Systematic Review of RCTs Assessing the Effectiveness of mHealth Interventions to Improve Statin Medication Adherence: Using the Behaviour-Change Technique Taxonomy to Identify the Techniques That Improve Adherence

Abstract

Statin non-adherence is a common problem in the management of cardiovascular disease (CVD), increasing patient morbidity and mortality. Mobile health (mHealth) interventions may be a scalable way to improve medication adherence. The objectives of this review were to assess the literature testing mHealth interventions for statin adherence and to identify the Behaviour-Change Techniques (BCTs) employed by effective and ineffective interventions. A systematic search was conducted of randomised controlled trials (RCTs) measuring the effectiveness of mHealth interventions to improve statin adherence against standard of care in those who had been prescribed statins for the primary or secondary prevention of CVD, published in English (1 January 2000–17 July 2020). For included studies, relevant data were extracted, the BCTs used in the trial arms were coded, and a quality assessment made using the Risk of Bias 2 (RoB2) questionnaire. The search identified 17 relevant studies. Twelve studies demonstrated a significant improvement in adherence in the mHealth intervention trial arm, and five reported no impact on adherence. Automated phone messages were the mHealth delivery method most frequently used in effective interventions. Studies including more BCTs were more effective. The BCTs most frequently associated with effective interventions were “Goal setting (behaviour)”, “Instruction on how to perform a behaviour”, and “Credible source”. Other effective techniques were “Information about health consequences”, “Feedback on behaviour”, and “Social support (unspecified)”. This review found moderate, positive evidence of the effect of mHealth interventions on statin adherence. There are four primary recommendations for practitioners using mHealth interventions to improve statin adherence: use multifaceted interventions using multiple BCTs, consider automated messages as a digital delivery method from a credible source, provide instructions on taking statins, and set adherence goals with patients. Further research should assess the optimal frequency of intervention delivery and investigate the generalisability of these interventions across settings and demographics.

Effectiveness of mHealth Interventions in Medication Adherence among Patients with Cardiovascular Diseases: A Systematic Review

“…The effectiveness of mHealth interventions on cardiovascular medication adherence has also been reported in other systematic reviews, which showed that the majority of studies reported an improvement in medication adherence and other health outcomes [ 39 , 40 ]. Similar findings from an existing body of literature strengthen the current review’s evidence [ 41 , 42 , 43 ].…”

Effect of Nudges to Clinicians, Patients, or Both to Increase Statin Prescribing

“…More research has been performed on how to improve statin adherence than on how to improve statin initiation, but nudges for other conditions may serve as a guide. In previous work, nudges delivered to patients by text message in the days preceding a primary care visit significantly increased influenza vaccination .…”

What is the quantity, quality and type of systematic review evidence available to inform the optimal prescribing of statins and antihypertensives? A systematic umbrella review and evidence and gap map

“…Medications of interest within the 80 reviews included in our umbrella review were: statins (n=10),25–34 antihypertensives (n=38),35–72 and statins and antihypertensives (n=34) 73–104. Nine of the reviews synthesised qualitative evidence,27 31 42 50 55 58 60 61 83 104 four of which also included quantitative evidence in a mixed evidence synthesis 42 50 58 61.…”

“…Nine of the reviews synthesised qualitative evidence,27 31 42 50 55 58 60 61 83 104 four of which also included quantitative evidence in a mixed evidence synthesis 42 50 58 61. Of the reviews synthesising quantitative evidence evaluating interventions, interventions focused on: enhancing patient adherence to medication as prescribed (n=57),25 30 32–35 37–41 43–46 48 49 51 53 54 56 57 59 62 63 65–71 73–81 86 87 89–96 98–103 105 deprescribing a prescribed medication (n=6)36 46 72 80 88 93 or optimising the prescribing of medication to meet the needs of the patient (n=13) 26 28 29 38 52 64 71 84 85 87 90 100 106. Three of these reviews were judged by reviewers to have dual aims 71 87 90.…”

“…Thirty-two systematic reviews synthesised quantitative evidence to promote medication adherence. Statins were the medication of interest for 10 reviews, 2 of ‘high’ overall quality81 103 and 8 of ‘critically low’ overall quality 33 75 87 91 93 94 101 102. Antihypertensives were the medication of interest in 20 systematic reviews; 3 were of ‘high’ quality,54 81 103 2 of ‘moderate’ overall quality53 65 and 15 were ‘critically low’ overall quality 37 43 45 49 51 56 66 71 75 87 91 94 95 101 102.…”