的动脉闭塞。该研究将在哥伦比亚、加纳和印度进行，这三个国家代表了经济发展和卫生保健系统处于不同阶段的主要地理区域。我们期望，我们对欠发达国家的广泛覆盖将有助于其他欠发达国家迅速采用我们的干预措施（如果成功的话）。我们的研究将为世界卫生组织关于使用移动短信干预措施改善心血管疾病等慢性病管理的倡议提供信息

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