Investigating the feasibility of text message reminders to improve adherence to nebulized medication in children and adolescents with cystic fibrosis

Abstract

BackgroundChildren with cystic fibrosis (CF) often have suboptimal adherence rates to nebulized medication. Adherence barriers cited include forgetting to take the nebulizers, due to busy home and social lives. Text message reminders have been shown to be effective at improving adherence rates in other chronic diseases such as asthma and diabetes.ObjectiveThe objective of this study was to assess the feasibility and efficacy of sending text reminders for a prolonged period of time to children with CF.Materials and methodsChildren with CF aged 5–16 years taking at least one medication via a nebulizer with an electronic adherence monitor were consented for the study. Text message reminders were sent to participants and/or parents via the hospital’s automated text service, up to twice a day, for 6 months. The adherence rates for the 6-month text period were compared to the previous 6 months before the study. Rates were calculated for weekdays, weekends, and school holidays.ResultsSeventeen participants were recruited to the study, with a mean age of 12 years and a mean forced expiratory volume in 1 second (FEV1) of 81% predicted. Fifteen children completed the 6-month text period, and I-neb data were accurately analyzed for 13 participants. The mean adherence rate in the 6 months receiving texts was 80%, compared to 81% in the prior 6 months. Overall adherence rates on weekdays, weekends, and school holidays were equivalent during the 2 time periods. A subgroup of patients with moderate baseline adherence showed increased adherence during the text period, particularly at weekends.ConclusionIt is feasible to send text message reminders to children with CF, and they are amenable to this approach. Although text reminders do not increase rates in patients with existing optimal adherence, they may be of value in patients with more moderate baseline rates.

Impact of home spirometry on medication adherence among adolescents with cystic fibrosis

“…Many of the same studies that elicited the aforementioned barriers have also identified multiple adherence motivators such as recognition of the impact of non‐adherence on health outcomes, a strong relationship with the CF care team and encouragement from friends and family . Interventions that promote self‐management skills, whether they be a knowledge‐based intervention such as providing more education about the disease process and available treatments, or a behavioral intervention like motivational interviewing, appear to improve medication adherence in individuals with CF . The use of technology to promote self‐management skills and adherence is becoming increasingly popular .…”

“…Interventions that promote self‐management skills, whether they be a knowledge‐based intervention such as providing more education about the disease process and available treatments, or a behavioral intervention like motivational interviewing, appear to improve medication adherence in individuals with CF . The use of technology to promote self‐management skills and adherence is becoming increasingly popular . Medication reminders have been successful in enabling patients with CF to take ownership of their disease and have resulted in improved adherence .…”

“…The use of technology to promote self‐management skills and adherence is becoming increasingly popular . Medication reminders have been successful in enabling patients with CF to take ownership of their disease and have resulted in improved adherence . However, very little data, exists on the impact of these interventions on the already high perceptions of treatment burden.…”

Aerosol Therapy in Asthma–Why We Are Failing Our Patients and How We Can Do Better

“…For over 10 years, mobile phone technology has been used in the management of chronic disease with applications such as appointment reminders and short message service (SMS) prompts to take medication (78,79). Within asthma alone, webbased programmes have also been used to facilitate decisionmaking via self-help algorithms.…”

Digital technologies and adherence in respiratory diseases: the road ahead

“…To address the need for optimised adherence to maintenance medication in patients with respiratory diseases, a number of digital technologies have been developed. Strategies used to date include approaches to monitoring and improving adherence, such as electronic inhalers, text messaging and reminders, and self-management tools (such as web-based and mobile applications to record symptoms and monitor lung function) [5–8]. Examples of digital interventions targeting adherence in patients with asthma and COPD that were published between 2007 and 2017, including electronic monitoring devices (EMDs), text messaging, and web and mobile applications, are summarised in table 1.…”